优化新生脉散方治疗心力衰竭的网络药理学机制分析

[目的] 运用网络药理学方法分析优化新生脉散方治疗慢性心力衰竭（CHF）的作用机制。[方法] 基于中药系统药理数据库和分析平台（TCMSP）、BATMAN-TCM及UniProt数据库查询优化新生脉散方药物的主要活性成分与相应靶点，利用GeneCards数据库检索CHF相关靶点，通过OmicShare网站分析并结合Cytoscape-v3.6.0软件构建优化新生脉散方中药-化合物-靶点-疾病网络图，使用DAVID数据库对潜在靶点进行基因功能（GO）及京都基因和基因组百科全书（KEGG）通路富集分析。[结果] 根据类药性（DL）、口服吸收利用度（OB）、参数评分（Scorecutoff）筛选出与CHF相关的潜在化合物85种及靶点89个，其中，化合物有quercetin、luteolin、kaempferol等，靶点包括SCN5A、ADRB2、NOS2等。功能富集分析涉及生物过程、分子功能、细胞组分的GO条目共497个，主要参与调控细胞凋亡、增殖及缺氧、炎症反应等方面，KEGG通路富集得到139条，主要与缺氧诱导因子-1（HIF-1）、磷脂酰肌醇3激酶/蛋白激酶B（PI3K-Akt）、肿瘤坏死因子（TNF）信号通路等有关。[结论] 优化新生脉散方治疗CHF具有多成分、多靶点、多途径的作用，为进一步研究优化新生脉散方治疗CHF的潜在复杂机制提供参考方向。     

Prognostic value of preoperative inflammatory markers in resectable biliary tract cancer – Validation and comparison of the Glasgow Prognostic Score and Modified Glasgow Prognostic Score in a Western cohort

IntroductionEstablished preoperative prognostic factors for risk stratification of patients with biliary tract cancer (BTC) are lacking. A prognostic value of the inflammation-based Glasgow Prognostic Score (GPS) and Modified Glasgow Prognostic Score (mGPS) in BTC has been indicated in several Eastern cohorts. We sought to validate and compare the prognostic value of the GPS and the mGPS for overall survival (OS), in a large Western cohort of patients with BTC.Material and methodsWe performed a retrospective single-center study for the period 2009 until 2017. 216 consecutive patients that underwent surgical exploration with a diagnosis of perihilar cholangiocarcinoma (PHCC), intrahepatic cholangiocarcinoma (IHCC), or gallbladder cancer (GBC) were assessed. GPS and mGPS were calculated where both CRP and albumin were measured pre-operatively (n = 168/216). Survival was analyzed by Kaplan-Meier estimate and uni-/multivariate Cox regression.ResultsGPS and mGPS were negatively associated with survival (p < 0.001/p < 0.001), and the association was significant in all three subgroups. GPS, but not the mGPS, identified an intermediate risk group: with GPS = 1 having better OS than GPS = 2 (p = 0.003), but worse OS than GPS = 0 (p = 0.008). In multivariate analyses of resected patients, GPS (p = 0.001) and mGPS (p = 0.03) remained significant predictors of survival, independent of postoperatively available risk factors.ConclusionsPreoperative GPS and mGPS are independent prognostic factors in BTC. The association to OS was shown in all patients undergoing exploration, in resected patients only, and in both cholangiocarcinoma and gallbladder cancer. Furthermore, GPS – which weights hypoalbuminemia higher – could identify an intermediate risk group.     

Benefits of Optimizing Heart Failure Medication Dosage

Heart failure is the leading cause of hospitalizations and readmissions. Guideline-directed medical therapy is the cornerstone to improving outcomes, but less than 20% of patients with heart failure marked by reduced ejection fraction receive target doses. This report reviews the neurohormonal cascade that occurs in heart failure and the role of guideline-directed medical therapy based on the results of landmark trials. In addition, evidence-based strategies to up-titrate medications are described. Nurse practitioners are in an optimal situation to titrate guideline therapy with frequent follow-up and monitoring.     

Heart-type fatty acid-binding protein: an overlooked cardiac biomarker

Abstract

Cardiac troponins (cTn) are currently the standard of care for the diagnosis of acute coronary syndromes (ACS) in patients presenting to the emergency department (ED) with chest pain (CP). However, their plasma kinetics necessitate a prolonged ED stay or overnight hospital admission, especially in those presenting early after CP onset. Moreover, ruling out ACS in low-risk patients requires prolonged ED observation or overnight hospital admission to allow serial measurements of c-Tn, adding cost. Heart-type fatty acid-binding protein (H-FABP) is a novel marker of myocardial injury with putative advantages over cTn. Being present in abundance in the myocellular cytoplasm, it is released rapidly (<1?h) after the onset of myocardial injury and could potentially play an important role in both earlier diagnosis of high-risk patients presenting early after CP onset, as well as in risk-stratifying low-risk patients rapidly. Like cTn, H-FABP also has a potential role as a prognostic marker in other conditions where the myocardial injury occurs, such as acute congestive heart failure (CHF) and acute pulmonary embolism (PE). This review provides an overview of the evidence examining the role of H-FABP in early diagnosis and risk stratification of patients with CP and in non-ACS conditions associated with myocardial injury.

• Key messages

• Heart-type fatty acid-binding protein is a biomarker that is elevated early in myocardial injury

• The routine use in the emergency department complements the use of troponins in ruling out acute coronary syndromes in patients presenting early with chest pain

• It also is useful in risk stratifying patients with other conditions such as heart failure and acute pulmonary embolism.

     

无创呼吸机用于急诊急性心力衰竭合并呼吸衰竭的临床疗效

目的 分析无创呼吸机用于急诊急性心力衰竭合并呼吸衰竭的临床疗效。方法 选取我院2018年6月～2019年6月在我院急诊治疗的急性心力衰竭合并呼吸衰竭患者62例,随机分为观察组和对照组,每组各31例。对照组患者予强心、利尿、平喘、纠正电解质紊乱等基础治疗,同时予低流量鼻导管吸氧治疗;观察组予无创呼吸机治疗。治疗后对比分析两组的临床疗效及血气分析指标的变化情况。结果 观察组患者治疗后的总有效率达93.5%,高于对照组74.2%,差异有统计学意义(P0.05);两组患者的pH、PaO2及PaCO2水平分别比较,观察组改善情况均优于对照组(P0.05)。结论 无创呼吸机治疗急性心力衰竭合并呼吸衰竭疗效确切,且能有效改善动脉血气指标,促进患者呼吸功能迅速恢复,保护肺功能,从而改善患者的临床症状,且操作简便,值得推广和应用。     

芪苈强心胶囊配合保元汤加减治疗慢性心力衰竭临床研究

目的:观察芪苈强心胶囊配合保元汤加减用于慢性心力衰竭的治疗效果。方法:选取收治的慢性心力衰竭患者104例作为研究对象,运用随机数字表法将其分为观察组(52例)和对照组(52例),两组患者均接受常规治疗,对照组采用保元汤治疗,观察组同时应用芪苈强心胶囊联合保元汤治疗。观察患者治疗前及治疗后6个月的6 min步行试验的步行距离(6MWD)及纽约心脏病学会心功能分级(NYHA)、血清学指标N末端B型利尿钠肽原(NT-proBNP)、半乳糖凝集素3(Galectin-3)及白介素6(IL-6)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子α(TNF-α)、心脏指数(CI)、左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室重量指数(LVMI)和室壁运动指数(WMI)、左室间隔厚度(IVST)变化情况。结果:治疗前后,两组患者比较心功能指标、Galectin-3、炎性因子指标、心室重构指标差异有统计学意义(P<0.05); 观察组与对照组患者相比,6 min步行距离、CI、LVEF、升高更为显著(P<0.05); 观察组患者NYHA分级、NT-proBNP、Galectin-3、IL-6、hs-CRP、TNF-α、LVEDD、LVESD、LVMI、WMI、IVST降低更为显著(P<0.05)。结论:芪苈强心胶囊辅助保元汤加减能够有效改善慢性心力衰竭患者心脏功能,有利于患者体内炎性因子及Galectin-3水平降低,抑制心室重构进展,患者心脏舒缩功能改善效果更佳。     

养心定悸胶囊治疗伴长RR间期的心房颤动合并慢性心力衰竭的临床研究

目的观察养心定悸胶囊治疗伴长RR间期的心房颤动合并慢性心力衰竭患者的效果。方法将2016年5月1日—2018年6月1日就诊于河北省人民医院的104例伴长RR间期的心房颤动合并慢性心力衰竭患者随机分为试验组52例和对照组52例,2组均给予改善心功能、稳定心率在内的规范化治疗,试验组在此基础上加服养心定悸胶囊,6粒/次,2次/d。观察2组患者治疗12周后症状、心率、RR间期、心功能[左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左房内径(LAD)、N端前脑钠肽(NT-proBNP)]及心率变异性指标[窦性心率RR间期标准差(SDNN)、RR间期平均值标准差(SDANN)、相邻RR间期差值的均方根(RMSSD)、窦性相邻RR间期之差>50 ms的计数占总RR间期数的百分比(PNN50)]的变化,记录2组不良反应发生情况。结果治疗12周后,试验组和对照组的临床症状总有效率分别为88.5%(46/52)和75.0%(39/52),试验组明显高于对照组(P<0.05);2组患者的24 h总心搏次数、心率及长RR间歇次数均显著少于治疗前,最长间歇时间均显著短于治疗前,且试验组最长间歇时间显著短于对照组,长RR间歇次数显著少于对照组,差异均有统计学意义(P均<0.05);2组患者的LVEF及均心率变异性各指标显著高于治疗前,LVEDD、LAD及NT-proBNP水平均显著低于治疗前,且试验组的变化都更为显著,差异均有统计学意义(P均<0.05)。治疗期间2组患者的不良反应发生率比较差异无统计学意义(P>0.05)。结论养心定悸胶囊辅助治疗可明显改善伴长RR间期的心房颤动合并慢性心力衰竭患者症状,有效稳定心率,缩短长间歇,改善心功能,调节心率变异性,且安全性高。