Chinese herbal medicine for chronic heart failure: a multicenter,randomized, double-blind,placebo-controlled trial

ObjectiveThe purpose of this study was to assess the efficacy and safety of Chinese herbal medicine (CHM) in the treatment of chronic heart failure (CHF) patients according to syndrome differentiation.MethodsIn this multicenter, randomized, double-blind, placebo-controlled clinical trial, a total of 220 CHF patients were assigned to receive CHM or placebo granules without decoction according to syndrome differentiation in addition to their standard western treatment for 4 weeks. The change in the left ventricular ejection fraction (LVEF) was the primary outcome, and the changes in the TCM syndrome scores (TCM-SS) and New York Heart Association functional classification (NYHA-FC) were the secondary outcomes.ResultsAfter 4 weeks of treatment, the mean changes in the LVEF (13.1 ± 9.78 vs. 7.34 ± 7.40, P < 0.001) and the TCM syndrome scores (−34.2 ± 24.6 vs. −23.5 ± 25.2, P = 0.002) were better in the CHM group than in the placebo group. After two weeks of treatment, the mean changes in the LVEF (9.26 ± 7.83 vs. 4.72 ± 5.60, P < 0.001) and the TCM syndrome scores (−23.5 ± 18.6 vs. −14.0 ± 15.9, P < 0.001) were better in the CHM group than in the placebo group. In addition, repeated-measures analysis of variance (ANOVA) indicated significant time course effects of CHM versus placebo in the LVEF and TCM syndrome cores (P < 0.001 for all). The distention of the jugular vein (P = 0.021), expectoration (P = 0.044), abdominal distention (P = 0.004), and rib pain (P = 0.005) were significantly less in the CHM group than in the placebo group after two weeks of treatment. Fatigue (P = 0.001), less gas and lazy words (P = 0.001), dizziness (P = 0.003), gasping for breath (P = 0.027), abdominal distention (P = 0.011), nausea (P = 0.001) and emesis (P = 0.012) were significantly less in the CHM group than in the placebo group after treatment for four weeks. After four weeks of treatment, the change in the NYHA functional classification in the CHM group was better than that in the placebo group (P < 0.001). There was one death in the placebo group, and one patient in the CHM group experienced atrial fibrillation.ConclusionCHM treatment according to syndrome differentiation effectively improved the LVEF, TCM-SS, and NYHA-FC in patients with CHF and also appeared to be safe. Thus, CHM treatment could be used as an adjuvant therapy in the treatment of CHF (Clinical trial registration: NCT01939236).     

血清Gal-3与慢性心力衰竭的相关性及其临床意义

目的 探讨血清半乳糖凝集素-3(Gal-3)与慢性心力衰竭的相关性及其临床意义.方法 选取2014年2月至2016年2月因慢性心力衰竭于西安市第一医院心血管内科住院治疗的98例患者作为CHF组,选取同期在我院体检的86例健康者作为对照组.根据心衰程度将CHF组患者分为NYHA心功能Ⅱ级组31例、心功能Ⅲ级组35例和心功能Ⅳ级组32例.检测各组受检者的血清Gal-3、N末端脑钠肽前体(NT-proBNP)、左心室射血分数(LVEF)、超敏C反应蛋白(hs-CRP)、总胆固醇(TC)、尿素氮(BUN)以及甘油三酯,分析血清Gal-3与NT-proBNP、hs-CRP、LVEF、NYHA心功能分级的相关性.结果 ①CHF组患者和对照组的血清Gal-3[(32.69±12.37)μg/L vs(14.59±10.33)μg/L]、NT-proBNP[(2.64±0.47)pg/mL vs(1.18±0.39)pg/mL]和hs-CRP[(6.39±2.75)mg/L vs(3.41±2.46)mg/L]水平比较,CHF组均高于对照组,差异均具有统计学意义(P<0.05);②心功能Ⅱ级组、Ⅲ级组和Ⅳ级组患者的血清Gal-3水平分别为(23.05±2.41)μg/L、(26.39±2.75)μg/L和(28.52±2.77)μg/L,血清Gal-3水平随着NYHA心功能分级的升高而显著升高,差异具有统计学意义(P<0.05);③血清Gal-3与NT-proBNP、hs-CRP水平呈正相关(r=0.957、0.787,P<0.05),与LVEF呈负相关(r=-0.631,P<0.05).结论 血清Gal-3与慢性心力衰竭具有相关性,对慢性心力衰竭具有良好的诊断效果,可以作为诊断慢性心力衰竭的生物学指标.     

氨氯地平对CHF大鼠血浆ET-1和BNP表达的影响

目的探讨氨氯地平对充血性心力衰竭（CHF）大鼠血浆中内皮素-1（ET-1）和B型钠尿肽（BNP）表达的影响。方法SD大鼠随机分为3组：对照组、心衰组、氨氯地平组。CHF组大鼠腹腔注射阿霉素累积剂量达20mg/kgBW制作CHF模型,氨氯地平组大鼠腹腔注射阿霉素同时每天给予氨氯地平10mg/kg。4周后各组大鼠经颈内动脉插管至左心室行血流动力学测定,同时测定大鼠血浆中ET-1和BNP的含量。结果CHF组大鼠左室压力最大上升速率（＋dp/dtmax）和最大下降速率（-dp/dtmax）均显著低于对照组,其血浆内ET-1和BNP均显著高于对照组（P〈0.01）。氨氯地平组±dp/dtmax均显著低于对照组但高于CHF组,其血浆内ET-1和BNP均显著高于对照组低于CHF组（P〈0.01）。结论氨氯地平治疗CHF大鼠的作用机制之一可能是通过保护CHF大鼠左室功能、结构及心肌细胞,间接降低ET-1、BNP表达水平。     

呋塞米联合小剂量多巴胺对老年慢性心衰患者BNP的影响

目的 探讨呋塞米联合小剂量多巴胺治疗老年慢性心力衰竭(CHF)的临床疗效及对血浆脑钠肽(BNP)等的影响.方法 2015年1月至2016年12月期间铜陵市人民医院心内科住院的60例老年CHF患者按随机数表法分为观察组(n=30)和对照组(n=30).对照组在常规抗心衰基础上静脉注射呋塞米,观察组在对照组基础上再加用小剂量多巴胺治疗.评估两组治疗疗效,分析治疗前后血浆BNP等生化指标和超声心动图检查结果.结果 观察组患者的治疗总有效率[93.33%(28/30]明显高于对照组[76.67%(23/30)],差异有统计学意义(P<0.05);两组患者治疗前血浆BNP、C反应蛋白(CRP)水平、呼吸、全身症状程度比较差异均无统计学意义(P>0.05),治疗后两组BNP、CRP、呼吸、全身症状程度均明显改善,与治疗前比较差异均有统计学意义(P<0.05);治疗后观察组患者的BNP、CRP分别为(143.18±31.32)pg/mL、(5.44±1.12)mg/L,明显低于对照组的(180.14±25.10)pg/mL、(7.32±1.23)mg/L,差异均有统计学意义(P<0.05);观察组患者的呼吸困难、肺部啰音、水肿、乏力程度分别为(1.28±0.40)分、(1.19±0.31)分、(1.02±0.19)分、(1.21±0.22)分,明显低于对照组的(1.89±0.39)分、(1.79±0.31)分、(1.54±0.27)分、(1.61±0.24)分,差异均有统计学意义(P<0.05);观察组治疗后活动后无胸闷气促、心绞痛发生率为6.67%(2/30)、3.33%(1/30),明显低于对照组的26.67%(8/30)、20.00%(6/30),差异均有统计学意义(P<0.05).结论 呋塞米联合小剂量多巴胺可显著提高老年CHF的临床疗效,有效改善心功能与BNP水平,并可降低不良事件发生风险.     

缬沙坦治疗高血压伴心力衰竭的疗效及其对血清hs-CRP水平的影响

目的 探讨缬沙坦治疗高血压伴心力衰竭的疗效及其对血清超敏C反应蛋白(hs-CRP)水平的影响.方法 选择深圳市福永人民医院心内科于2015年12月至2016年12月期间收治的46例高血压伴心力衰竭患者为研究对象,根据随机数表法将患者分为观察组与对照组,每组23例,两组患者均予常规抗心衰治疗,对照组再应用苯磺酸氨氯地平降压,观察组则应用缬沙坦降压,疗程均为3个月.比较两组患者治疗前后的血压、左心室射血分数(LVEF)以及血清hs-CRP和脑钠肽(BNP)水平.结果 治疗后,观察组患者的收缩压(SBP)、舒张压(DBP)分别为(131.4±6.8)mmHg、(82.4±4.2)mmHg,与对照组的(134.9±6.7)mmHg、(83.9±3.8)mmHg比较,差异均无统计学意义(P>0.05);治疗后,观察组患者的血清hs-CRP、BNP水平分别为(7.3±2.2)mg/L、(131.5±43.2)pg/mL,明显低于对照组的(9.9±2.3)mg/L、(185.2±46.1)pg/mL,LVEF为(49.8±4.5)%,明显高于对照组的(46.3±3.3)%,差异均有统计学意义(P<0.05).结论 缬沙坦治疗高血压伴心衰不仅可以降低血压,且能够有效抑制炎症反应,进一步改善心功能.     

血清B型脑钠肽前体、AVP和内皮素在CHF患者中的检测价值

目的:探讨血清B型脑钠肽前体、AVP和内皮素在充血性心力衰竭(CHF)患者中的检测价值.方法:选取我院明确诊断有CHF的118例不同病因、不同心功能分级患者以及同时期住院治疗的非CHF患者41例,测定所有受试对象入院时以及治疗前后的血清(血管紧张素)AVP、B型脑钠肽前体(NT-proNT-proBNP)、内皮素(ET-1)水平,比较发生心血管事件以及未发生心血管时间患者的AVP、NT-proBNP、内皮素(ET-1)水平.结果:心衰患者的NT-proBNP、AVP、ET-1水平均明显高于正常对照组,CHF患者的血浆NT-proBNP、AVP、ET-1水平随着心功能不全的加重而明显升高,治疗后均较治疗前明显改善,心脏发生事件组的NT-proBNP、AVP、ET-1水平均明显高于无事件组,组间比较有统计学差异.结论:血清B型脑钠肽前体、AVP和内皮素在CHF患者中的检测对于判断CHF患者的病情严重度以及预后有着积极的意义,尤其在治疗后对其浓度进行监测对于CHF的风险评估具有重要的意义.     

Reduction of ventricular M2 muscarinic receptors in cardiomyopathic hamster (CHF 147) at the necrotic stage of the myopathy

We have previously demonstrated that isolated ventricular myocytes from cardiomyopathic hamsters (CHF 147) during the necrotic stage (70–100 days) exhibit an attenuated contractile response to muscarinic stimulation. In the present study we have investigated whether this dysfunction may be related to a change in the density (or affinity) of cardiac muscarinic receptors. Thus, we have characterized and quantified the binding of the muscarinic antagonist [³H]-N-methyl scopolamine (NMS) to M₂ muscarinic receptors in cardiac micropunches and in suspensions of isolated intact cardiomyocytes obtained from cardiomyopathic (CHF 147) and Golden Syrian hamsters. The hamsters were either 70–100 days old, when the cardiomyopathy had reached the cytolytic and necrotic stage or 30 days old, i. e. before the onset of the cardiomyopathy. In both preparations (micropunches and dissociated cardiomyocytes) the specific binding of [³H]-NMS was stereospecific, reversible, saturable, of high affinity and linearly dependent upon increasing amounts of tissue and cells. The binding site also possessed the drug specificity typical of an M₂ muscarinic receptor. Saturation binding analysis revealed that the hearts of the older CHF 147 hamsters contain significantly fewer M₂ muscarinic receptors than the control Golden Syrian hamsters while the affinity (K _d) was not altered. This reduction of M₂ receptor number was not observed in CHF 147 hamsters at 30 days. Further, we found no differences in -adrenergic or in ₁-adrenergic binding in the two strains of hamster at either age. Thus, our results indicate that the parasympathetic regulation of cardiac function in CHF 147 hamsters may be compromised by a decreased number of muscarinic receptors at the necrotic stage of the cardiomyopathy.     

Nephrologist Follow-Up Care of Patients With Acute Kidney Disease Improves Outcomes: Taiwan Experience

ObjectivesAcute kidney injury (AKI) and acute kidney disease (AKD) are a continuum on a disease spectrum and frequently progress to chronic kidney disease. Benefits of nephrologist subspecialty care during the AKD period after AKI are uncertain.MethodsPatients with AKI requiring dialysis who subsequently became dialysis independent and survived for at least 90 days, defined as the AKD period, were identified from the Taiwanese population’s health insurance database. Cox proportional hazard models using death as the competing risk before and after propensity-score matching were applied to evaluate various endpoints.ResultsAmong a total of 20 260 patients with AKI requiring dialysis who became dialysis independent, only 7550 (37.3%) patients were followed up with by a nephrologist (F/U_nephrol group) during the AKD period. During a mean 4.04 ± 3.56 years of follow-up, the patients in the F/U_nephrol group were more often administered statin, antihypertensives, angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB), diuretics, antiplatelet agents, and antidiabetic agents. The patients in the F/U_nephrol group had a lower mortality rate (hazard ratio [HR] = 0.87, P < .001) and were less likely to have major adverse cardiovascular events (MACE) (subdistribution HR [sHR] = 0.85, P < .001), congestive heart failure (CHF) (sHR = 0.81, P < .001), and severe sepsis (sHR = 0.88, P = .008) according to the Cox proportional model after adjusting for mortality as a competing risk. During the AKD period, an increase in the frequency of nephrology visits was associated with improved outcomes.ConclusionsIn this population-based cohort, even after weaning off acute dialysis, only a minority of patients visited a nephrologist during the AKD period. We showed that nephrology follow-up is associated with a decrease in MACE, CHF exacerbations, and sepsis, as well as lower mortality; thus it may improve outcomes in patients with AKD.     

甲状腺素和充血性心力衰竭的关系94例分析

目的：探讨充血性心力衰竭（ＣＨＦ）患者的甲状腺素变化及机制。方法：用放射兔疫法测定９４例患者的甲状腺素各成分，对比分析不同心功能状态下甲状腺素的变化。结果：ＣＨＦ时甲状腺素普遍降低，以ＦＴ３和ＴＴ３降低者最多，占７９．７％和８２．２％；随心衰的加重，甲状腺素进行性下降，以ＦＴ３、ＴＴ３、ＴＴ４降低程度最大，心功能Ⅳ级与心功能Ⅰ级比有显著性差异。肝肾瘀血较非瘀血者明显降低，组间有显著性差异。结论：ＣＨＦ时甲状腺素异常，以低Ｔ３综合征为主；甲状腺素降低程度与心衰程度成正比，γＴ３则与之相反。血浆内儿茶酚胺，糖皮质激素增高、肝肾功能异常，使Ｔ４转化为Ｔ３减少，是ＣＨＦ时甲状腺素降低的主要机制。