| In recent years,the research on the pathogenesis of hypertension and antihypertensive drugs has been developed rapidly,but the incidence of heart,brain,kidney and other target organ lesions associated with hypertension,disability and death rates have not been well controlled.Cardiac and vascular remodeling,which is the common pathologic basis of target organ damage,plays a key role and has become one of the hotspots of research at home and abroad.Left ventricular hypertrophy(LVH)is one of the serious complications of hypertension and is an adaptive response of the ventricle to hypoxia or stress overload.The heart,one of the target organs,is closely associated with hypertension and chronic stress load increases.Growth factors such as catecholamine and angiotensin Ⅱ can stimulate hypertrophy of the heart cells and interstitial fibrosis,causing changes in the structure and function of the heart resulting in hypertrophy of the left ventricle.Hypertension and LVH are independent risk factors for cardiovascular disease,and LVH significantly increases the risk of coronary heart disease,heart failure,stroke and death in patients with hypertension.Conversely,effectively managing blood pressure and reversing LVH can significantly reduce the risk of cardiovascular events and death.Qutan Huoxue Decoction is a classic prescription for treating hypertension in our department,and its clinical effect is good.We use it in patients with hypertension and left ventricular hypertrophy with phlegm and blood stasis syndrome,as well as in spontaneously hypertensive rats(SHR)with myocardial hypertrophy and fibrosis models.Clinically,we observe whether Qutan Huoxue Decoction can effectively improve the symptoms of phlegm and blood stasis syndrome in patients with hypertension and left ventricular hypertrophy,and whether it will affect blood lipids,plasma inflammatory cytokines,and cardiac function.Relevant indicators of left ventricular hypertrophy,and further explore the related efficacy and possible mechanism of Qutan Huoxue Decoction on myocardial hypertrophy and fibrosis in patients through animal models.1、Clinical effect of expectorant Huoxue Decoction on syndrome of left ventricular phlegm stasis and hypertrophyPurpose:To observe whether Qutan Huoxue Decoction can improve the clinical syndromes of patients with hypertension accompanied by left ventricular hypertrophy with phlegm stasis syndrome,and its effect on blood lipids,plasma inflammatory cytokines,cardiac function,and left ventricular hypertrophy related indicators.Materials and methods:From September 2021 to December 2022,80 patients with hypertension and left ventricular hypertrophy who were hospitalized in the Department of Cardiology of Changzhou Traditional Chinese Medicine Hospital were selected.The TCM syndrome differentiation was phlegm blood stasis syndrome,aged 18-75 years old.They were randomly divided into two groups:the control group and the TCM group.The control group was treated with olmesartan;The Chinese medicine group took Qutan Huoxue Decoction for 12 weeks while receiving the same treatment.The baseline data of the two groups were compared:gender,age,height,weight and other general conditions,blood pressure changes were measured,and TCM syndrome scores before and after treatment were recorded and compared.The blood lipid,plasma inflammatory cytokines,cardiac function and cardiac structure related indicators of patients were detected,including triacylglycerol(TG),total cholesterol(TC),high-density lipoprotein(HDL-C),low-density lipoprotein(LDL-C),TNF-α、hs CRP)、IL-6,IL-10,BNP,IVST,LVPWT,LVEDD,LVMI and LVEF.Result:1.After 12 weeks of study,the total effective rate was found to be 95.0%in the TCM group and 92.5%in the control group.The two groups were analyzed and compared,both the Chinese medicine group and the control group could play a certain antihypertensive effect,and the difference was not statistically significant(P>0.05).Hypertension patients with left ventricular hypertrophy mixed with phlegm and blood stasis showed higher blood pressure after treatment,and the difference was analyzed:Compared with before treatment,blood pressure in both groups was reduced,with statistical difference(P<0.05).However,compared with the control group,there was statistical difference between the results after treatment and before treatment(P>0.05).TCM syndrome scores in the two groups were improved,and TCM syndrome scores in the TCM group were significantly increased compared with the control group.The total effective rate was 70.0%(P<0.05).2.The treatment of expectorant Huoxue decoction showed that the blood lipid value of the patients with real hypertension combined with left ventricular hypertrophy and phlegm-stasis interjunction was significantly reduced.The difference analysis showed that compared with the control group,the result had statistical difference(P<0.05).After difference analysis:compared with before treatment,the TNF-α value of control group was decreased after treatment,and the comparison result had statistical difference(P<0.05).The contents of hs-CRP and IL-6 in TCM group after treatment were decreased compared with those before treatment,and the comparison results were statistically different(P<0.05).The level of IL-10 in the two groups after treatment was higher than that before treatment,with statistical difference(P<0.05).After difference analysis:However,IL-10 in different groups after treatment had statistical difference(P>0.05).After treatment,the BNP level of 2 groups was lower than that of this group,and the results were statistically different(P<0.05).The results were also different at different time points in each group.There was no significant difference in BNP between the two groups at the end of treatment(P>0.05).The relevant indexes of left ventricular hypertrophy in the two groups were compared.After treatment,IVST,LVPWT,LVEDD and LVMI in the Chinese medicine group were decreased compared with those before treatment,and LVMI in the Chinese medicine group was lower than that in the control group,with statistical difference(P<0.05).Compared with before treatment,LVEF in the TCM group was significantly increased after treatment,with statistical difference(P<0.05),while there was no statistical difference in the control group before and after treatment(P>0.05).Conclusion:1.Qutan Huoxue Decoction can improve the clinical symptoms and signs of patients with hypertension accompanied by left ventricular hypertrophy with phlegm and blood stasis syndrome,reduce their blood pressure,and alleviate the phlegm and blood stasis syndrome.2.The mechanism of Qutan Huoxue Decoction on patients with hypertension accompanied by left ventricular hypertrophy with phlegm stasis syndrome may be related to its role in regulating blood fat,improving heart function,reducing plasma inflammatory cytokines and reducing myocardial fibrosis indicators.2、Qutan Huoxue Decoction passes TGF-βThe Mechanism of 1/Smad Pathway Preventing Myocardial Hypertrophy and Fibrosis in RatsPurpose:This experiment mainly studies the protective effect of Qutan Huoxue Decoction on myocardial hypertrophy and fibrosis in SHR rats,and further studies whether the protective effect of Qutan Huoxue Decoction on myocardial hypertrophy and fibrosis in SHR rats is related to TGF-β1/Smad pathway,to explore the mechanism of the protective effect of Qutan Huoxue Decoction on myocardial hypertrophy and fibrosis in rats.Materials and methods:Twenty SHR rats were randomly divided into four groups:①model group,②low-dose group of Qutan Huoxue Decoction,③high-dose group of Qutan Huoxue Decoction,and ④western medicine group(Omesartan);Five Wistar rats were used as blank control.After four weeks of intragastric administration,the effects of Qutan Huoxue Decoction on blood pressure and left ventricular mass index(LVMI)of SHR rats were observed,and the effects of Qutan Huoxue Decoction on myocardial cell morphology,endothelin-1(ET-1),angiotensin Ⅱ(Ang II)The influence of nitric oxide(NO)content;Measurement of transforming growth factor in myocardial tissue-β1(TGF-β1)mRNA level and Smad2/3 and Smad7 protein expression.Result:1.Qutan Huoxue Decoction can significantly reduce SHR blood pressure,LVMI,improve SHR myocardial cell morphology,reduce SHR plasma ET-1,Ang Ⅱ content,and increase SHR serum NO level.2.Qutan Huoxue Decoction can reduce SHR TGF-β1 mRNA level and Smad2/3 protein expression increased the expression of Smad7 protein.Conclusion:Qutan Huoxue Decoction can reduce myocardial hypertrophy and fibrosis and improve cardiac function in spontaneously hypertensive rats,and the mechanism of this protective effect may be through inhibiting TGF-β1/Smad signal path. |
PDF Full Text Request