目的 研究利心水方对大鼠心肌纤维化的影响.方法 应用腹主动脉缩窄法制备大鼠心肌纤维化模型,用低、中、高剂量利心水方干预治疗5周后,超声动图检测不同处理组中大鼠的心肌功能,通过HE染色法分析不同处理组中大鼠心肌组织的变化,应用Masson染色对比不同组大鼠的胶原蛋白的含量,利用RT-q PCR和Western blotting对比不同处理组中大鼠心肌组织中Collagen Ⅰ、α-SMA、TGF-β、Fibronectin的表达.结果 与假手术组相比,模型组中大鼠的LVEDD和LVESD明显增加,FS和EF较假手术组明显降低(P＜0.01),低、中、高剂量的利心水方组大鼠LVEDD和LVESD较模型组显著下降,高剂量组效果最显著,而利心水方组大鼠FS和EF较模型组显著升高(P＜0.05).HE和Masson染色显示:与假手术组对比,模型组中大鼠心肌细胞排列紊乱,细胞肥大,细胞间隙明显增大,并可见大量胶原的沉积;与模型组相比,利心水方组大鼠心肌细胞排列较为整齐,细胞间隙较小,有少量胶原组织的沉积.RT-qPCR和Western blotting结果显示,与假手术组相比,模型组大鼠心肌组织的Collagen Ⅰ、α-SMA、TGF-β、Fibronectin mRNA和蛋白的表达水平显著升高(P＜0.01),利心水方组干预后,心肌组织的Collagen Ⅰ、α-SMA、TGF-β、Fibronectin mRNA及其蛋白的表达水平均显著下降(P＜0.05).结论 中药复方利心水方对于大鼠的心肌纤维化有一定的保护作用.

Objective To explore the inhibitory effect of Danyu formula on foam cell formation in rat aortic endothe-lial cells(RAECs)induced by oxidized low-density lipoprotein(Ox-LDL)and its possible mechanism.Methods RAECs were randomly divided into the control group,model group,low-dose Danyu formula group,medium-dose Danyu formula group,and high-dose Danyu formula group,and atorvastatin group.Except for the control group,RAECs in the rest of the five groups were treated with 200 μg/mL Ox-LDL for 72 h,and the low-,medium-,and high-dose Danyu formu-la groups and the atorvastatin group were treated with 50,100,and 200 μg/L Danyu formula solution and 300 μg/L atorv-astatin,respectively.After 24,48,and 72 h of treatment,the cell proliferation ability was detected by CCK-8.The foam formation was observed by oil red O staining in the cells treated for 72 h in each group.The protein levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),malondialdehyde(MDA),and superoxide dismutase(SOD)in the cell superna-tant were measured by ELISA.The reactive oxygen species(ROS)content was determined by the 2-hydroxyethylfluoresce-in oxidation fluorescence reaction.The relative mRNA expression levels of protein tyrosine kinase 2(JAK2)and signal transducer and activator of transcription 3(STAT3)were detected by real-time fluorescence quantitative PCR.The relative protein expression levels of JAK2,p-JAK2,STAT3,and p-STAT3 were determined by Western blotting,and the ratios of p-JAK2/JAK2 and p-STAT3/STAT3 were calculated.Results Compared with the control group,the OD values of the model group decreased at the same time points(all P＜0.05).Compared with the model group at the same time points,the OD values of the high-dose Danyu formula group and the atorvastatin group increased,and the OD values of the medium-dose Danyu formula group increased at 48 and 72h(all P＜0.05).The control group cells did not exhibit foam formation,while the cells in the model group showed obvious foam formation.Compared with the model group,the foam formation in the atorvastatin group and the high-,medium-,and low-dose Danyu formula groups improved,with the high-dose Danyu formula group and the atorvastatin group showing the most significant improvement,almost approaching the control group.Compared with the control group,the levels of TNF-α,IL-6,ROS,JAK2 mRNA expression,STAT3 mRNA expression,p-JAK2/JAK2,p-STAT3/STAT3,and MDA in the cell supernatant of the model group increased,while the expression of SOD in the cell supernatant decreased(all P＜0.05).Compared with the model group,the levels of TNF-α,IL-6,ROS,JAK2 mRNA expression,STAT3 mRNA expression,p-JAK2/JAK2,p-STAT3/STAT3,and MDA in the cell supernatant of the atorvastatin group and the high-,medium-,and low-dose Danyu formula groups decreased,while the expression of SOD in the cell supernatant increased,with the most significant changes in the atorvastatin group and the high-dose Danyu formula group(all P＜0.05).There were no significant differences in the relative protein expression levels of JAK2 or STAT3 among these groups(all P＞0.05).Conclusion The high-dose,medium-dose,and low-dose Danyu formula can inhibit foam formation in Ox-LDL-induced RAECs,with the significant effect in the high-dose Danyu formula,and its mechanism may be related to the inhibition of inflammatory reaction,oxidative stress response,and JAK2/STAT3 signal-ing pathway.

目的:采用利心水方干预冠心病心力衰竭,观察其对患者临床疗效、心功能、心肌纤维化及心肌重构的影响.方法:纳入符合标准的冠心病心力衰竭患者,按照随机数字表法,分为对照组和治疗组,治疗疗程为12周.观察两组治疗前后中医症状、纽约心功能分级(NYHA);心脏彩超:左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室射血分数(LVEF)、每搏输出量(SV);心肌纤维化指标:Ⅰ型胶原前体C前肽(PICP)、Ⅲ型胶原前体N前肽(PⅢNP)、Ⅰ型胶原羧基末端端肽(ⅠCTP)、PICP/PⅢNP、左室质量(LVM)、左室质量指数(LVMI)等.结果:经治疗后,治疗组中医证候改善有效率为87.18％,高于对照组57.50％,中医证候总积分也有改善(P<0.05);治疗组NYHA心功能分级疗效为84.62％,高于对照组57.50％,差异有统计学意义(P<0.05);两组与治疗前比较,治疗后LVEDD、LVESD、LVEF、SV较治疗前均有改善,且差异有统计学意义(P<0.05);与对照组比较,治疗组治疗后LVESD、LVEF、SV改善差异均具有统计学意义(P<0.05);治疗后两组PICP、PⅢNP、ⅠCTP较治疗前均有下降,差异有统计学意义(P<0.05);与对照组比较,治疗组治疗后ⅠCTP下降,差异具有统计学意义(P<0.05);对照组治疗前后PICP/PⅢNP比值比较,差异无统计学意义(P>0.05),而治疗组治疗前后PICP/PⅢNP比值比较,差异有统计学意义(P<0.05);两组LVM及LVMI均显著下降(P<0.05),但治疗组下降更明显,差异有统计学意义(P<0.05).结论:利心水方可以改善冠心病心力衰竭患者的临床症状和心功能,对心肌纤维化有一定作用,改善心肌重构.

目的 观察利心水方联合常规西药治疗冠心病心力衰竭的临床效果,以及对患者运动耐量、生活质量、N末端B型钠尿肽(NT-proBNP)及血管内皮生长因子(VEGF)的影响.方法 收集南京中医药大学附属盐城医院2020年2月至12月收治的冠心病心力衰竭患者82例,根据随机数字表法将其分为对照组和治疗组,每组40例.两组均以常规西药作为基础治疗,治疗组加用利心水方,两组疗程均为12周.观察两组临床疗效、中医证候积分、左室射血分数(LVEF)、明尼苏达州心力衰竭生命质量调查表(MLHFQ)评分、6 min步行试验(6MWT)距离、NT-proBNP、VEGF.记录两组治疗期间不良反应发生情况.结果 治疗组中脱落2例(1例失访,1例胃肠不适退出),对照组脱落1例(失访),本研究最终纳入79例患者.治疗组临床疗效优于对照组,差异有统计学意义(P<0.05).治疗后,两组各项中医证候积分均优于治疗前,治疗组气短、畏寒肢冷、唇甲青紫、乏力的中医证候积分优于对照组,差异有统计学意义(P<0.05).治疗后,两组MLHFQ评分、NT-proBNP均低于治疗前,6MWT距离、LVEF、VEGF均高于治疗前,且治疗组MLHFQ评分、NT-proBNP均低于对照组,6MWT距离、LVEF、VEGF均高于对照组,差异有统计学意义(P<0.05).两组治疗期间无不良反应发生.结论 利心水方联合常规西药治疗冠心病心力衰竭疗效确切,能提高患者运动耐量及心功能,改善生活质量,对促进血管新生有一定作用.

目的 研究丹参酮ⅡA对ApoE-/-小鼠冠心病伴抑郁的影响及作用机制.方法 采用高脂饲料喂养ApoE-/-小鼠,并进行慢性不可预知温和应急(CUMS)构建冠心病伴抑郁小鼠模型.将小鼠随机分为正常组、模型组、丹参酮ⅡA低剂量组(30 mg·kg-1)和丹参酮ⅡA高剂量组(60 mg·kg-1).采用HE和油红O染色检测ApoE-/-小鼠心脏主动脉窦的病理变化;强迫游泳实验(FST)、悬尾实验(TST)和糖水偏好实验(SPT)观察ApoE-/-小鼠抑郁样行为;ELISA法检测小鼠血脂及炎症因子水平;Western blot检测心脏主动脉窦组织和海马组织的炎症相关蛋白表达水平.结果 与正常组相比,模型组ApoE-/-小鼠心脏主动脉内膜脂质积累显著增加,血脂及促炎因子显著升高(P<0.01),FST和TST不动时间显著增加(P<0.01),SPT蔗糖偏好率显著降低(P<0.01),心脏主动脉窦组织和海马组织中p-GSK3β(Ser9)/GSK3β、p-CREB(Ser133)/CREB和p-NF-κB/NF-κB的比值显著增加(P<0.01).与模型组相比,丹参酮ⅡA高、低剂量组ApoE-/-小鼠心脏主动脉内膜脂质积累显著减少,血脂及促炎因子水平显著降低(P<0.01),FST和TST不动时间显著减少(P<0.01),SPT蔗糖偏好率显著增加(P<0.01).p-GSK3β(Ser9)/GSK3β和p-CREB(Ser133)/CREB的比值进一步呈剂量依赖性增加(P<0.05,P<0.01),p-NF-κB/NF-κB比值呈剂量依赖性降低(P<0.01).结论 丹参酮ⅡA具有显著的抗ApoE-/-小鼠冠心病伴抑郁作用,其机制可能是通过调节GSK3β的表达,继而影响NF-κB与CREB的活化来实现的.

温胆汤为治痰祖方,药简效宏,倍受历代医家所喜爱,临床所治病种极为广泛,在胸痹心痛中常常被使用.笔者以古代文献为线索,追本溯源,介绍温胆汤渊源,分析其功用主治及历史演变,探讨与胸痹心痛病之间内在联系,并结合临床实例,通过病案介绍了温胆在胸痹心痛病中的应用.

目的 分析对高血压患者应用天麻钩藤饮治疗的临床效果及不良反应发生率.方法? 于2017年1月—2020年1月开展研究,纳入80例观察对象,均是该阶段在本医院接受治疗的高血压患者,参考随机抽签结果 将所有对象平均分成实验组和对照组,两组患者均使用尼群洛尔治疗,前者增加天麻钩藤饮.比照两组患者的临床效果及不良反应发生率.结果 两组患者的治疗总有效率进行对比,提示实验组患者更高;两组患者的不良反应发生率进行对比,提示实验组患者更低;均存在明显差异(P<0.05).结论 对高血压患者应用天麻钩藤饮治疗可起到理想效果,能够使患者的血压降低,使其症状缓解,且不良反应发生几率低,值得广泛应用.

周华教授在慢性心力衰竭的诊治中,注重西医辨病分期与中医辨证分型相结合,立足指南,注重防变.依据心肾同治理论,将温补心肾贯穿病程始终,创新性提出鹿角系列方,针对慢性心力衰竭不同阶段分期论治,临床疗效显著.

目的 探究使用芪参益气滴丸对冠心病心力衰竭进行治疗的临床效果和可行性分析.方法 随机选取2017年3月–2020年3月来盐城市中医院就诊的80例冠心病心力衰竭的患者作为此次分析对象,通过动态化随机分组以及用药方式不同的方式将其分成观察组(40例,使用芪参益气滴丸药物进行治疗)和对照组(40例,采用常规药物治疗),对比2组的治疗效果、治疗前后6min步行距离、左室射血分数以及生存质量评分.结果 通过本实验研究表明,与对照组相比,观察组的治疗总有效率较高(P<0.05);通过治疗后,观察组6min步行实验效果更佳,左室射血分数以及生存质量评分变化显著(P<0.05).结论 使用芪参益气滴丸治疗冠心病心力衰竭的效果显著并且不良反应小,安全性较高,能够有效改善患者心功能,值得临床运用并加以推广.

曾学文教授对心脏病中医病名的考证颇有心得,文章从中西医角度对曾学文教授关于心脏病中医病名考这一学术思想进行整理和总结,阐述曾学文教授对心脏病中医病名、证名的认识.

Background. Ventricular remodelling is a common pathological change at all stages of heart disease. Luhong granules are widely used in patients with chronic ventricular remodelling after myocardial infarction and can alleviate chest tightness, shortness of breath, and other symptoms. However, its effect on ventricular remodelling remains to be studied. Purpose. In this study, we investigated the effects of these granules on myocardial fibrosis in a rat model of myocardial infarction in vivo. Methods. Male Wistar rats were randomly divided into four groups: the sham operation group, the acute myocardial infarction (AMI) group, the Luhong granule group, and the vancomycin group, with a sample size (n) of 10 rats in each group. The AMI model was established in all rats by ligation of the left anterior descending (LAD) coronary artery (the sham operation group did not undergo ligation). Luhong granules (0.5 ml·kg−1·d−1), vancomycin (0.075 g·ml−1·d−1), and 0.9% saline (5 ml·kg−1·d−1 for the sham operation and AMI groups) were administered orally for 6 weeks. Echocardiography was used to check cardiac structure and function. Myocardial and small intestinal tissue morphology was observed by haematoxylin and eosin (H&E) staining, and heart samples were stained with Masson’s trichrome to analyse myocardial fibrosis. 16S rDNA sequencing was performed to detect changes in the gut flora. The level of trimethylamine N-oxide (TMAO) in plasma samples was quantified by stable isotope dilution liquid chromatography-tandem mass spectrometry (LC-MS). Results. H&E and Masson’s trichrome staining of cardiac tissues showed that Luhong granules could partially reverse ventricular remodelling and improve intestinal barrier function (P<0.05). Echocardiographic analysis showed that, compared with the AMI group, the left ventricular ejection fraction (LVEF) in the Luhong granule group was increased (P<0.05). Stool sequencing and microbiological analysis showed changes in Bacteroidales, Alistipes, Phascolarctobacterium, etc., which can produce TMAO. We found that Luhong granules can reduce Bacteroidales, Alistipes, and Phascolarctobacterium at the genus level. The levels of TMAO and lipopolysaccharides (LPS) in plasma samples were reduced in the Luhong granule group (P<0.05). Conclusions. Our results indicate that Luhong granules reduce TMAO and LPS levels in circulating blood by improving intestinal flora and intestinal barrier function to delay ventricular remodelling after myocardial infarction.

目的 对中药干预骨髓间充质干细胞治疗心肌梗死(MI)大鼠疗效进行系统评价.方法 用计算机检索中国知网、万方数据库、维普数据库、Pubmed、Embase及其他中医药相关期刊中有关中药干预骨髓干细胞治疗心血管疾病的大鼠实验研究.采用Cochrane协作组提供的Revman5.3软件对纳入的8篇实验性研究进行Meta分析.结果 中药干预骨髓间充质干细胞治疗心肌梗死大鼠心功能左心室射血分数疗效优于对照组[MD=16.70,95％ CI (10.46,22.95),P＜0.000 01],中药干预骨髓间充质干细胞治疗心肌梗死大鼠心功能左心室短轴缩短率疗效优于对照组[MD=15.39,95％CI(11.26,19.52),P＜0.000 01].结论 中药干预骨髓间充质干细胞治疗心肌梗死大鼠心功能有明显疗效,且安全性较高.

Stem cells are a promising solution for the treatment of heart failure due to their ability to repopulate injured myocardium and restore cardiac function. However, many hindrances (such as low survival/viability and integration of transplanted cells, poor homing and cardiac differentiation efficiency, and inadequate cell retention and engraftment) compromise the full regenerative potential provided by stem cells. Therefore, it is necessary to optimize stem cell/progenitor therapy to improve clinical efficacy. By analogy, in order for crops to grow, good seeds are needed. They also need sufficient fertilizer, herbicides, and pesticides to be "optimized." In this review, we provide a comprehensive overview of "seeds" (comparison of stem cell types, different combinations of stem cells, age, size, and dose of stem cells) and "fertilizers" (optimizing stem/progenitor cells and genetic strategies, preconditioning with drugs, and physical changes) for heart failure.

目的:观察强心康颗粒辅治慢性心力衰竭的疗效.方法:56例随机分为治疗组和对照组各28例.两组均给予西医常规治疗,治疗组加用强心康颗粒治疗.结果:心功能疗效总有效率治疗组89.29％、对照组85.71％,两组比较差异无统计学意义(P＞0.05).中医症候疗效总有效率治疗组92.86％、对照组82.14％,两组比较差异有统计学意义(P＜0.05).结论:强心康颗粒辅治慢性心力衰竭效果较好.

Background. Whether additional benefit can be achieved with the use of L-carnitine (L-C) in patients with chronic heart failure (CHF) remains controversial. We therefore performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the effects of L-C treatment in CHF patients. Methods. Pubmed, Ovid Embase, Web of Science, and Cochrane Library databases, Chinese National Knowledge Infrastructure (CNKI) database, Wanfang database, Chinese Biomedical (CBM) database, and Chinese Science and Technology Periodicals database (VIP) until September 30, 2016, were identified. Studies that met the inclusion criteria were systematically evaluated by two reviewers independently. Results. 17 RCTs with 1625 CHF patients were included in this analysis. L-C treatment in CHF was associated with considerable improvement in overall efficacy (OR = 3.47, P < 0.01), left ventricular ejection fraction (LVEF) (WMD: 4.14%, P = 0.01), strike volume (SV) (WMD: 8.21 ml, P = 0.01), cardiac output (CO) (WMD: 0.88 L/min, P < 0.01), and E/A (WMD: 0.23, P < 0.01). Moreover, treatment with L-C also resulted in significant decrease in serum levels of BNP (WMD: -124.60 pg/ml, P = 0.01), serum levels of NT-proBNP (WMD: -510.36 pg/ml, P < 0.01), LVESD (WMD: -4.06 mm, P < 0.01), LVEDD (WMD: -4.79 mm, P < 0.01), and LVESV (WMD: -20.16ml, 95% CI: -35.65 to -4.67, P < 0.01). However, there were no significant differences in all-cause mortality, 6-minute walk, and adverse events between L-C and control groups. Conclusions. L-C treatment is effective for CHF patients in improving clinical symptoms and cardiac functions, decreasing serum levels of BNP and NT-proBNP. And it has a good tolerance.

Current drugs and interventional therapy can improve the symptoms of myocardial infarction,reduce short-term mortality,but the course of the irreversible cause patients to die.As cardiac stem cells (CSCs)were confirmed,and found that CSCs have self-renewal and multi-directional differentiation ability,CSCs become the most ideal method of treatment for myocardial infarction.In this paper,summarizes the research progress of cardiac stem cells promoting cardiomyocyte regeneration and traditional Chinese medicine.

目的 观察曾学文之通补兼施方对高血压早期肾损害的治疗效果.方法 50例患者随机分为治疗组与对照组各25例.对照组常规使用西医等治疗,治疗组在对照组西医治疗的基础上加用通补兼施方.结果 治疗组总有效率92.00％优于对照组的68.00％ (P＜ 0.05).治疗前两组SBP、DBP差别不大(均P＞ 0.05).治疗后两组血压均较治疗前明显降低(均P＜ 0.05),但两组间血压差别不大(均P＞0.05).治疗组对眩晕、腰膝酸软、五心烦热、夜尿频多、脉络痰血及舌苔、脉象的改善优于对照组(均P＜0.05);但在头痛头胀、急躁易怒、口干口苦、耳鸣等症状改善方面,两组差别不大(均P＞ 0.05).两组治疗前尿mAlb、β2-MG、NAG差别不大(均P＞0.05),两组治疗后尿mAlb、β2-MG、NAG均较治疗前均下降(均P＜0.05),且治疗组尿mAlb、β2-MG下降程度优于对照组(均P＜ 0.05).结论 通补兼施方对高血压早期肾损害有较好治疗效果,与常规西药配合治疗有一定的协同作用.

炙甘草汤、四逆汤、四逆散、真武汤、枳实薤白桂枝汤、葶苈大枣泻肺汤、小青龙汤出自张仲景的《伤寒论》及《金匮要略》,为曾学文治疗心系疾病的常用方.曾学文主任认为其理法方药,阐述了张仲景心系疾病辨证论治的理论和方法,心系疾病发病多因本虚标实,病位在心,“心动则五脏皆摇”,可牵及肺、脾、肝、肾,本虚多以心气、心阳不足为主,可累及心阴,标实多以寒邪、痰饮、水湿、血瘀为主,“气、血、水”乃心脏疾病三步曲.

目的 探讨胸痹心痛中医病性证素的分布、主要组合规律及冠心病不同类型证素分布.方法 对223例胸痹心痛患者进行中医病性证素分布的临床调查,分析病性证素的分布及组合情况,并分析冠心病不同分型证素分布规律.结果 胸痹心痛常见病性证素分布频率由高至低依次为血瘀、气虚、阴虚、痰浊、气滞、阳虚、寒凝;其组合情况:双因素组合中,气虚+血瘀最多,其他依次为气虚+阴虚、血瘀+气滞、血瘀+痰浊、气虚+痰浊、阳虚+血瘀、气虚+阳虚、血瘀+阴虚;三因素组合中,气虚+阴虚+血瘀最多,其次为气虚+痰浊+血瘀、气虚+阴虚+痰浊、气滞+血瘀十痰浊、阳虚+血瘀+气滞;冠心病心绞痛与心肌梗死中医病性证素分布存在差异.结论 胸痹心痛在治疗上应标本兼顾,以益气活血、滋阴化痰的方药为主.

目的 探讨胸痹心痛病中医病性证候要素与冠状动脉CTA结果之间的相关性.方法 借助64层螺旋CT冠状动脉成像的现代医学诊断技术,将客观指标与中医辨证有机结合,对235例胸痹心痛患者进行中医病性证素分布的临床调查,分析与冠状动脉CTA不同病变支数、狭窄程度与冠心病心绞痛中医证素分布的相关性.结果 胸痹心痛病常见病性证素分布由多到少排列为血瘀、气虚、阴虚、痰浊、气滞、阳虚、寒凝;血瘀证素和痰浊证素以三支病变为主,气滞证素以单支病变为主;冠心病患者狭窄程度较重者多见气虚证素、阴虚证素、痰浊证素.结论 胸痹心痛病中医病性证素分布与冠状动脉CTA结果之间存在一定相关性,能为临床正确辨证论治、判断病情、拟定治法、调方用药效提供客观依据.