| Research Backgrounds:Chronic heart failure, or congestive heart failure(CHF),which refers to the terminal phase of heart disease caused by various pathogen, is a common, multiple complex Clinical syndrome.Nowadays, CHF is still one of the major clinical challenges and the only cardiovascular disease whose mortality rate is on the rise seriously threatening human life quality and safety, becoming the most important cardiovascular disease in the 21st century.In recent 20 years, researchers has come to realize that the happen-ing and development of heart failure is a result of the joint action of many factors, such as hemodynamic disorders, the activation of sym-pathetic nervous system and renin angiotensin aldosterone system (RA AS),the secretion of neural humoral factors and ventricular remodeling caused by myocardial cell apoptosis,ect, which will aggravate the myoc-ardial injury and decrease cardiac function.Recent researches show that the aim of treating heart failure is not simply to improve symptoms and cardiac function, but also to prevent and delay the ventricular remodeling, improve the quality of patients' life and prolong the survival time. Meanwhile, a large number of basic and experimental studies have been made in the treatment of chronic heart failure with traditional Chinese medicine(TCM), showing that TCM, through various interventions, can act as a useful way to prevent and treat heart failure, and is helpful to improve patients'heart function and the prognosis. After years of clinical study, submicron powder of Qiangxin Anshen decoction, which can supplement qi, nourish yin, strength heart and be used as a tranquilizer and sedative, proves to have useful clinical effects on patients suffering from chronic heart failure with qi and yin deficiency. Therefore, our study will further verify its clinical effect and investigate the possible mechanism.Clinical Study[Objectives):To treat chronic heart failure with both qi and yin defici-ency by submicron powder of Qiangxin Anshen decoction. The heart fun-ction, integral of TCM symptoms,chest X-ray,6-MWT, echo cardiograph, PRA,Angâ…¡,ALD and Serum NT-proBNP are compared before and after treatment so that the clinical effect of submicron powder of Qiang-xin Anshen decoction can be evaluated; the routine urine, blood and stool test, the function of live and kidney and ECG, which are observed before and after treatment, act as the safety indexes of Qiangxin Anshen decoction.Consequently, the preliminary mechanism of submicron powder of Qiangxin Anshen decoction in treatment of chronic heart failure with deficiency of both qi and yin treated by is to be inspected.[Methods]:100 cases of chronic heart failure with deficiency of both qi and yin were divided randomly into two groups:the treating group and the contrasting group.Besides the western medicine convention treatment of heart failure therapy, submicron powder of Qiangxin Anshen decoction was taken in the treating group,and placebo in the contrasting group.[results]:1.100 cases were observed in this research among which 5 cases shed off,48 cases in the treating group and 47 cases in the contrasting group. By contrast, no significant differences were found in demography char-acteristics, patient's condition, course of disease and the general subject of physical examination such as HR, BP, the NYHA class ification, 6MWT, laboratory data, tongue manifestation and pulse manifestation ect., and the two groups are of comparability (P>0.05)2.Before and after treatment,a contrast observation was made,the renin, angiotensin, aldosterone and NT-pro BNP of the patients in treating group were found to have improved noticeably, and the clinical efficacy was better than the contrasting group(P<0.05);3.Before and after treatment, the heart function, integral of TCM sym-ptoms, cardiothoracic ratio in the X-ray, efficacy of syndrome of Traditional Chinese Medicine and 6MWT of the two groups, and the differences were significant(P< 0.05).Experimental Study[Objectives]:To observe the effect of submicron powder of Qiangxin Anshen decoction on neurohormonal levels and AT1 mRNA in rat models of heart failure which received adriamycin, and to probe into its possible mechanism.[Methods]:60 Wister rats were divided randomly into the following groups:normal control group, model group, low-dose submicron powder of Qiangxin Anshen decoction treatment group,large-dose submicron powder of Qiangxin Anshen decoction treatment group and western medicine control group,12 rats in each group.To establish a rat model of heart failure, ADR was given intraperitoneally for 6 weeks, and after that the drug was given respectively for 4 weeks. Then the plasma Angâ…¡, ALD and ANP were determined by radioimmunoass ay, and the pictures of pathological change at myocardium of rats were observed as well as the expression of AT1 mRNA.[results]:In large-dose submicron powder of Qiangxin Anshen decoction treatment group,there was a significant inhibitive effect on the expression of AT1 mRNA and activation of neuro endocrine factor of rat models of heart failure which received adriamycin. In comparation with the contrast group, the difference was significant(P<0.05),and there was no significant difference between low-dose submicron powder of Qiangxin Anshen decoction treatment group and large-dose submicron powder of Qiangxin Anshen decoction treatment group(P> 0.05).Conclusions:This clinical and experimental study prove that treating chronic congestive heart failure with both submicron powder of Qiangxin Anshen decoction and western medicine is effective clinically, which can better the clinical symptom of the patients and the rate of integral of TCM symptoms, therefore achieving the goal of improving their life quality. submicron powder of Qiangxin Anshen decoction can decrease the neurohormonal levels of patients remarkably and has a significant inhibitive effect on the expression of AT1 mRNA which is probably one of underlying mechanisms and targets for its clinical treatment of chronic heart failure. In addition, submicron powder of Qiangxin Anshen decoction is safe and has no obvious side effects. |
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