| Objective:1.To observe the clinical efficacy and safety of Tiao Pihuxinfang Decocti-on in the treatment of chronic heart failure with Cardiacspienic asthenia.2.To observe the changes of serum interleukin-6(IL-6),tumor necrosis factor-a(TNF-a)and hypersensitive c-reactive protein(hs-CRP)in patients of chronic heart failure with tiaopihuxinfang Decoction.3.To observe the expression of interleukin-6,tumor necrosis factora,toll-like receptor4(TLR4)and the pathologic observation of myocardial cells in the patients with chronic heart failure rats.Method:1.Clinical observation:The study collected 40 patients with chronic heart failure who were admitted to anhui provincial hospital for cardiovascular outpatient and hospitalization during the period from August 2015 to August 2017.these patients were randomly divided into control group and treatment group by using the random number table method.there were 20 cases in each group,both groups were given routine treatment of western medicine,the treatment group was added to Tiao Pihuxinfang decoction on this basis of conventional western medicine.Once a day,a course of treatment for 4 weeks.The changes were observed before and after treatment in two groups of these indicators,which are TCM syndrome integral score,Lee's heart failure score,quality of life score of Minnesota(MLHFQ),heart function NYHA grade of heart function,left ventricular ejection fraction(LVEF)and serotype B brain natriuretic peptide(BNP),interleukin-6(IL-6),tumor necrosis factor-a(TNF-a),hypersensitive creactive protein(hs-CRP).2.Experiments on animals:40 SD male rats were randomly divided into high tiaopihuxinfang group,low Tiao Pihuxinfang group,perindopril group,model control group and normal control group.each group of eight,which groups are drug lavage 4 weeks After success.The expression level of Toll like receptor 4 was detected by immunob-lotting and the expression of IL-6 and TNF-a was detected by immunohistochemistry.After the experiment,the myocardium specimens of each group were made by HE staining.The expression levels of toll-like receptor 4(TLR4),interleukin-(IL-6),tumor necrosis factor-a(TNF-a)and the pathological changes of rat myocardial cells in rats were observed after treatment.Result:Clinical observation:1.In the case of TCM syndrome,the treatment group has a total efficiency of 95%,th-e control group is 75.0%,and the treatment group is better than the control group,and the difference between the two groups is statistically significant.2.In terms of TCM syndromes,Lee's heart failure score and Minnesota life quality score,the two groups significantly decreased after treatment,with statistically significant difference(P<0.05).After treatment,the treatment group was better than the control group(P<0.05).3.In terms of the efficacy of NYHA cardiac function,the effective rate of treatment group was 65.0% and the control group was 90.0%.The difference between the two groups was statistically significant(P<0.05).The treatment group was superior to the control group.4.In the case of BNP,both groups were significantly lower after treatment than bef-ore treatment,and the difference was statistically significant(P<0.05).After treatment,the efficacy of treatment group was better than that of the control group(P<0.05).5.In terms of LVEF value,both groups were significantly increased after treatment,and the difference was statistically significant(P<0.05).Compared between the two groups,the difference was not statistically significant.6.In the IL-6,TNF-a,hs-CRP,the two groups after treatment was significantly lower,the difference is statistically significant(P< 0.05).After treatment,the efficacy of the treatment group was better than that of the control group(P<0.05).7.During the period of clinical observation,Tiao Pihuxinfang was found no adjustable spleen mindarmor obvious adverse drug reactions.Experiments on animals:1.In the case of BNP,the serum BNP level of rats in the treatment groups were significantly lower than that before treatment(P<0.05),among which the high tiaopihuxinfang group and the perinopripley group were relatively close(P>0.05),and compared with the low Tiao Pihuxinfang group,the high Tiao Pihuxinfang group and the perinopripley group were significantly different(P<0.05).2.In the case of TLR4,the serum TLR4 level of rats in the treatment groups were significantly lower than that before treatment(P<0.05),among which the high tiaopihuxinfang group and the perinopripley group were relatively close(P>0.05),and compared with the low Tiao Pihuxinfang group,the high Tiao Pihuxinfang group and the perinopripley group were significantly different(P<0.05).3.In the case of IL-6?TNF-a,the serum IL-6?TNF-a level of rats in the treatment groups were significantly lower than that before treatment(P<0.05),among which the high Tiao Pihuxinfang group and the perinopripley group were relatively close(P>0.05),and compared with the low Tiao Pihuxinfang group,the high tiaopihuxinfan-g group and the perinopripley group were significantly different(P<0.05).4.At the end of the experiment,the morphology and arrangement of cardiomyocytes were observed in the control group,and the myocardial fibers were normal;In the control group,myocardial fibers were thickened,edema,and myocardial cells were disordered;The myocardial cell edema and necrosis were slightly improved inthe low tiaopihuxinfang group,and the permutation of myocardial cells and myocardial cell fiber were not obvious;The myocardial cells edema and necrosis were significantly improved in the high Tiao Pihuxinfang group and perindopril group,and the myocardial cells were closely aligned,and the myocardial nuclei were oval and deeply stained,located in the center of the cell.Conclusions:1.Tiao Pihuxinfang combined with conventional western medicine is superior to the simple Western medicine standard treats the chronic heart failure in terms of improving the efficacy of TCM syndromes,quality of life scores,scoring of Lee's heart failure,NYHA cardiac function,serum B-type brain natriuretic peptide(BNP),serum interleukin-6(IL-6),tumor necrosis factor-a(tnf-a),and high-sensitivity C-reactive protein.2.The experimental about Tiao Pihuxinfang on animals results showed that regulating the spleen and protecting the heart had the effect of reducing the immune system mediated,thus reducing the level of il-6,TNF-a and TLR4 in heart failure rats.moreover,there is a difference in the dose concentration of the drug,and in a certain range,the dosage of the spleen protecting heart can be increased to achieve the optimal therapeutic effect.3.No obvious adverse reactions about Tiao Pihuxinfang were found in the clinical trials and animal experiments. |
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