| Objective:Chronic Heart Failure(CHF)is a disease characterized by the damage of cardiac function and structure by various pathogenic factors,resulting in the destruction of cardiac structure,gradual decline or loss of cardiac function,and the Failure of cardiac blood supply to meet the body’s metabolic needs and cardiac endocrine dysfunction[1].This study aims to research the pathogenesis of Chronic Heart Failure(CHF)with cognitive dysfunction and the effect of Yiqi xifei decoction on this disease by evaluating the CHF patients with cognitive impairment and studying the cognitive function of CHF rat model.This study advocate to pay attention to the quality of life of CHF patients with cognitive impairment in the future research,aiming to early assessment,early detection,early intervention,delay the course of disease,and improve the quality of life of CHF patients with cognitive impairment.Methods:1.Clinical trial:according to the diagnostic criteria of Chinese guidelines for the diagnosis and treatment of heart failure(2018 edition)and Chinese guidelines for the diagnosis and treatment of dementia(2017 edition),44 CHF patients with cognitive impairment were collected from the cardiovascular department of Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine from January 2019 to January 2020.According to the randomized group with or without diabetes,those 44 CHF patients with cognitive impairment were divided into two groups:22 cases in the control group(including 11 diabetes cases)and 22 cases in the Yiqi xiefei decoction group(including 12 diabetes cases).Observation indicators:(1)cardiac function evaluation:NT-ProBNP value;Echocardiography:LVEF value,FS value;MLHFQ scale,Chinese medicine symptomatology scale;(2)cognitive function assessment:MMSE scale,MoCA scale.Statistical methods:SPSS25.0 statistical software was used,T-test was used for comparison between two groups,independent T-test was used for comparison between groups,and paired T-test was used for comparison within groups.2.Animal experiments:70 SPF grade male,12-week-old SD rats were selected,and the rat model of heart failure was established by ligating the anterior descending branch of coronary artery,while the sham group were not ligated.The rats were divided into 3 groups according to the Q waves number of ECG postoperatively:20 in the sham group,20 in the model group,and 20 in the Yiqixiefei decoction group.Administration methods:the sham group and the model group were given normal saline 5.0ml/(kg·d)by intragastric administration,and the Yiqi xiefei decoction group was given Yiqixiefei decoction granule 5g/(kg·d)by intragastric administration,twice a day,for 8 weeks in total.Main observation indexes:(1)NT-ProBNP、AngII;(2)echocardiography:LVEF value,FS value;(3)electrocardiogram:Q wave number before and after the use of drug,ST section depression(4)water maze:swimming distance,escape latency time,the number of times across the platform difference.Statistical methods:SPSS25.0 statistical software was used.Animal experiment indicators:Ang II concentration,echocardiography and electrocardiogram(ecg)data,through the platform number comparison between groups using one-way ANOVA analysis,comparison in the group by T test.The swimming distance and escape incubation period of rats were calculated using the multi-factor analysis of variance(anova)of repeated measurement data.Results:1.Clinical trial:Index evaluation:(1)basic data and safety index evaluation:before use of drug,the age,education years,BMI,hypertension,hyperlipidemia,diabetes,NYHA classification(Ⅱ-Ⅳlevel),lacunar cerebral infarction,COPD,chronic kidney disease(CKD),blood routine and biochemical indexes,NT-ProBNP,LVEF,FS,MMSE,MoCA score,MLHFQ and TCM symptomatology rating scale did not see obvious difference between the two group patients(P>0.05).After treatment,the comparison of safety indicators between the two groups showed increased platelet count and decreased triglyceride level in Yiqi xiefei decoction group(P<0.05),while no significant difference was found in other indicators(P>0.05).(2)NT-proBNP:compared with the control group,NT-proBNP in Yiqixifei decoction group was significantly reduced(P<0.05).(3)echocardiography:compared with the control group,the LVEF value in the Yiqi xifei decoction group was significantly increased(P<0.05),and the FS value was increased,but there was no statistical significance(P>0.05).(4)MLHFQ and Chinese medicine symptomatology scale:compared with the control group,the scores of MLHFQ and Chinese medicine symptomatology scale in Yiqi xiefei decoction group were significantly lower(P<0.05).(5)MMSE and MoCA scores:compared with the control group,the total MMSE score of the Yiqi xiefei decoction group was significantly improved(P<0.05),and the directional force,immediate recall ability and language ability were all improved(P<0.05).There was no difference in MoCA score between the two groups(P>0.05).2.Animal experiments:(1)Ang Ⅱ:compared with the sham group,the Ang Ⅱ concentration in model group and Yiqi xiefei decoction group were significantly increased(P<0.05);Compared with model group,the Ang Ⅱ concentration in Yiqi xiefei decoction group was significantly decreased(P<0.05).NT-proBNP concentration:to be determined.(2)ECG:compared with the sham group,the number of Q wave in the model group was increased significantly(P<0.05),the depression range of ST segment was increased significantly,and the number of T-wave inversion increased significantly(P<0.05).There was no statistical difference between the control group and the Yiqi xiefei decoction group in the Q wave of ECG,ST segment depression amplitude and number of inverted T wave(P>0.05),and the baseline was consistent.Compared with the model group,there was no significant difference in the pathological changes of Q wave and T wave inversion in Yiqi xiefei decoction group(P>0.05),but the depression range of ST segment was significantly reduced(P<0.05).(3)echocardiography:compared with the sham group,the LVEF and FS values of rats in the model group were significantly reduced(P<0.05).Compared with the model group,the LVEF and FS values of Yiqi xiefei decoction group showed an increasing trend,but there was no statistical significance(P>0.05).(4)water maze experiment:compared with the model group,the escape latency time of the sham group and Yiqi xiefei decoction group was significantly shortened and the times of crossing the platform were significantly increased(P<0.05).However,there was no statistical difference among the three groups in swimming distance,target quadrant residence time and other indicators(P>0.05).Conclusion:1.Clinical trials:(1)Yiqi xiefei decoction could enhance the pumping capacity of the heart,improve the cardiac function of patients,delay the course of heart failure,and improve the quality of life of CHF patients with cognitive impairment.(2)Yiqi xiefei decoction can improve the cognitive impairment of patients with heart failure and improve their quality of life.2.Animal experiments:(1)Yiqi xiefei decoction can relieve the symptoms of CHF rats and relieve the symptoms of blood stasis in rats with heart failure,but it is not found that Yiqi xiefei decoction can improve the LVEF and FS values in rats with heart failure.(2)Yiqi xiefei decoction can improve the cognitive function of rats with heart failure with cognitive impairment,and improve their learning and memory ability. |
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