Pharmacodynamic study and mechanism of action of Linggui Zhugan Decoction in the intervention of Nonalcoholic fatty liver disease

Objective: To explore the therapeutic effect of Linggui Zhugan Decoction on nonalcoholic fatty liver disease through in vivo animal experiments, and to explore the mechanism of action of Linggui Zhugan Decoction in the intervention of nonalcoholic fatty liver disease through network pharmacology and molecular docking technology. Methods: A rat model of non- alcoholic fatty liver disease was established after 20 weeks of high-fat feeding, and the rats were divided into six groups, normal group, model group, simvastatin group (4 mg/kg), low- dose group of Linggui Zhugan Decoction (2.1 g/kg), medium-dose group of Linggui Zhugan Decoction (4.2 g/kg), and high-dose group of Linggui Zhugan Decoction (8.4 g/kg), and the liver morphological changes of HE staining and oil red O staining after the intervention of Linggui Zhugan Decoction were observed, and the microplate reader detected aspartate aminotransferase, alanine aminotransferase, Four levels of blood lipids. Network pharmacology combined with molecular docking was used to screen the potential mechanism and target of Linggui Zhugan Decoction for the intervention of non-alcoholic fatty liver disease. Results: Linggui Zhugan Decoction significantly improved the levels of alanine aminotransferase and alanine aminotransferase in model rats (P<0.05). HE staining and oil red O staining showed that Linggui Zhugan Decoction significantly reduced liver lipid deposition in rats in the model group. Linggui Zhugan Decoction could significantly reduce the quadruplical levels of blood lipids in model rats (P<0.05). Network pharmacology screened out 10 key targets and 5 key signaling pathways;The molecular docking results showed that the first 20 active ingredients all had good binding ability to the top 10 targets. Conclusion: The results show that Linggui Zhugan Decoction has the effect of regulating blood lipids and improving liver tissue lesions in non-alcoholic fatty liver disease, and preliminarily verifies the regulatory effect of Linggui Zhugan Decoction on lipid metabolism-related genes.

Analyzing the pharmacological substances and targets of Xuefu Zhuyu decoction in hypertensive vascular endothelial cells

Background:Xuefu Zhuyu decoction(XFZY)could significantly improve the function of hypertensive vascular endothelial cells,but the targets and mechanism are not clear.This study is to analyze the pharmacological substances and targets of Xuefu Zhuyu decoction in hypertensive vascular endothelial cells.Methods:This study used Xuefu Zhuyu decoction to intervene human umbilical vein endothelial cells incubated by hypertensive patients’serum,then detected the function of vascular endothelial cells.The aqueous extract of XFZY was analyzed and validated by liquid chromatography-mass spectrometry technology;Finally,macromolecular docking technology was used to analyze the potential active substances and targets of XFZY in the prevention and treatment of hypertension.Results:Compared with the model group,the XFZY group showed a significant increase in NO expression(P<0.01)and a significant decrease in ET-1 expression(P<0.001);and the expression of BIP,P-JNK,CHOP,and BAX in XFZY group cells was significantly decreased(P<0.001),while the expression of JNK and BCL2 was significantly increased(P<0.001).19 main compounds were identified in XFZY and there were 3 pairs of molecular complexes with high affinity for markers of the endoplasmic reticulum stress,including BIP-Hesperidin complex,BIP-HSYA complex and JNK-Naringin complex.Conclusion:This study analyzed the potential pharmacodynamic substance and targets of Xuefu Zhuyu decoction in improving the function of hypertensive vascular endothelial cells,which could provide a scientific basis for the future molecular mechanism of XFZY in treating hypertension.

Mechanism of the Xuefu Zhuyu decoction in treating diabetes mellitus erectile dysfunction based on the CaSR/Gq-PLC-PKC pathway

Background:To investigate the mechanism of Xuefu Zhuyu decoction in the treatment of diabetes mellitus erectile dysfunction.Methods:Rats with diabetes mellitus erectile dysfunction were developed using streptozocin and randomly assigned into model,low-dose herbal,and high-dose herbal groups.All rats were administered normal saline or the corresponding drugs by oral gavage for 4 weeks.The related indices were detected using enzyme-linked immunosorbent assays,immunohistochemistry,western blotting,and transmission electron microscopy.Results:The levels of lectin-like oxidized low-density protein receptor-1,endothelin-1,NADH oxidase,vascular cell adhesion molecule-1,and intercellular adhesion molecule-1 in the model group were significantly higher than they were in the mock group but lower than they were in the herbal treatment group.The level of nitric oxide was lower in the model group than was in the mock group but higher than the level in the herbal treatment group.The calcium-sensitive receptor,phospho-protein kinase Cδ/protein kinase Cδ,phosphorylated c-Jun amino-terminal kinase/c-Jun amino-terminal kinase,and phospho-P38 mitogen-activated protein kinase/P38 mitogen-activated protein kinase expression levels in the model group were higher than were in the mock group but lower than were in the herbal treatment group.The structures of the Corpus cavernosum penis endothelial cells were significantly improved in the herbal treatment group than they did in the model group.Conclusion:Xuefu Zhuyu decoction can decrease injury to the endothelium,improve vascular endothelial diastolic and contractive function,and inhibit vascular fibrosis in rats with diabetes mellitus erectile dysfunction.This mechanism may be related to the CaSR/Gq-PLC-PKC pathway.

Linggui Zhugan Decoction Improves High Glucose-Induced Autophagy in Podocytes

Objective To explore the influence of Linggui Zhugan Decoction(LGZGD)on high glucose induced podocyte autophagy Methods LGZGD containing serum were prepared by intragastric administation of 4.2 g·kg^(-1)(low dose),8.4 g·kg^(-1)(medium dose),and 12.6 g·kg^(-1)(high dose)LGZGD into SD rats respectively.MPC5 and AB8/13 cells were treated with 60 mmol/L glucose to establish diabetic nephropathy podocyte model in vitro.Podocytes,MPC5 and AB8.13,were divided into control group,high glucose group,low dose LGZGD group,medium dose LGZGD group,and high dose LGZGD group,respectively.For the three LGZGD groups,before LGZGD intervention,podocytes were treated with 60 mmol/L glucose for 3 days.After treated with LGZGD containing serum,cells were collected to analyze cell migration using Transwell assay,proliferation using CCK8,apoptosis and cell cycle using flow cytometry,,autophagosome formation using transmission electron microscopy,and expression levels of Beclin-1,Atg5,LC3II/I,and P62 proteins using western blot.Results Compared with the control group,the proliferation and migration of MPC5 and AB8.13 cells in high glucose group showed slightly decreased,whereas these parameters restored after intervention with low and medium concentrations of LGZGD,with the medium dose LGZGD having the best effect.Flow cytometry analysis showed that the medium dose LGZGD group had a lower apoptosis rate(P<0.05)and higher survival rate(P>0.05)compared to the high dose group.High glucose arrested podocytes in G1 phase,whereas LGZGD shifted podocytes from being predominant in G1 phase to increasing into G2.High dose LGZGD significanly reduced increased autophagosome formation due to high glucose in both podocytes(P<0.05).Western blot analysis showed that Beclin-1,Atg5,LC3Ⅱ/Ⅰ,and P62 expressions were increased in MPC5 cells treated with high glucose,and reversed after adminstration of low and medium doses of LGZGD(P<0.05).Conclusion LGZGD reduced apoptosis and enhanced autophagy in high glucose treated podocytes via regulating Beclin-1/LC3II/I/Atg5 expression.

Clinical intervention effect of Xuefu Zhuyu decoction on chronic heart failure complicated with depression

BACKGROUND The diagnosis and treatment of depression in patients with chronic heart failure(CHF)is challenging,with no ideal treatment at present.AIM To analyze the clinical intervention effect of Xuefu Zhuyu decoction(XFZYD)on CHF complicated with depression.METHODS The study cohort comprised 116 patients with CHF complicated with depression who received treatment from July 2020 to July 2023,of which 55 received Western medicine(control group)and 61 received XFZYD(research group).Data on clinical effectiveness,traditional Chinese medicine(TCM)syndrome score,cardiac function,negative emotions,and serum inflammatory factors,were collected for comparative analyses.RESULTS Compared with the control group,the research group had an evidently higher total effective rate.Furthermore,there were marked reductions in TCM symptom score,left ventricular end-diastolic diameter,left ventricular end-systolic diameter,Self-Rating Depression Scale,Hamilton Depression Scale,high-sensitivity C-reactive protein,monocyte chemoattractant protein-1,and matrix metalloproteinase-9 in the research group after treatment,and these were lower than the corresponding values in the control group.Left ventricular ejection fraction was increased and higher in the research group compared with the control group after treatment.CONCLUSION Our findings conclusively proved that XFZYD was considerably superior to Western medicine for treating CHF complicated with depression because it significantly alleviated patients’symptoms,improved cardiac function,relieved negative emotions,and reduced the levels of serum inflammatory factors.

The mechanism of Xuefu Zhuyu decoction in treating erectile dysfunction based on Arrowsmith tool

Arrowsmith,a literature retrieval tool,was used to explore the theoretical pharmacological mechanism of action of Xuefu Zhuyu decoction and its single herb against erectile dysfunction.Cytoscape 3.6.1 software was used to analyze the correlation between the components of Xuefu Zhuyu decoction and the identified mechanism of action.Different herbs in Xuefu Zhuyu decoction may play a therapeutic role by regulating iNOS,COX-2,mTOR,Wnt,AMPK,Nrf2,TLR4,CYP2D6,BDNF,MAPK,Akt,STAT3,PI3K,ERK1,P38MAPK,JNK,VEGF,and other targets.The treatment of erectile dysfunction with Xuefu Zhuyu decoction embodied the multicomponent,multitarget,and multipathway.The Arrowsmith tool retrieval and analysis provided a scientific basis for further elucidation of the mechanism of Xuefu Zhuyu decoction against erectile dysfunction.

Effects of Xuefu Zhuyu Decoction combined with conventional therapy on inflammatory response, oxidative stress, endothelium and related factors in patients with acute cerebral infarction

Objective: To explore the effects of Xuefu Zhuyu Decoction combined with conventional therapy on inflammatory response, oxidative stress, endothelium and related factors in patients with acute cerebral infarction. Methods: A total of 162 patients with acute cerebral infarction admitted to our hospital from November 2016 to January 1818 were selected as subjects. According to the random sampling method, the subjects were divided into 81 cases in the control group and 81 cases in the observation group. The control group was treated with conventional intracranial pressure, anticoagulation, anti-oxidation and lipid-lowering treatment. The observation group was treated with Xuefu Zhuyu Decoction on the basis of the control group. The changes of inflammatory response, oxidative stress, endothelium and related factors were compared and analyzed. Results:Before treatment, the levels of TNF-α, CRP, SOD, MDA, AOPPS, NO, ET-1, MMP-9, PAF and IGF-1 in the two groups were not significantly different, and there was no statistical significance. After treatment, the levels of TNF-α and CRP in the two groups were significantly lower than those before treatment, and the levels of TNF-α and CRP in the observation group were significantly lower than control group;the levels of MDA and AOPPS in the two groups were significantly lower than those before treatment, while the level of SOD was significantly higher than before treatment, and the levels of MDA and AOPPS in the observation group were significantly lower than control group, while the level of SOD was significantly higher. In the control group;the level of ET-1 in the two groups was significantly lower than that before treatment, while the level of NO was significantly higher than that before the treatment, and in the observation group the level of ET-1 was significantly lower than the control group, while the level of NO was significantly higher. In the control group;the levels of MMP-9 and PAF in the two groups were significantly lower than those before treatment, while the level of IGF-1 was significantly higher than before treatment, and the levels of MMP-9 and PAF in the observation group were significantly lower than control group, while the level of IGF-1 was significantly higher than control group. Conclusions: Xuefu Zhuyu Decoction combined with conventional treatment of acute cerebral infarction can effectively reduce inflammation and oxidative stress, improve vascular endothelial function and nerve function, and significantly reduce the degree of brain injury, which has clinical significance.

The Efficacy of Banxia Baizhu Tianma Decoction(半夏白术天麻汤)Combined with Xuefu Zhuyu Decoction(血府逐瘀汤)for Essential Hypertension and the Effects on Endothelial Function:A Systematic Review and Meta-analysis

Objective:Banxia Baizhu Tianma Decoction(半夏白术天麻汤,BBTD)combined with Xuefu Zhuyu Decoction(血府逐瘀汤,XFZYD)is widely used to treat essential hypertension in China,but its efficacy remains largely unexplored.We systemically summarized relevant evidence from randomized controlled trials(RCTs)to assess the therapeutic efficacy of BBTD+XFZYD.Methods:This review retrieved 6 databases like Pubmed,Cochrane Library,Embase,CNKI,et al.RCTs of BBTD+XFZYD plus conventional Western drugs(experimental group)and conventional Western drugs alone(control group)for hypertension was collected from the database establishment to August 5,2020.And the outcomes included clinical total effective rate,systolic blood pressure(SBP),diastolic blood pressure(DBP),nitric oxide(NO)and endothelin-1(ET-1).All studies’risk of bias were assessed by the Cochrane Collaboration tool 5.1.0.The data was statistically analyzed by RevMan5.3 Software.Results:Six studies with 608 participants were identified.About duration of treatment,4 studies were 1 month,2 studies were 2 months.The quality presented a high risk of bias.The experimental group showed that clinical total effective rate of the 1-month and 2-month was higher(P<0.00001),the systolic pressure was significantly lower(P<0.05),the NO increased(P<0.00001),and the ET-1 decreased(P<0.00001)compared with the conventional Western drugs used alone.However,DBP was significantly lower(P<0.05)at 2 months of treatment.Conclusion:BBTD+XFZYD plus conventional Western drugs might reduce blood pressure,improve clinical efficacy,repair endothelial function,but still need high-quality RCTs to better assess the outcomes.

Xuefu Zhuyu decoction improves neurological dysfunction by increasing synapsin expression after traumatic brain injury

Xuefu Zhuyu decoction has been used for treating traumatic brain injury and improving post-traumatic dysfunction, but its mechanism of action needs further investigation. This study established rat models of traumatic brain injury by controlled cortical impact. Rat models were intragastrically administered 9 and 18 g/kg Xuefu Zhuyu decoction once a day for 14 or 21 days. Changes in neurological function were assessed by modified neurological severity scores and the Morris water maze. Immunohistochemistry, western blot assay, and re- verse-transcription polymerase chain reaction were used to analyze synapsin protein and mRNA expression at the injury site of rats. Our results showed that Xuefu Zhuyu decoction visibly improved neurological function of rats with traumatic brain injury. These changes were accompanied by increased expression of synaptophysin, synapsin I, and postsynaptic density protein-95 protein and mRNA in a dose-de- pendent manner. These findings indicate that Xuefu Zhuyu decoction increases synapsin expression and improves neurological deficits alder traumatic brain injury.

The efficacy of Xuefu Zhuyu prescription for diabetic encephalopathy: A meta-analysis of randomized controlled trials

Objective:To evaluate the safety and effectiveness of Xuefu Zhuyu Decoction in treating diabetic encephalopathy.Methods:Computer search and manual search of Pub Med,Web of Science,The Cochrane Library,CNKI,WF,VIP and CBM from January 2000 to April 2020 on the treatment of diabetic encephalopathy with Xuefu Zhuyu Decoction In randomized controlled clinical trials,select documents that meet the criteria for analysis using Rev Man 5.3 software.Results:A total of 11 articles and 838 patients were included in the study.Metaanalysis showed that Xuefu Zhuyu Decoction was effective(OR=3.71,95%CI[2.42,5.70],P<0.00001),and the patient’s neurological deficit score(MD=-4.52,95%CI[-5.10,-3.94],P<0.00001),fasting blood glucose(MD=-1.05,95%CI[-1.51,-0.59],P<0.00001),2 hours postprandial blood glucose(MD=-1.31,95%CI[-1.94,-0.69],P<0.00001),glycated hemoglobin(MD=-0.94,95%CI[-1.15,-0.72],P<0.00001),TCM symptom score(MD=-2.44,95%CI[-3.82,-1.06],P=0.0005<0.01),vitality score(MD=12.79,95%CI[8.79,16.79],P<0.00001),the improvement effect is obvious Better than conventional Western medicine treatment.Conclusion:Xuefu Zhuyu Decoction can improve the clinical efficiency of patients with diabetic encephalopathy,reduce brain damage,reduce blood sugar and glycated hemoglobin levels,and has good safety.However,the quality of some of the included literatures is low,and the number of clinical cases is small,which may affect the authenticity of the Meta analysis results.Still need to be further verified by clinical randomized controlled trials with high-quality large samples.

Identification of prototype compounds and their metabolites in rats’ serum from Xuefu Zhuyu Decoction by UPLC-Q-TOF/MS

Objective: As a classic prescription in traditional Chinese medicine, Xuefu Zhuyu Decoction(XFZYD) has been widely used in the clinical treatment of cardiovascular and cerebrovascular diseases. In order to unveil the potentially effective compounds, a rapid ultra-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry(UPLC-Q-TOF/MS) method was established to identify prototype compounds and their metabolites from XFZYD in rats’ serum.Methods: The serum from rats after intragastric administration of XFZYD aqueous extract was analyzed by UPLC-Q-TOF/MS method. The prototype compounds and their metabolites were identified by comparison with the reference standards and tentatively characterized by comprehensively analyzing the retention time, MS data, characteristic MS fragmentation pattern and retrieving literatures.Results: A total of 175 compounds(24 prototype compounds and 151 metabolites) were identified and tentatively characterized. The metabolic pathways of prototype compounds in vivo were also summarized, including glucuronidation, hydrolyzation, sulfation, demethylation, and hydroxylation, and so on.Conclusion: In this study, a UPLC-Q-TOF/MS technique was developed to analyze prototype compounds and their metabolites from XFZYD in serum, which would provide the evidence for further studying the effective compounds of XFZYD.

A Microarray Analysis of Angiogenesis Modulation Effect of Xuefu Zhuyu Decoction (血府逐瘀汤) on Endothelial Cells

Objective： To study the angiogenesis modulation mechanism of Xuefu Zhuyu Decoction （血府逐瘀汤） on the endothelial cell line ECV304. Methods： ECV304 cells were treated with 2.5% Xuefu Zhuyu Decoction- containing serum （XFZYD-CS） for 24 h, 48 h or 72 h. Thiazolyl blue tetrazolium bromide （MTT）, fluorescence activating cell sorter （FACS）, migration, adhesion and in vitro tube formation assays were conducted to confirm an angiogenesis effect of XFZYD at 3 time points. An analysis of angiogenesis regulator profiles was performed at 3 times with real-time polymerase chain reaction （RT-PCR） superarray. Results： At 48 h, XFZYD-CS induced ECV304 significantly improved cell viability, number in S phase, migration, adhesion and tube formation. At 24 h and 72 h, only cell migration was elevated. Microarray results showed that the expression of 27 angiogenesis-related genes was changed. Conclusion： XFZYD-CS treatment induced angiogenesis on ECV304 cells with significant cellcular changes occurring at 48 h and genetic changes as early as 24 h.

In Vitro Angiogenesis Effect of Xuefu Zhuyu Decoction(血府逐瘀汤)and Vascular Endothelial Growth Factor:A Comparison Study

Objective： To compare the angiogenesis behaviors of vascular endothelial growth factor（VEGF） and Chinese medicine Xuefu Zhuyu Decoction（血府逐瘀汤,XZD） treatments.Methods： Human microvascular endothelial cells（HMEC-1） were treated with various concentrations of either XZD-containing serum（XZD-CS） or VEGF for 24,48,and 72 h,respectively.Cell viability,proliferation,migration,adhesion,and in vitro tube formation assays were used to assess their angiogenic effects.Results： VEGF promoted all cellular phases involved in angiogenesis including cell viability,proliferation,migration,adhesion,and tube formation（P〈0.05 or P〈0.01）.Unlike the continuous promotion effects of VEGF at the above stages,XZD inhibited cell viability and proliferation（P〈0.05 or P〈0.01） and only promoted tube formation in the early phase of angiogenesis（P〈0.01）.Conclusions： These two medications promote different angiogenesis behaviors,which might be an important reason for their distinct therapeutic profile in clinical usage.

The Effect of Xuefu Zhuyu Decoction(血府逐瘀汤) on in vitro Endothelial Progenitor Cell Tube Formation

Objective： To observe the effect of Xuefu Zhuyu Decoction （血府逐瘀汤）-containing serum （XFZYD-CS） on endothelial progenitor cell （EPC） tube formation in vitro. Methods： Mononuclear cells from rat bone marrow were prepared in a Ficoll density gradient centrifuge. EPCs were separated by the differential attachment method, and observed with inverted microscope for the effect of XFZYD-CS on EPC tube formation. Results： After one day, EPCs exposed to the serum containing 5%, 10% and 15% XFZYD-CS formed typical tubes or vessel networks. The tube formation time was two days ahead of the control group and the size of most tubes in the serum groups was smaller than in the control group. Conclusion： XFZYD-CS could induce EPC angiogenesis and hasten tube formation, especially in capillary vessels. The study provides experimental evidence for the plausibility of Xuefu Zhuyu Decoction in the treatment of ischemic diseases.

Effects of the Modified Linggui Zhugan Decoction(加味苓桂术甘汤) Combined with Short-term Very Low Calorie Diets on Glycemic Control in Newly Diagnosed Type 2 Diabetics

Objective:To evaluate the effects of the modified Linggui Zhugan Decoction(加味苓桂术甘汤) combined with short-term very low calorie diets(VLCDs) on glycemic control in newly diagnosed type 2 diabetes mellitus(T2DM) patients.Methods:A total of 20 subjects with newly diagnosed T2DM were treated with the modified Linggui Zhugan Decoction(one-month administration) combined with short-term VLCDs(5 days),and 3-months follow-up.A standard 75-g oral-glucose-tolerance test(OGTT) indexes fasting plasma glucose(FPG),post-prandial 0.5 h and 2 h plasma glucose(P0.5hPG,P2hPG),glycated hemoglobin A1C(GHbA1C),body weight,body mass index(BMI),insulin function,insulin resistance index,incidence of hypoglycemia,and the liver and renal functions were evaluated before and after treatment.Correlations of BMI with insulin function and insulin resistance were also assessed.Results:After the treatment,the patients' plasma glucose decreased steadily,FPG decreased from 5.8±0.9 mmol/L at pre-treatment to 5.0±0.6 mmol/L at 3-months follow-up(P<0.05),and P2hPG decreased from 11.7±3.8 mmol/L at pre-treatment to 6.9±0.9 mmol/L at 3-months follow-up(P<0.01).The level of GHbA1C declined from(6.47±1.24)% at pre-treatment to(6.14±0.99)% at 3-months follow-up(P<0.01).Body weight and BMI also declined significantly.Insulin resistance index was improved obviously and no event of hypoglycemia occurred.Part of the patients companied with fatty liver had a transient increase in hepatic transaminase during the treatment,but it turned to normal after the treatment.Conclusions:The modified Linggui Zhugan Decoction combined with short-term VLCDs can be safely implemented for steady glycemic control in newly diagnosed T2DM patients.

加味苓桂术甘汤对阳虚水停证慢性心力衰竭患者TGF-β1、TNF-α、NT-proBNP及心室重构的影响

目的探究加味苓桂术甘汤对阳虚水停证慢性心力衰竭患者TGF-β1、TNF-α、NT-proBNP及心室重构的影响。方法将2017年12月至2020年11月六安市中医院收治的98例阳虚水停证慢性心力衰竭患者纳入本研究,随机分为两组,各49例。对照组行西医常规治疗,观察组在此基础上行加味苓桂术甘汤口服治疗,治疗6个月后检测心功能,血清肿瘤坏死因子(tumor necrosis factor,TNF)-α、转化生长因子(transforming growth factor,TGF)-β1、同型半胱氨酸(homocysteine,Hcy)、氨基末端脑钠素原(amminoterminal brain sodium minogen,NT-proBNP)水平并比较临床疗效。结果两组患者治疗后各项指标均较治疗前明显改善(P<0.05)。其中观察组患者治疗后血清TNF-α、TGF-β1、Hcy、NT-proBNP、左室舒张末期内径、左室收缩末期内径和中医证候总积分低于对照组,左室射血分数、6 min步行距离和临床疗效高于对照组(P<0.05)。结论加味苓桂术甘汤治疗阳虚水停证慢性心力衰竭可减轻患者炎症反应,预防心室重构,提高临床疗效。

血府逐瘀汤治疗冠心病研究进展

冠心病是临床常见的心血管疾病之一,其发病率和病死率呈上升趋势,严重危害居民健康,加重国家经济负担。血府逐瘀汤有活血化瘀、理气止痛的功效,主治胸中血瘀证。临床上根据其功效常用于治疗血瘀证冠心病,并取得良好疗效。此文旨在对血府逐瘀汤治疗冠心病的临床运用、作用机制及研究进展展开探讨,为深入挖掘血府逐瘀汤临床及实验研究提供新思路。

从“微饮”立论射血分数保留的心力衰竭早期防治思想

射血分数保留的心力衰竭(heart failure with preserved ejection fraction, HFpEF)是目前心血管领域的治疗难点,防治前线前移对于减缓或逆转HFpEF发病进程至关重要。聚焦HFpEF早期的中医防治,是发挥中医治未病优势的关键。通过梳理仲景提出的“微饮”内涵和证治,结合HFpEF早期的发病机制,提出HFpEF早期以微饮内停上焦为主要病机,临证应以苓桂术甘汤为主祛饮通阳,以期阻断饮证进一步发展,截断HFpEF发展进程。从“微饮”立论HFpEF早期防治,可以防微杜渐,具有重要的临床意义。

真武汤联合血府逐瘀方治疗老年冠心病伴慢性心力衰竭患者的疗效观察

目的探讨真武汤联合血府逐瘀方治疗老年冠心病伴慢性心力衰竭(Chronic heart failure,CHF)患者的临床疗效。方法选取2020年5月—2023年6月期间六安市中医院收治的老年冠心病伴CHF患者106例作为研究对象,依据简单随机数字表法分为对照组和研究组,每组各53例。对照组采取常规治疗,研究组在对照组基础上采取真武汤合血府逐瘀方,均治疗4周。观察比较两组患者临床疗效、不良反应发生情况,治疗前后中医证候积分、心功能[左心室射血分数(Left ventricular ejection fraction,LVEF)、心输出量(Cardiac output,CO)、左心室舒张末期内径(Left ventricular end-diastolic diameter,LVEDD)、左心室收缩末期内径(Left ventricular end-systolic diameter,LVESD)]、血流动力学[肺动脉平均压(Mean pulmonary artery pressure,MPAP)、左心房平均压(Mean left atrial pressure,MLAP)、平均二尖瓣跨瓣压差(Mean mitral valve intervalve pressure difference,MMPG)]、心力衰竭标记物[血管内皮生长因子(Vascular endothelial growth factor,VEGF)、可溶性生长刺激表达基因2蛋白(Soluble growth stimulation expressed gene2,sST2)、脑钠肽(Brain natriuretic peptide,BNP)]水平。结果治疗后研究组临床总有效率94.34%(50/53)明显高于对照组81.13%(43/53),差异有统计学意义(P<0.05)。治疗后两组患者肢冷、心悸、气短、喘促及肢体浮肿、胸闷、盗汗、乏力分值均较治疗前降低,差异有统计学意义(P<0.05);且研究组中医证候积分明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者LVEF、CO指标均较治疗前升高,LVEDD、LVESD指标均较治疗前降低,差异有统计学意义(P<0.05);且研究组LVEF、CO指标明显高于对照组,LVEDD、LVESD指标明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者血流动力学MPAP、MLAP、MMPG水平均较治疗前降低,差异有统计学意义(P<0.05);且研究组血流动力学MPAP、MLAP、MMPG水平明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者VEGF指标均较治疗前升高,sST2、BNP指标均较治疗前降低,差异有统计学意义(P<0.05);且研究组VEGF指标明显高于对照组,sST2、BNP指标均明显低于对照组,差异有统计学意义(P<0.05)。治疗期间,研究组不良反应发生率7.55%(4/53)与对照组3.77%(2/53)比较,差异无统计学意义(P>0.05)。结论常规基础上采取真武汤合血府逐瘀方治疗老年冠心病合并CHF可改善患者心功能,调节血流动力学状态及心力衰竭标记物水平,缓解临床症状,提升整体治疗效果,且具有安全性。

血府逐瘀汤联合恩替卡韦治疗瘀血阻络型乙型肝炎肝硬化代偿期患者的临床效果

目的 探讨血府逐瘀汤联合恩替卡韦治疗瘀血阻络型乙型肝炎肝硬化代偿期患者的临床效果。方法 选取80例瘀血阻络型乙型肝炎肝硬化代偿期患者,随机分为观察组和对照组,每组40例。给予观察组血府逐瘀汤联合恩替卡韦治疗,给予对照组恩替卡韦治疗,疗程均为24周。比较两组患者治疗前后失代偿期肝硬化发生率,HBV-DNA载量、肝功能[ALT、AST、总胆红素(TBIL)]、血清炎症因子[肿瘤坏死因子α(TNF-α)、白细胞介素(IL)-6、IL-22]、肝脏超声相关指标(门静脉主干内径、脾静脉内径、脾脏厚度、脾脏长度)、中医证候积分和中医证候疗效的变化情况,以及治疗期间不良反应发生情况。结果 治疗后12周、治疗后24周,两组患者失代偿期肝硬化发生率及门静脉主干内径、脾静脉内径、脾脏厚度、脾脏长度差异无统计学意义(P>0.05)。两组患者的血清ALT、AST、TBIL、TNF-α、IL-6、IL-22水平,以及HBV-DNA载量、中医证候积分随治疗时间延长而降低,且治疗后12周、治疗后24周,观察组的上述指标均低于对照组(P<0.05)。治疗后,观察组的中医证候疗效的总有效率高于对照组(P<0.05)。治疗期间两组患者的不良反应发生率差异无统计学意义(P>0.05)。结论 血府逐瘀汤联合恩替卡韦治疗瘀血阻络型乙型肝炎肝硬化代偿期患者的临床疗效优于单纯恩替卡韦治疗,可有效降低炎症细胞因子的表达水平,改善肝功能,且安全性较好。