护心方对冠心病合并糖代谢异常患者TLR4炎症通路和中医血瘀证评分的影响

目的：同步研究护心方对冠心病合并糖代谢异常患者Toll样受体4信号转导通路及中医血瘀证的影响,探讨以TLR4炎症通路为靶点护心方的干预机制,及炎症反应与血瘀证候的相关性。方法：选择60例冠心病合并糖代谢异常患者,随机分为对照组和治疗组。对照组按常规治疗,治疗组在常规治疗基础上加用护心方,总疗程为60 d。运用Realtime PCR法分别测定治疗前、治疗30 d、60 d外周血单核细胞TLR4 mRNA;ELISA检测外周血血清中C反应蛋白的表达水平。结果：护心方治疗组能在西医常规治疗的基础上更进一步减少了TLR4 mRNA的表达（P〈0.05）,其抑制炎症的效果与TLR4通路下游指标CRP基本一致。经过中医药治疗,冠心病合并糖代谢异常患者的中医血瘀证评分逐渐降低,至60 d时显示出统计学意义（P〈0.05）,与TLR4、CRP的表达呈正相关。结论：护心方能显著改善冠心病合并糖代谢异常患者的血瘀证候,而抑制外周血单核细胞To ll样受体4转导通路的激活,减少炎症反应,可能是其重要机制之一,中医的血瘀证候与炎症反应其本质有一定内在联系。

Effect of Huxin Formula on TLR4 Inflammatory Pathway and Blood Stasis Score of Patients with Coronary Heart Disease and Impaired Glucose Metabolism

Objective：To observe the effect of Huxin Formula on expression of TLR4 inflammatory pathway and blood stasis score of TCM of patients with coronary heart disease and impaired glucose metabolism in order to study the mechanism of Huxin Formula in the treatment and explore the correlation between inflammation and blood stasis syndrome.Methods： Sixty patients with coronary heart disease and impaired glucose metabolism were randomly divided into two groups. Half patients（n = 30） were treated with Huxin Formula combined with conventional therapy and another 30 patients with conventional therapy alone（control）. The mRNA expression level of TLR4 in the peripheral blood and expression of serum C reactive protein were detected by ELISA in two groups and were compared at prior treatment and 30 and60 days after the treatment. Results：The results showed that under the effects of Huxin Formula on patients with coronary heart disease and impaired glucose metabolism,mRNA expression level of TLR4 was decreased significantly after Huxin Formula treatment,which was consistent with CRP trends. There were significant differences between two groups（ P〈0. 05）. Blood stasis syndrome score of patients decreased to 60 days and showed statistically significant（P〈0. 05）. The expressions of TLR4 and CRP were positively correlated. Conclusion： Huxin Formula can significantly restrain the activation of TLR4 signal transduction pathway and reduce inflammatory reaction of patients with coronary heart disease and impaired glucose metabolism. This may be one of the molecular mechanisms of Huxin Formula in the improvement the patient＇s blood stasis syndrome. To some extent,blood stasis syndrome of TCM and inflammation in essence has some contact.