| ObjectiveModified Shen Fu particles chronic congestive heart failure, exercise tolerance observed in clinical studies; observed in animal experiments on rats with heart failure myocardial ul trastructure and mitochondrial Na+-K+-ATPase enzyme, Ca2+-ATPase activity the impact in terms of energy metabolism, and then explore the possible mechanism of the modified Shen Fu particle treatment of chronic heart failure.MethodThis study consists of two parts, the first part is for the study of patients with chronic heart failure. The second part of the chronie heart failure rat, model for the study.(A) The first part (clinical research)In accordance with the principles of randomized controlled study,80patients with chronic heart failure Western diagnostic criteria (NYHA Heart Association functional class Ⅱ, Ⅲ) were divided into treatment group and TCM belong to the "the heart yang (gas) virtual stasis water retention certificate" and the control group, the treatment group selection of flavored Shenfu particles, the control group used the conventional Western medicine treatment. The key observation of patients before and after treatment clinical symptoms, BNP, ef%,E/A,6-minute walk test.(B) The second part (animal experiments)Clean SD male rats40, in accordance with the digital tables principles are divided into normal control group, model control group, western medicine group, modified Shen Fu particle group A (clinical equivalent group) and modified Shen Fu particle group B (2times the clinical equivalent amount of group),8rats in each group. In addition to the normal control group, each group first modeling process. After the modeling of each group to the appropriate intervention:control group:to give daily fed with distilled water2ml; model control group:to give daily fed with distilled water2ml; western medicine group:daily gavage5.4mg/kg given qumei He hydrochloride tablets; modified Shen Fu the particle group A:give fed daily6.84g crude drug/kg (equivalent to the clinical effective amount) Modified Shen Fu the particles group B:to give fed daily13.68g of crude drug/kg (equivalent to2times the clinical effective amount) 4weeks. OUTCOME MEASURES:body weight, heart weight, left ventricular mass, heart weight ratio, left ventricular heart than arterial pressure, right ventricular pressure, heart rate, left ventricular pressure maximum rise and fall rate [Max+DP/dt (mmHg/s)], myocardial mi tochondrial structure, mitochondrial Na+-K+-ATP enzyme and Ca2+-ATPase enzyme activity.Result(A) The first part (clinical research)(1)Groups NYHA class compare the efficacy of the treatment group was87.50%, total effective rate was70.00%in the control group, two groups, treatment group, the total effective rate was higher than that in the control group, and the difference was statistically significant (P<0.05).(2) two sets of Lee’s heart failure efficacy of scoring method to compare the treatment group the total effective rate was85.00%, total effective rate was67.50%in the control group, two groups, treatment group, the total effective rate was higher than that in the control group, and the difference was statistically significant (P<0.05).(3)After treatment6MWT distance increased, the treatment group increased to336by the pre-treatment288.57±46.10±40.12, control group increased to312by the pre-treatment273.94±31.17±38.69, the same group before and after treatment and after treatment groups contrast, the difference was significant (P<0.05) was statistically significant. The two groups could significantly extend the6MWT distance, and the treatment group than the control group.(4)After treatment LVEF and E/A has been reduced. LVEF, the treatment group before treatment45.44±7.19to56.38±7.07in the control group before treatment46.49±7.63to49.32±6.22; E/A aspects of the treatment group before treatment,0.78±0.39to1.43±0.49, control group before treatment to0.79±0.41increased to1.08±0.35, in terms of both the treatment group than the control group, the difference was significant, statistically significant. Modified Shen Fu particles systolic and diastolic function improved in patients with chronic heart failure.(5)Treatment after BNP has decreased in the treatment group decreased from754.37±53.10before treatment to286±52.32; control group decreased from738.64±41.32before treatment to352±38.6, compared wi th the group before and after treatment, significant differences (P<0.05); comparison group,the difference was significant (P<0.05); improve patient BNP modified Shen Fu particles(B) The second part (animal experiments)(1)Heart rate:the model group heart rate is higher than the normal group, the trimetazidine group of Modified Shen Fu the particle group A modified Shen Fu the particles group B (p<0.05); Modified Shen Fu particle group A and the modified Shen attached particle group B to improve heart rate is better than the trimetazidine group compared between groups (p<0.05), but flavored Shenfu the particle group A and group B, the contrast between the two groups was no significant difference (P>0.05)(2)Heart weight:Rats in heart weight increased significantly, model group, trimetazidine group, flavored Shenfu particle group A modified Shen Fu the particles group B with the normal group contrast, significant difference (P <0.05), was statistically significant; modified Shen Fu particle group A, which is the the clinical equivalent amount flavored Shenfu particles intervention, with the model group compared the increase in heart weight inhibition, comparison group, the difference was significant (P<0.05), and was statistically significant; left ventricular mass index:modeling elevated left ventricular mass index, compared with the normal group, P<0.05, the difference was statistically significant; Modified Shen Fu the particle group A, group B, Trimetazidine triazine group and model group comparison, P<0.05, statistically significant; modified Shen Fu particle group A, group B with trimetazidine group compared P>0.05, the difference was not statistically significant; reveal Modified Shen Fu particles prevention of ventricular remodeling.(3)±dP/dt max aspects:trimetazidine group, flavored Shenfu the particle group A and flavored the Shenfu particle group B±dp/dt max higher than model group (p<0.05); Modified Shen Fu group A and group B higher in the trimetazidine group, but not statistically significant (P>0.05);4blood pressure:modeling groups systolic arterial pressure (SAP), diastolic blood pressure (DAP), left ventricular end-diastolic pressure (LVEDP) compared with the normal group, a significant difference (p<0.01) was statistically significant; with the model group compared trimetazidine group, modified Shen Fu the particle group A, Modified Shen Fu the particles group B showed significant improvement, significant difference (p<0.01) was statistically significant;Trimetazidine triazine group, Modified Shen Fu particle group A modified Shen Fu particle group B, group comparison, there are differences, but not statistically significant.(4)Na+-K-ATP enzyme and Ca2+-ATPase enzyme activity:the model group Na+-K+-ATP enzyme and Ca2+-ATPase enzyme activity were lower, while qumei he triazine group, flavored parameters attached to particles of group A and flavored Shenfu particle group B compared with the model group was significantly increased compared with the model group, the difference was significant (P<0.05), a statistically significant; modified Shen Fu particle group A, group B with trimetazidine group, the contrast between the two groups exist difference, but p>0.05, not statistically significant; modified Shen Fu the particle group A, group B, the contrast between the two groups there are differences between the same p>0.05, not statistically significant. Chronic heart failure after myocardial ultrastructure:flavored Shenfu particles intervention rat cardiac myofibrils arranged in neat rows, the sarcomere structure, neatly myoneme, light and dark with clear, during which the visible mitochondria and sarcoplasmic reticulum, mitochondria arranged in neat, clear structure, the ridge structure is clear, no significant swelling, shows a small amount of lipid droplets in mitochondria,nucleus nuclear membrane more clearly, encapsulated, non-caking and edge set of phenomena, vacuolization.Conelusion(A) clinical research component(1)Modified Shen Fu particles can improve cardiac function in patients with chronic heart failure, reduce symptoms, is an effective medicine treatment of chronic heart failure.(2)Modified Shen Fu particles can improve clinical medicine chronic heart failure syndromes.(3)Modified Shen Fu particles can increase endurance activity in patients with chronic heart failure.(B) Experimental research component(1) successful model in rats wi th chronic heart fai lure, the use of modeling methods are abdominal aortic coarctation, the steps are relatively simple, high success rate.(2)Modified Shen Fu particles rats with chronic heart failure can be improved hemodynamics, including heart rate, blood pressure and±dP/dt max.(3)Modified Shen Fu particles can improve chronic heart failure rat model of myocardial ultrastructure and improve left ventricular mass index, inhibit ventricular remodeling in rats with chronic heart failure role.(4)Modified Shen Fu particles can improve chronic heart failure rats Na+-K+-ATP enzyme and Ca2+-ATP inhibition of enzyme activity, thereby improving myocardial energy metabolism.Therefore, the particle is the treatment of Modified Shen Fu "heart yang (gas) deficiency, blood stasis water stop" permit effective medicine in patients with chronic heart failure can improve cardiac ejection fraction, lower BNP, reverse ventricular remodeling, improve patient exercise tolerance, which may be one of the mechanisms to enhance myocardial energy metabolism. |
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