坎离颗粒对冠心病心肾阳虚证患者动脉弹性影响及机制探讨

目的:研究益气温阳、活血利水中药坎离颗粒在改善冠心病心肾阳虚证患者心功能,及对动脉功能、结构的影响及其可能机制。方法:收集冠心病心肾阳虚证患者62例,随机分为西药组、坎离颗粒组。治疗前后测定心功能,同时检测动脉弹性指标,包括心脏脚踝血管指数(CAVI),踝臂指数(ABI),观察主动脉血流剪切率(SRs),动脉重构情况(颈动脉内中膜厚度等),测定血清内皮功能相关指标,包括一氧化氮(NO),内皮素-1(ET-1)等,胶原代谢相关指标为Ⅰ型胶原代谢产物氨基末端前肽(PINP)和羧基末端肽(ICTP),通过观察血流介导的内皮功能和动脉壁结构改变两方面探讨坎离颗粒对动脉影响的可能机制。结果:坎离颗粒加载治疗后,与治疗前比较,冠心病心肾阳虚证患者左室射血分数明显升高(P0.05),坎离颗粒组动脉弹性指标ABI明显提高(P0.05),与西药组比较ABI提高更显著(P0.05)。与治疗前比较,治疗后西药组SRs,一氧化氮合酶(iNOS)明显降低(P0.05)。结论:坎离颗粒加载治疗可改善冠心病心肾阳虚证患者左室收缩功能,其机制可能是由于左室收缩功能改善,动脉内血流加速,使内皮细胞表面SRs增加,从而稳定内皮功能所致。

Effect and Mechanism of Kanli Granule on Arterial Elasticity of Patients with Stable Coronary Artery Disease and Syndrome of Heart & Kidney Yang Deficiency

Objective: To observe the curative efficacy of Kanli granule in treating coronary artery disease (CAD) patients with syndrome of heart and kidney Yang deficiency, investigate its effect on function and structure of artery, and explore the possible mechanism of these effects. Method: Totally 62 CAD patients with syndrome of heart and kidney Yang deficiency were randomly divided into western medicine group (31 cases) and Kanli granule group (31 cases). Changes in heart function and arterial elasticity indexes cardio ankle vascular index (CAVI), ankle brachial index (ABI) were measured, aortic flow shear rate (SRs) and arterial remodeling conditions (intima-media thickness) were observed;indexes related to serum endothelial functions (NO, ET-1) were measured, levels of type I collagen metabolites procollagen I N-terminal peptide (PINP) and type I carboxy-terminal peptide (ICTP) were measured. The possible mechanism of Kanli granule effect on artery was investigated by observing the blood flow mediated changes in endothelial function and arterial wall structure. Result: After treatment with Kanli granule, left ventricular ejection fraction (LVEF) was significantly increased in CAD patients with syndrome of heart and kidney Yang deficiency (P<0.05). After treatments, ABI of arterial elasticity indexes was significantly improved in Kanli granule group (P<0.05), and the improvement was more obvious than that of western medicine group (P<0.05). SRs in western medicine group was significantly decreased after treatment(P<0.05). In serum indexes, iNOS was significantly reduced in western medicine group after treatment (P<0.05). Conclusion: Kanli granule can improve left ventricular systolic function and significantly improve arterial elasticity function in the patients with stable coronary artery disease and syndrome of both heart and kidney yang deficiency. Its mechanism may be associated with endothelial protection by raising SRs and reducing NO level activated by iNOS.