麝香保心丸对心力衰竭大鼠Th1和Th2型细胞因子水平的影响

Objective To investigate the effects of Shexiangbaoxin pills (SXBXP) on the serum levels of T helper type 1 (Th1) cytokines including tumor necrosis factor-a (TNF-α),interferon-γ(IFN-γ) and T helper type 2 (Th2) cytokines incloding interleukin-4 (IL-4),interleukin-10 (IL-10)in rats with chronic heart failure (CHF).Methods The CHF models were established by left anterior descending coronary artery ligation.Fifty-four Wistar rats were randomly divided into six groups:control group,sham operation group,CHF model group,small dose SXBXP group,large dose SXBXP group and positive medicine group.Heart function was examined by echocardiography before and after therapy,the TNF-α and IL-10 levels were measured by radioimmunoassay,IFN-γ and IL-4 levels were measured by enzyme linked immunosorbent assay (ELISA).Results (1) Before therapy,there was no significant difference between control group and sham operation group in ejection fraction of left ventricle (LVEF).Compared with control group and sham operation group,the levels of LVEF were significantly decreased in CHF model group,small dose SXBXP group,large dose SXBXP group and positive medicine group (all P＜0.01).(2) After therapy,compared with sham operation group,the serum levels of TNF-α and IFN-γ were markedly increased,and IL-4 and IL-10 were significantly decreased in CHF model group (all P＜0.01 ).Compared with CHF model group,LVEF was significantly improved,serum levels of TNF-α and IFN-γ were markedly decreased,IL-4 and IL-10 were markedly increased in large dose SXBXP group (all P＜0.05).In small dose SXBXP group,serum levels of IFN-γ were markedly decreased and IL-10 were markedly increased (all P＜0.05).In positive medicine group,serum levels of TNF-α and IFN-γ were markedly decreased and IL-10 were markedly increased (all P＜0.05).In small dose SXBXP group and positive medicine group,serum levels of IL-4 increased and LVEF decreased,even though there was no significant difference compared with CHF model group.Conclusions The SXBXP therapy of rats with CHF induced by myocardial infarction improves the heart function,decreases the serum levels of TNF-α and IFN-γ,and increases serum levels of IL-4 and IL-10.     

麝香保心丸对心力衰竭大鼠Th1和Th2型细胞因子水平的影响

Objective To investigate the effects of Shexiangbaoxin pills (SXBXP) on the serum levels of T helper type 1 (Th1) cytokines including tumor necrosis factor-a (TNF-α),interferon-γ(IFN-γ) and T helper type 2 (Th2) cytokines incloding interleukin-4 (IL-4),interleukin-10 (IL-10)in rats with chronic heart failure (CHF).Methods The CHF models were established by left anterior descending coronary artery ligation.Fifty-four Wistar rats were randomly divided into six groups:control group,sham operation group,CHF model group,small dose SXBXP group,large dose SXBXP group and positive medicine group.Heart function was examined by echocardiography before and after therapy,the TNF-α and IL-10 levels were measured by radioimmunoassay,IFN-γ and IL-4 levels were measured by enzyme linked immunosorbent assay (ELISA).Results (1) Before therapy,there was no significant difference between control group and sham operation group in ejection fraction of left ventricle (LVEF).Compared with control group and sham operation group,the levels of LVEF were significantly decreased in CHF model group,small dose SXBXP group,large dose SXBXP group and positive medicine group (all P＜0.01).(2) After therapy,compared with sham operation group,the serum levels of TNF-α and IFN-γ were markedly increased,and IL-4 and IL-10 were significantly decreased in CHF model group (all P＜0.01 ).Compared with CHF model group,LVEF was significantly improved,serum levels of TNF-α and IFN-γ were markedly decreased,IL-4 and IL-10 were markedly increased in large dose SXBXP group (all P＜0.05).In small dose SXBXP group,serum levels of IFN-γ were markedly decreased and IL-10 were markedly increased (all P＜0.05).In positive medicine group,serum levels of TNF-α and IFN-γ were markedly decreased and IL-10 were markedly increased (all P＜0.05).In small dose SXBXP group and positive medicine group,serum levels of IL-4 increased and LVEF decreased,even though there was no significant difference compared with CHF model group.Conclusions The SXBXP therapy of rats with CHF induced by myocardial infarction improves the heart function,decreases the serum levels of TNF-α and IFN-γ,and increases serum levels of IL-4 and IL-10.     

麝香保心丸对心力衰竭大鼠Th1和Th2型细胞因子水平的影响

Objective To investigate the effects of Shexiangbaoxin pills (SXBXP) on the serum levels of T helper type 1 (Th1) cytokines including tumor necrosis factor-a (TNF-α),interferon-γ(IFN-γ) and T helper type 2 (Th2) cytokines incloding interleukin-4 (IL-4),interleukin-10 (IL-10)in rats with chronic heart failure (CHF).Methods The CHF models were established by left anterior descending coronary artery ligation.Fifty-four Wistar rats were randomly divided into six groups:control group,sham operation group,CHF model group,small dose SXBXP group,large dose SXBXP group and positive medicine group.Heart function was examined by echocardiography before and after therapy,the TNF-α and IL-10 levels were measured by radioimmunoassay,IFN-γ and IL-4 levels were measured by enzyme linked immunosorbent assay (ELISA).Results (1) Before therapy,there was no significant difference between control group and sham operation group in ejection fraction of left ventricle (LVEF).Compared with control group and sham operation group,the levels of LVEF were significantly decreased in CHF model group,small dose SXBXP group,large dose SXBXP group and positive medicine group (all P＜0.01).(2) After therapy,compared with sham operation group,the serum levels of TNF-α and IFN-γ were markedly increased,and IL-4 and IL-10 were significantly decreased in CHF model group (all P＜0.01 ).Compared with CHF model group,LVEF was significantly improved,serum levels of TNF-α and IFN-γ were markedly decreased,IL-4 and IL-10 were markedly increased in large dose SXBXP group (all P＜0.05).In small dose SXBXP group,serum levels of IFN-γ were markedly decreased and IL-10 were markedly increased (all P＜0.05).In positive medicine group,serum levels of TNF-α and IFN-γ were markedly decreased and IL-10 were markedly increased (all P＜0.05).In small dose SXBXP group and positive medicine group,serum levels of IL-4 increased and LVEF decreased,even though there was no significant difference compared with CHF model group.Conclusions The SXBXP therapy of rats with CHF induced by myocardial infarction improves the heart function,decreases the serum levels of TNF-α and IFN-γ,and increases serum levels of IL-4 and IL-10.     

麝香保心丸对心力衰竭大鼠内皮素1和肾上腺髓质素水平的影响

目的探讨麝香保心丸对心肌梗死后慢性心力衰竭大鼠血浆内皮素1(ET-1)和肾上腺髓质素(ADM)水平的影响。方法 80只Wistar大鼠随机分为正常对照组(A组,10只)、假手术组(B组,10只)、其余60只制作心力衰竭模型,将制模成功35只大鼠又分对照组(C组,9只)、麝香保心丸小剂量组(D组,9只)、麝香保心丸大剂量组(E组,9只)和阳性药物对照组(F组,8只),采用灌胃法给药。超声心动图检测用药前后大鼠心脏功能,放射免疫法检测ET-1、ADM水平。结果 A组与B组用药前LVEF、左心室舒张末内径(LVEDD)、左心室收缩末内径(LVESD)无显著差异。与B组用药前比较,C组、D组、E组、F组大鼠LVEF明显降低,LVEDD、LVESD明显增加(P0.01);与C组用药后比较,E组大鼠LVEF明显升高,LVEDD、LVESD明显减小(P0.05),D组、F组LVESD明显减小(P0.05);与B组比较,C组大鼠ET-1、ADM水平明显升高(P0.05,P0.01);与C组比较,D组、E组、F组大鼠ET-1水平明显降低(P0.05,P0.01),E组ADM水平明显降低(P0.01)。结论麝香保心丸可能通过改善心肌血供,进而抑制慢性心力衰竭时神经内分泌系统的激活,并起到了有效治疗作用。     

免疫调节治疗对老年慢性心力衰竭患者细胞因子的影响

目的 研究免疫调节治疗对老年慢性充血性心力衰竭(CHF)患者心脏功能、细胞因子的影响.方法 入选96例年龄60～78岁CHF患者,美国纽约心功能分级(NYHA)Ⅱ～Ⅳ级,抽签随机分为治疗组(常规治疗的基础上加用胸腺五肽治疗,3个疗程,共75 d)和对照组(采用常规治疗),另以45例健康老年人为健康对照组,年龄60～80岁;分别在用药前、用药第1个疗程后(第15天)、第3个疗程后(第75天)测定各组患者的左心室射血分数(LVEF)、血清炎性细胞因子肿瘤坏死因子-α(TNF-α)及白细胞介素-1β(IL-1β),血清抗炎细胞因子白细胞介素-10(IL-10)、血浆高敏C反应蛋白(hsCRP)、血浆脑钠肽(BNP),并进行明尼苏达心力衰竭生活质量评分.结果 (1)治疗前,与健康对照组比较,治疗组和对照组患者血清TNF-α、IL-1β、TNF-α与IL-10比值、血浆BNP、hCRP、明尼苏达心力衰竭生活质量评分增高(P＜0.05或P＜0.01),LVEF、血清IL-10降低(P＜0.01),治疗组和对照组两组间比较各项指标差异无统计学意义;(2)第1个疗程后与对照组比较,治疗组的血清IL-10增高(P＜0.01);血清TNF-αIL-1β、血浆BNP、hsCRP降低(P＜0.05或P＜0.01);LVEF值有增高趋势,TNF-α与IL-10比值(治疗组与对照组分别为4.84±0.53与5.28±0.66)和生活质量评分有降低趋势,但差异无统计学意义.(3)第3个疗程后,与对照组比较,治疗组的血清IL-10、LVEF值显著增高(P＜0.05或P＜0.01);血清TNF-α、IL-1β、TNF-α与IL-10比值(治疗组与对照组分别为4.55±0.69与5.18±0.38)、血浆BNP、hsCRP和生活质量评分降低(P＜0.05或P＜0.01).结论 免疫调节剂胸腺肽能够改善细胞因子失衡,进而改善心功能;免疫调节治疗为老年CHF患者提供了新的治疗途径.

Abstract：

Objective To investigate the effect of immune modulation therapy on heart function and cytokines in elder patients with chronic heart failure (CHF). Methods The 96 patients aged 60-78 years with New York Heart Association(NYHA)functional. class Ⅱ-Ⅳ CHF were randomly divided into two groups: CHF treatment group received regular therapy and thymopetidum and CHF control group received regular therapy. Another 45 healthy individuals aged 60-80 years were involved as normal control. The ejection faction of left ventricle (LVEF), inflammatory cytokines including tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β), anti-inflammatory cytokine interleukin-10 (IL-10), plasma high sensitive C-reactive protein (hsCRP), plasma brain natrium peptide (BNP)and Minnesota Living with Heart Failure Questionnaire (LHFQ) assessment were tested before therapy, 15 days and 75 days after treatment. Results (1) Before therapy, compared with normal control group, the levels of TNF-α, IL-1β, TNF-α/IL-10 ratio, BNP, hsCRP and LHFQ were significantly increased (P ＜ 0. 05 or P ＜ 0. 01 ), and the levels of IL-10, LVEF were markedly decreased (P＜0.01) in the patients of CHF treatment group and CHF control group. While no difference between the two CHF groups was observed. (2) After the first course of treatment,compared with CHF control group, the levels of IL-10 were increased (P＜0. 01), while the levels of TNF-α, IL-1β, BNP and hsCRP were decreased (P＜0.05 or P＜0.01) in CHF treatment group. The level of LVEF was increased, TNF-α/IL-10 ratio (4.84 ±0. 53 vs. 5.28±0. 66) and LHFQ were decreased even though there was no significant difference between the two groups. (3) After the second course of treatment, compared with CHF control group, the levels of IL-10 and LVEF were increased (P＜0. 05 or P＜0.01), while the level of TNF-α, IL-1β, TNF-α/IL-10 ratio (4.55±0. 69 vs. 5.18±0.38), BNP, hsCRP and LHFQ were decreased (P＜0.05 or P＜0.01) in CHF treatment group. Conclusions Thymopetidum, as an immunemodulating agent, might regulate the equilibrium of cytokines and improve the heart function of patients with CHF, indicating that immune modulation therapy might improve the treatment strategy for CHF patients.     

麝香保心丸对冠心病心力衰竭患者康复的疗效

目的:评价麝香保心丸对冠心病慢性心力衰竭患者的临床疗效。方法:选择86例冠心病慢性心力衰竭(CHF)患者随机分为对照组(43例,常规抗心衰治疗),和麝香保心丸组(43例,在常规治疗的基础上加服麝香保心丸2粒,3次/d,服用6个月),观察两组治疗前后左室射血分数(LVEF)、左室收缩末容积指数(LVESVI)、左室舒张末容积指数(LVEDVI)、6min步行距离、24h心肌缺血发作次数,以及再住院率。结果:麝香保心丸组LVEF、LVESVI、6min步行距离、24h心肌缺血发作次数较对照组有明显改善(P<0.05),同时麝香保心丸组的再住院率较对照组有明显降低(P<0.05),未发现与药物相关的不良反应。结论:麝香保心丸能改善冠心病慢性心力衰竭患者的心功能,提高生活质量。     

麝香保心丸对心力衰竭大鼠肺脏肾上腺素受体表达的影响

目的探讨麝香保心丸对心力衰竭大鼠肺脏α_(1A)-肾上腺素受体(α_(1A)-AR)和β_1、β_2肾上腺素受体(β-AR)表达水平的变化。方法选择Wistar大鼠54只,随机分为对照组(A组,10只)、假手术组(B组,10只)、心力衰竭模型对照组(C组,9只)、阳性药物对照组(D组,9只)、麝香保心丸小剂量组(E组,9只)和麝香保心丸大剂量组(F组,9只)。超声心动图检测用药前后大鼠心功能,采用Western blot测定各组大鼠肺组织α_(1A)-AR和β_1-AR、β_2-AR蛋白表达水平。结果用药前,A组与B组大鼠LVEF比较,差异无统计学意义(P>0.05);与B组比较,C、D、E、F组大鼠LVEF明显降低(P<0.01)。用药后与C组比较,F组大鼠LVEF明显改善;与B组比较,C组大鼠α_(1A)-AR、β_1-AR蛋白明显降低,β_2-AR蛋白明显升高;与C组比较,D、E、F组大鼠α_(1A)-AR、β_1-AR、β_2-AR蛋白明显升高(P<0.05,P<0.01)。结论麝香保心丸能改善心肌梗死后心力衰竭大鼠的心脏功能,肾上腺素受体表达水平的变化,有利于维持心力衰竭时肺脏的通气/血流比值,进而对心力衰竭起到有益的治疗作用。     

普伐他汀对扩张型心肌病患者心功能及细胞因子的影响

目的 观察普伐他汀对扩张型心肌病(DCM)心力衰竭患者心功能及血清肿瘤坏死因子(TNF-α)、白细胞介素-6(IL-6)水平的影响.方法 选择DCM心力衰竭患者68例,随机分为治疗组(35例)及对照组(33例).对照组给予常规纠正心力衰竭药物治疗,治疗组在常规治疗基础上加用普伐他汀,10 mg,每晚一次.治疗前及后6个月后行心脏彩超检查,测定左心室舒张末内径(LVEDd)、左心室射血分数(LVEF),测定血清TNF-α、IL-6浓度.结果 两组患者治疗6个月时LVEDd均较治疗前显著缩小(P＜0.05),LVEF较治疗前显著提高(P＜0.05).治疗6个月时治疗组与对照组比较LVEF较对照组显著提高(P＜0.05),LVEDd有进一步缩小趋势,但差异无统计学意义.治疗6个月时,治疗组血清TNF-α(146.26±1.27和174.58±1.42,P＜0.05)、IL-6(25.56±1.79和35.23±1.87,P＜0.05)水平较治疗前显著下降,对照组较治疗前无明显变化.结论 普伐他汀可明显改善DCM心力衰竭患者心功能,降低血清TNF-α、IL-6水平,有利于DCM的治疗.     

麝香保心丸治疗冠心病心力衰竭的临床疗效观察

目的:观察麝香保心丸治疗冠心病心力衰竭的临床效果。方法:116例冠心病心力衰竭患者被随机分为两组,常规治疗组予以利尿剂、血管紧张素转换酶抑制剂、β受体阻滞剂、正性肌力药物、扩血管药物及营养心肌等药物治疗,麝香保心丸组在此治疗基础上加用麝香保心丸2粒,3次/d,口服,治疗6个月后对比观察两组临床症状、左室射血分数、左室舒张末期内径、6min步行距离、24h心肌缺血发作次数以及两组患者在6个月中因心力衰竭恶化的再住院率。结果:麝香保心丸组总有效率91.66%,临床症状较治疗前明显改善,左室射血分数、6min步行距离明显增加,左室舒张末期内径明显缩小,24h心肌缺血发作次数及再住院率明显减少,且优于常规治疗组(P均0.01)。结论:麝香保心丸能改善慢性心力衰竭患者的心功能,提高生活质量。     

卡维地络对充血性心力衰竭患者促炎细胞因子的影响

目的：观察卡维地络对充血性心力衰竭（CHF）患者促炎细胞因子浓度的影响。方法：选择66例CHF患者，随机分为常规治疗组和卡维地络治疗组，32例健康体检者为正常对照组。用双抗体夹心ELISA法测定血浆肿瘤坏死因子-α（TNF-α）、白介素-6（IL-6）和IL-1β的浓度，分析其与CHF程度的关系。结果：（1）CHF患者三种细胞因子浓度均明显高于正常对照组（P〈0．05或〈0．01），CHF程度越重细胞因子浓度越高（P〈0．01）；（2）治疗后卡维地络组心功能分级左室收缩末内径较治疗前显著降低（P均〈0．05），左室短轴缩短率（LVFS）、每搏量（SV）、左室射血分数（LVEF）较治疗前显著升高（P〈0．05～〈0．01）；常规治疗组仅LVEF显著升高（P〈0．05）；治疗后卡维地络组LVEF、LVFS较常规治疗组显著升高（P〈0．05）；（3）治疗后卡维地络组三种细胞因子浓度显著降低（P〈0．01或〈0．05）；常规治疗组TNF—α、IL-6降低（P〈0．05），而IL-1β水平降低不显著。结论：CHF患者促炎细胞因子浓度升高，可作为判断心衰严重程度的指标。卡维地络能有效抑制促炎细胞因子的产生，改善心功能和心室重构。     

老年慢性心力衰竭患者细胞因子和心率变异性的相关性研究

目的 观察老年慢性心力衰竭(CHF)患者炎性细胞因子和心率变异性(HRV)的相关性.方法 128例60岁及以上老年CHF患者(CHF组),对照组50例为健康体检者.比较两组炎性细胞因子包括肿瘤坏死因子可溶性受体Ⅰ、Ⅱ(sTNF-RⅠ、sTNF-RⅡ)和白细胞介素6(IL-6)表达水平,24 h内的全部HRV参数[正常心动周期的标准差(SDNN)、24 h内5 min节段平均心动周期的标准差(SDANN)、24 h内全部5 min节段所有心动周期标准差的平均值(SDNNI)、相邻正常心动周期差值均方的平均根(rMSSD)和相邻两正常心动周期差值大于50 ms的个数所占的百分比(pNN50)],分析二者相关性.结果 CHF组患者HRV参数低于对照组:SDNN分别为(99.8±22.4)和(146.6±43.2)ms、SDANN分别为(85.5±23.6)和(138.7±40.9)ms、SDNNI分别为(41.7±15.8)和(56.9±18.8)ms、rMSSD分别为(23.4±13.0)和(30.0±12.9)ms、pNN50分别为(5.5±3.8)和(12.0±4.7)%;CHF患者炎性细胞因子明显高于对照组(均为P＜0.05);CHF患者HRV参数与炎性细胞因子浓度间呈负相关(r≥-0.44,P＜0.05).结论 炎性细胞因子sTNF-R Ⅰ、sTNF-RⅡ和IL-6可能是老年CHF患者HRV下降的原因之一.     

心力衰竭患者部分神经激素和细胞因子的变化及卡维地洛的干预作用

目的:探讨充血性心力衰竭(CHF)患者部分神经激素、细胞因子的变化及与心功能的关系,观察卡维地洛对神经激素、细胞因子及心功能的影响,并比较不同剂量卡维地洛疗效的差别。方法:选择CHF患者90例,随机分成A、B、C3组。A组为对照组:予以血管扩张剂、利尿剂、地高辛等常规心力衰竭治疗。B组、C组在上述治疗基础上均予以卡维地洛口服,目标剂量B组:10mg,bid,C组:20mg,bid,然后维持稳定剂量至3个月。用药前后分别观察NYHA分级,左室射血分数(LVEF)、每搏量(SV)、短轴缩短率(FS)及醛固酮(ALD)、内皮素(ET)、肿瘤坏死因子(TNFα)、心钠素(ANP)等指标变化情况。结果:CHF患者心功能越差,神经激素、细胞因子水平越高。C组3个月后ALD、ET、TNFα、ANP水平与治疗前比较显著下降,LVEF、FS、SV明显提高,NYHA分级得到改善。B组除ET、TNFα、ANP有显著下降,LVEF明显升高外,其他指标改善不显著。A组上述指标与治疗前比较虽有改善,却差异无统计学意义。结论:①CHF患者神经激素和细胞因子水平明显升高,且与心功能分级及病情严重程度呈正相关;②卡维地洛可显著降低神经激素的激活及细胞因子的浓度,改善CHF患者心脏功能,其疗效呈剂量依赖性。     

冠心病合并心力衰竭患者血清脂联素水平变化

目的探讨冠心病合并心力衰竭患者血清脂联素水平的变化及其临床意义。方法选择冠心病患者60例、冠心病合并心力衰竭患者60例[其中心功能（NYHA）Ⅱ级18例、心功能Ⅲ级27例、心功能Ⅳ级15例]、健康对照组25例,测定血清脂联素并对其变化进行两两比较。结果冠心病合并心力衰竭患者血清脂联素为（14．22±5．34）mg／L;冠心病无心力衰竭组血清脂联素为（4．79±1．61）mg／L;健康对照组为（6．98±1．62）mg／L,两两比较差异有统计学意义（P〈0．01）。冠心病合并心力衰竭患者随着心功能分级的升高,血清脂联素水平也显著升高[NYHAII级为（9．25±2．71）mg／L,NYHAⅢ级为（13．72±3．38）mg／L,NYHAIV级为（18．0±6．72）mg／L,P〈0．01]。结论合并心力衰竭的冠心病患者血清脂联素水平是升高的,且随着心功能分级的升高,血清脂联素水平也明显升高。血浆脂联素可能参与冠心病及心力衰竭的发病机制,血清脂联素水平变化对心力衰竭的进展和程度有一定的指导意义。