摘要
Heart failure is a clinical syndrome caused by various causes of myocardial damage and cardi-ac function decrease that cannot meet the body's metabolic needs.The proinflammatory cytokines play an im-portant role in the process of occurrence and development of heart failure.The Notch1/Jagged1 signaling path-way is related to the proinflammatory cytokines,inflammatory responses and immune responses.This paper discusses the involvement of the Notch1/Jagged1 signaling pathway in the development and development of chronic heart failure by modulating immune inflammation.
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Objective:The aim was to explore the needs of patients readmitted with chronic heart failure (CHF) for pre-discharge preparation services and to provide reliable evidence to support the development of a discharge preparation service plan.Methods:The research was based on the phenomenology research method. Using a purposive sampling method, 12 readmitted patients with CHF from the First Hospital of Heilongjiang University of Traditional Chinese Medicine were selected and interviewed in a semi-structured manner between February and April 2023, and the data were analyzed using the Colaizzi seven-step analysis.Results:Among 12 patients, 6 males, 6 females, aged 53 to 85 years old. The discharge preparation service needs of readmitted patients with CHF can be categorised into 3 major themes of physiological-psychological-social, containing 6 sub-themes: the need to improve self-management skills, the need for rehabilitation and exercise, the need for improvement of negative emotions, the need for improvement of health education, the need for improvement of home care, and the need for health resource services.Conclusions:Patients readmitted with CHF have greater needs for self-management knowledge and skills, family care needs, professional guidance needs, and information on referral services from primary health resources, and nursing staff should focus on assessing such needs of patients in order to develop individualized plans for discharge preparation services for patients with CHF.
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Objective:To explore the mediating role of disease progression′s fear and positive affect in the relationship between disease perception and demoralization in patients with chronic heart failure. It provided a theoretical basis for targeted interventions for healthcare workers.Methods:From October 2022 to March 2023, 320 patients with chronic heart failure in the First Affiliated Hospital of Zhengzhou University were selected as the research objects by convenience sampling. The General Information Questionnaire, Demoralization Scale Redacted Mandarin Version, Brief Illness Perception Questionnaire, Fear of Progression Questionnaire-Short Form, Positive and Negative Affect Schedule (Positive Affect Schedule) were used to conduct the questionnaire survey exploring the mediating effects of fear of disease progression and positive emotions between disease perception and disorientation by construction structural equation model.Results:There were 268 valid questionnaires. Of the 268 patients, 168 were male and 100 were female, 3.36% (9/268) were ≤40 years old, 55.22% (148/268) were 41-65 years old, and 41.42% (111/268) were >65 years old. Correlation analysis showed that disease perception was positively correlated with disease progression ′s fear, and every dimension of demoralization ( r values were 0.300-0.586, all P<0.01), and negatively correlated with positive affect ( r=-0.374, P<0.01); disease progression′s fear was negatively correlated with positive affect ( r=-0.318, P<0.01), and positively correlated with every dimension of demoralization ( r values were 0.339-0.464, all P<0.01); positive affect was negatively correlated with every dimension of demoralization ( r values were -0.430--0.334, all P<0.01). Structural equation model analysis showed that the direct effect of disease perception on demoralization was significant ( β=0.407, P<0.01), and both mediating effects of disease progression ′s fear and positive affect between disease perception and demoralization in patients with chronic heart failure were significant ( β=0.074, 0.079, both P<0.01). The chain mediating effect of disease progression ′s fear and positive effect was also significant ( β=0.019, P<0.01). Conclusions:Disease perception could directly predict the demoralization of patients with chronic heart failure and indirectly predict the demoralization of patients with chronic heart failure through the mediating effect of disease progression ′s fear, positive affect, and the chain mediating effect of disease progression ′s fear and positive affect.
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Chronic heart failure is the final stage of various cardiovascular diseases,and mitochondrial energy metabolism disorders have been proved to play an important role in the development of chronic heart failure.TCM believes that heart yin is the material basis of heart yang(qi),and deficiency of heart yang(qi)is the core pathogenesis of chronic heart failure.Based on mitochondrial energy metabolism,this article expounded the scientific connotation of"reinforcing yang from yin"in the treatment of chronic heart failure from the aspects of theoretical connotation,pathogenesis,pathophysiological relationship and modern research.In-depth study at the microscopic level demonstrated that the application of"reinforcing yang from yin"method can effectively improve the reconstruction of heart energy substrate(yin),enhance mitochondrial function,and finally provide energy support(yang),which could offer ideas for theoretical research and clinical prevention and treatment of chronic heart failure.
摘要
Chronic heart failure(CHF)is a common and frequent clinical condition with complex pathogenesis.The micro-inflammatory state exists in the development of CHF and is manifested by a continuous increase in inflammatory proteins and inflammatory cytokines in the circulation,affecting the body's metabolism and immune function.Micro-inflammatory state of CHF belongs to the syndrome of deficiency in nature and excess in superficiality in the TCM field.The basic pathogenesis of CHF is"deficiency qi retention";the nature is the deficiency of heart energy and the superficiality is retention of qi,blood stagnation,phlegm,water and dampness,with"deficiency,stagnation and water"running throughout the disease.Therefore,based on the theory of"deficiency qi retention",this article took"reinforcing deficiency and removing stagnation"as its basic treatment method,regulated the body's immunity and inflammatory indicators such as serum high-sensitivity C-reactive protein,tumor necrosis factor-α,in order to alleviate the micro-inflammatory state,which is of great significance for the prevention and treatment of CHF.
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Objective To analyze the relationship of lipoprotein(a)[Lp(a)]with poor prognosis in chronic heart failure(CHF)patients aged over 80 years,and explore the influencing factors for poor prognosis in these patients.Methods A total of 135 over-80-year-old patients with acute de-compensated CHF admitted in Tianjin University Chest Hospital from June 2018 to August 2021 were enrolled in this study.With Lp(a)300 mg/L as the cut-off value,they were divided into higher Lp(a)group(73 cases)and lower Lp(a)group(62 cases).Their baseline clinical data and outcomes after 12 months of follow-up were collected.The primary endpoint was composite end-point including re-hospitalization due to CHF and/or all-cause mortality.Kaplan-Meier survival curve were plotted to compare the survival rates between the two groups.Logistic regression anal-ysis was employed to analyze the risk factors of poor prognosis in these patients.Results The higher Lp(a)group had larger proportion of chronic kidney disease and higher levels of homocys-teine,total cholesterol and low-density lipoprotein-cholesterol than the lower Lp(a)group(P＜0.05).Kaplan-Meier survival analysis showed that the lower group obtained significantly longer 1-year survival time without primary endpoint events than the higher group[9.8 months(95％CI:8.884-10.665)vs 8.2 months(95％CI:7.057-9.272),P＜0.05].Multivariate logistic regression analysis revealed that Lp(a)≥300 mg/L(OR=2.841,95％CI:1.133-7.092,P=0.026),female(OR=2.809,95％CI:1.111-7.092,P=0.029)and use of diuretic(OR=4.631,95％CI:1.103-19.443,P=0.036)were independent risk factors for primary endpoint events within 1 year.Con-clusion Lp(a)≥300 mg/L is an independent risk factor for re-hospitalization due to CHF and/or all-cause mortality in elderly CHF patients within 1 year after discharge.
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Objective To understand the research situation of animal model of chronic heart failure(CHF)based on visualization software and bibliometrics methods,and to explore the research hotspots of animal models of CHF and guide the design of animal experiments and scientific research.Methods Literature related to animal model of CHF included in Web of Science core collection from January 1,2001 to October 10,2022 were retrieved.After reading the full text and obtaining the final included literature,VOSviewer and CiteSpace software were used to analyze the contents of institutions,journals and co-cited journals,authors and co-cited authors,keywords.Results A total of 961 papers were included,and the number of published papers increased steadily.The United States and China are the main research countries.Johns Hopkins University and Harvard University are major research institutions.The most frequently published and cited journals are AM J PHYSIOL-HEART C and CIRCULATION,etc..Schultz Harold D and Sabbah Hani N are more influential in author selection."Myocardial infarction","cardiac hypertrophy",and"rat"are the most frequent keywords,10 clusters and 18 emergent words were formed.Conclusion The research in this field is numerous,high quality but scattered.Commonly used animal models are rodents and dogs.The main modeling methods are surgery and drugs.The main pathological mechanisms are mainly myocardial hypertrophy,oxidative stress,and myocardial fibrosis.
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Objective To evaluate the pharmacodynamics of astragaloside Ⅳ derivatives for chronic heart failure, screen the candidate compounds and preliminarily explore the mechanism of the candidate compound HHQ16 against heart failure. Methods Chronic heart failure was induced by left anterior descending artery ligation in C57BL/6 mice for 4 weeks, and the mice were divided into 4 groups, including sham group, model group, positive control captopril group, and astragaloside Ⅳ derivatives group. After continuous intragastric administration for four weeks, the cardiac function was detected by echocardiography, and the optimal astragaloside Ⅳ derivative HHQ16 was selected for the treatment of heart failure. The preliminary mechanism for HHQ16 was further explored. The size of heart was observed by gross morphology; pathological changes were observed by HE staining; collagen deposition in the myocardium was observed by Masson staining; protein levels of myocardial fibrosis indexes COL1, COL3, and αSMA were detected by immunohistochemical staining, and mRNA levels of myocardial fibrosis indexes COL1, COL3, αSMA, and TGF-β1 were determined by qPCR technique. Results All astragaloside Ⅳ derivatives significantly improved cardiac function with increasing LVEF and LVFS, of which HHQ16 was the optimal compound. Compared with the model group, the heart volume of HHQ16 group was significantly reduced; myocardial hypertrophy was reduced; collagen deposition in myocardial tissues was reduced; and myocardial fibrosis indexes, COL1, COL3, αSMA and TGF-β1 mRNA levels, as well as the protein levels of COL1, COL3 and αSMA were significantly reduced. Conclusion HHQ16 is an optimal astragaloside Ⅳ derivatives for the treatment of chronic heart failure in mice, which could improve cardiac function by improving myocardial remodeling, and inhibit myocardial hypertrophy and myocardial fibrosis.
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ObjectiveTo evaluate the clinical effectiveness of Bushen Huoxue Formula （补肾活血方） in the treatment of heart failure with mid-range ejection fraction. MethodsA total of 277 patients of heart failure with mid-range ejection fraction with syndrome of qi deficiency and blood stasis were randomly divided into the treatment group （139 cases） and the control group （138 cases）. The control group was given conventional western medicine， and the treatment group was given Bushen Huoxue Formula on the basis of the control group. Both groups were treated for 8 weeks. Left ventricular ejection fraction （LVEF）， N-terminal B-type natriuretic peptide （NT-pro BNP） level， cardiac function grade， Minnesota heart failure quality of life score， anxiety score， depression score， and the major incidence of cardiovascular adverse events and re-hospitalization rate after 6-month treatment were compared between the two groups before and after treatment. ResultsThere were 10 withdrawals in the treatment group and 6 withdrawals in the control group， so 129 cases in the treatment group and 132 cases in the control group completed the trial. After treatment， LVEF increased and NT-pro BNP level decreased in both groups （P＜0.05）； compared with those in the control group， LVEF increased and NT-pro BNP level decreased in the treatment group （P＜0.05）. The total rate of graded improvement of cardiac function in the treatment group （97.67%， 126/129 cases） was higher than that in the control group （84.09%， 111/132 cases） （P＜0.05）. After treatment， the Minnesota heart failure quality of life score， anxiety score， and depression score were lower in both groups （P＜0.05）， and the above scores in the treatment group were lower than those in the control group （P＜0.05）. After 6-month treatment， there was no death event in both groups， and there was no significant difference in the major incidence of cardiovascular adverse events between the treatment group （25.58%， 33/129 cases） and the control group （33.33%， 44/132 cases） （P＞0.05）. The rate of re-hospitalization in treatment group （14.73%， 19/129 cases） was lower than that in control group （30.30%， 40/132 cases） （P＜0.05）. ConclusionBushen Huoxue Formula can increase LVEF， reduce NT-pro BNP， improve quality of life， improve anxiety and depression， and reduce the rate of re-hospitalization in patients of heart failure with mid-range ejection fraction with syndrome of qi deficiency and blood stasis.
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Objective To compare animal models of chronic heart failure(CHF)prepared by three different protocols,to establish a stable,reliable,and reproducible mouse model of CHF.Methods Twenty-five male C57BL/6J mice were divided randomly into four groups:a blank group,model A group(MA group),model B group(MB group),and model C group(MC group).The model groups adopted different preparation protocols for continuous injection of isoprenaline.The MA group and MB group were dose-decreasing models:MA group:subcutaneous injection of 10 mg/kg on day 1,5 mg/kg on day 2,2.5 mg/(kg·d)on days 3～30,total 30 days;and MB group:subcutaneous injection of 20 mg/kg on day 1,10 mg/kg on day 2,5 mg/(kg·d)on days 3～14,total 14 days.The MC group used a constant dose of intraperitoneal injection of 7.5 mg/(kg·d)for 28 days.The day after the final injection,the survival and model-formation rates for each group of mice were calculated.Cardiac function was measured by cardiac ultrasound and serum levels of N-terminal pro B-type natriuretic peptide,interleukin-6,and tumor necrosis factor-α were measured.Results CHF was successfully induced in all the model groups after all injections at the end of the fourth week.However,comprehensive test result showed that the MC model was the most stable.Conclusions An isoprenaline-induced mouse model of CHF using constant intraperitoneal injection of 7.5 mg/(kg·d)for 28 days may be the most suitable model for subsequent research on traditional Chinese medicine.
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Physiological pacing,such as His bundle pacing and left bundle branch area pacing,could significantly enhance cardiac electromechanical synchrony.Compared to His bundle pacing,left bundle branch area pacing is associated with higher implantation success,lower and stable pacing thresholds,and lower complications.The feasibility,safety,and efficacy of left bundle branch area pacing in patients with chronic heart failure and concomitant left bundle branch block have been preliminarily confirmed,making this strategy as a gradually emerging research focus now.This article aimed to summarize relevant study results and advancements of left bundle branch area pacing in patients with combined left bundle branch block and heart failure.
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Objectives:To assess the effectiveness and safety of ivabradine for the treatment of chronic heart failure in the context of the new quadruple combination. Methods:Clinical data of 656 chronic heart failure patients hospitalized in Nanjing Drum Tower Hospital from March 2021 to June 2022 were retrospectively collected,and the patients were divided into control group(n=361)and observation group(n=295)according to ivabradine use,and both groups were treated with the new quadruple drug therapy.Propensity score matching was performed,268 patients in the observation group and 268 patients in the control group were successfully matched.The effectiveness(primary endpoint was the composite endpoint of cardiovascular death and rehospitalisation for worsening heart failure within 1 year of discharge;secondary endpoints were rehospitalisation for worsening heart failure,all-cause rehospitalisation,cardiovascular death,and all-cause death)and safety outcome measures(including bradycardia,atrial fibrillation,blurred vision,renal impairment,and hypertension)were compared between the two groups at 1 year after treatment. Results:After matching,there were no statistically significant differences at baseline characteristics between the two groups.Kaplan-Meier survival curve showed that the occurrence rates of primary endpoints(P=0.031),readmission for worsening heart failure(P=0.020),and all-cause readmission(P=0.036)were lower in the observation group than in the control group.Multivariate Cox proportional hazard regression analysis showed that the occurrence rates of primary endpoint events(P=0.045)and readmission for heart failure worsening(P=0.028)were lower in the observation group than in the control group. Conclusions:The ivabradine use on top of the new quadruple therapy regimen in patients with chronic heart failure is beneficial to improve one-year prognosis with favorable safety profile.
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Objective To explore the application effect of sacubitril valsartan in patients with chronic heart failure(CHF).Methods A total of 66 CHF patients admitted to Xinyu Yuanhe Hospital from September 2021 to September 2022 were selected and divided into control group and study group according to random number table method,with 33 cases in each group.The control group was treated with benazepril + spironolactone + metoprolol,and the study group was treated with sacubitril valsartan + spironolactone + metoprolol.The clinical efficacy,ventricular remodeling,cardiac function,serum factor levels and adverse reactions were compared between two groups.Results The total effective rate in study group was significantly higher than that in control group(χ2=5.974,P=0.015).After treatment,left ventricular mass index,myocardial wall stress,left ventricular posterior wall thickness,left ventricular ejection fraction,N-terminal pro-brain natriuretic peptide(NT-proBNP),angiotensin Ⅱ and aldosterone in study group were significantly lower than those in control group,and left ventricular remodelling index,stroke volume and left ventricular end-diastolic volume were significantly higher than those in control group(P<0.05).There was no significant difference in adverse reactions between two groups(P>0.05).Conclusion The treatment effect of sacubitril valsartan in CHF patients is significant,which can effectively improve cardiac function indicators,reverse ventricular remodeling,reduce serum NT-proBNP level,and have fewer adverse reactions.
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@#Objective To study the clinical effect of Shengjin Yiwei Decoction on chronic heart failure(CHF)complicated with gastrointestinal dysfunction in patients with deficiency of stomach Yin.Methods Totally 68 patients with stomach Yin deficiency syndrome CHF complicated with gastrointestinal dysfunction in our hospital were selected.On the basis of active treatment of heart failure,the control group was treated with omeprazole enteric-soluble capsule,domperidone tablet and pancrease enteric-soluble capsule,and the experimental group was treated with Shengjin Yiwei Decoction.The clinical efficacy of the two groups was compared.traditional Chinese medicine symptom quantification score,gastrointestinal function quantification score,serum gastrin(GAS),plasma motilin(MTL),interleukin(IL)-6 and tumor necrosis factor(TNF)-α levels.Results The effective rate of experimental group was significantly higher than that of control group(χ2=13.73,P<0.05).After treatment,the quantitative score of gastrointestinal dysfunction,quantitative score of TCM symptoms,serum IL-6 and serum TNF-α levels in 2 groups were significantly lower than before treatment,and the above indexes in test group were significantly lower than control group(P<0.05).The levels of serum GAS and plasma MTL in 2 groups were significantly higher than before treatment,and the above indexes in test group were significantly higher than those in control group(P<0.05).Conclusion Shengjin Yiwei Decoction has obvious curative effect on stomach and Yin deficiency syndrome CHF complicated with gastrointestinal dysfunction,can improve clinical manifestations,adjust the level of gastrointestinal hormones and inflammatory factors,and is worthy of clinical application.
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@#Objective To analyze the efficacy of Astragalus membranaceus and Draba nemorosa in the treatment of chronic heart failure(CHF),the change of cardiac color ultrasound parameters and its predictive value for adverse end events.Methods A total of 92 patients with Qi-deficiency and blood-stasis combined with Shuiyin CHF treated in Wenzhou Hospital of Traditional Chinese Medicine from September 2019 to September 2021 were randomly selected and divided into two groups by random number table method,with 46 cases in each group.Patients in control group were received conventional Western medicine treatment,and patients in observation group were received the addition and subtraction treatment of Yiqi Huoxue Lishui prescription based on Astragalus membranaceus and Draba nemorosa.The clinical efficacy,TCM syndrome score,heart color ultrasound parameters and the incidence of adverse endpoint events within 6 months were compared between the two groups.Cardiac color doppler ultrasound parameters were compared between the occurrence group and the non-occurrence group,and receiver operating characteristic curve was drawn to analyze the predictive value of cardiac color Doppler ultrasound parameters for adverse end events.Results The total clinical effective rate of the observation group(95.65%)was higher than that of the control group(71.74%)(P<0.05).After treatment,palpitation,weakness,shortness of breath,lethargy and lip purple score in observation group were lower than those in control group(P<0.05).The left ventricular end-diastolic diameter(LVEDD)and left arial diameters(LAD)of the observation group were lower than those of the control group after treatment(P<0.05).After treatment,the left ventricular ejection fraction(LVEF)of the observation group was higher than that of the control group(P<0.05);The incidence of adverse endpoint events within 6 months in the observation group(2.17%)was lower than that in the control group(19.57%)(P<0.05).The LVEDD and LAD in the adverse end point event group were higher than those in the without adverse end point event group(P<0.05),and the LVEF was lower than that in the without adverse end point event group(P<0.05).The area under the curve(AUC)of LVEDD,LAD and LVEF combined to predict the occurrence of adverse endpoint events was 0.812,and the 95%CI confidence interval was 0.734-0.968;The sensitivity of combined detection(93.42%)was higher than that of single detection(71.52%,75.11%,79.62%)(P<0.05).The specificity of combined detection(82.27%)compared with that of single detection(70.19%,73.07%,77.28%)(P>0.05).Conclusion Supplementing qi and promoting blood circulation and rehydrating water based on Astragalus membranaceus and Draba nemorosa can effectively improve the cardiac function of CHF patients,alleviate symptoms such as palpitations and fatigue,and reduce the incidence of adverse endpoint events.In addition,the combined detection of cardiac ultrasound parameters can improve the prediction efficiency of adverse endpoint events,which has certain clinical value.
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@#Objective Network pharmacology was used to explore the mechanism of action of Yixin Jianpi prescription in the treatment of coronary heart disease and chronic heart failure.Methods With the help of traditional Chinese medicine systems pharmacology(TCMSP),traditional Chinese medicine integrated database(TCMID)and other databases combined with literature data to screen the active ingredient targets of Yixin Jianpi prescription,the human gene database(GeneCards),online mendelian inheritance in man(OMIM)and other databases were used to search for disease targets.The STRING platform combines Cytoscape software to construct a"component-target-disease"network diagram and protein interaction network.Gene ontology(GO)functionality and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway analysis using the DAVID database.The key components are taken and the target is molecularly docked with AutoDuck tools.Results 265 potential targets of Yixin Jianpi Prescription were obtained,and 106 of them were common targets of"homotherapy for heteropathy";The key active ingredients were quercetin,kaempferol,β-sitosterol,etc.and the core targets were SRC,AKT1,MAPK1,TP53,etc.Biological processes involve positive regulation of gene expression,negative regulation of apoptosis,signal transduction,etc.involving lipid and atherosclerosis,fluid shear stress,atherosclerosis and inflammatory response.Molecular docking verified the stable docking of key components quercetin and kaempferol with SRC,AKT1 and MAPK1 targets.Conclusion The study reveals the multi-component,multi-target,and multi-pathway mechanism of"homotherapy for heteropathy"of coronary heart disease and chronic heart failure by Yixin Jianpi prescription,and provides a basis for exploring its new clinical applications.
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ObjectiveTo investigate the effects of Linggui Zhugantang on mitochondrial fission and fusion and silencing information regulator 3（Sirt3）/adenosine monophosphate dependent protein kinase （AMPK） signaling pathway in chronic heart failure （CHF） rats after myocardial infarction （MI）. MethodSD rats randomly divide into sham operation group （normal saline ，thread only without ligature）， model group （normal saline， ligation of the left anterior descending coronary artery proximal to the heart）， Linggui Zhugantang group （4.8 g·kg-1） and Captopril group （0.002 57 g·kg-1）， with 10 rats in each group. Administere drug continuously for 28 days. Echocardiography detected cardiac function parameters. Hematoxylin eosin （HE） staining observed the pathological changes of the heart. Immunofluorescence detected the levels of reactive oxygen species （ROS）. JC-1 detect mitochondrial membrane potential. Colorimetry measure adenosine triphosphate （ATP）， superoxide dismutase （SOD）， malondialdehyde （MDA）， mitochondrial respiratory chain complex activity （Ⅰ-Ⅳ）. TdT-mediated dUTP nick end labeling （TUNEL） staining detected the apoptosis rate of myocardial tissue. Western blot detected protein expression levels of Sirt3， phosphorylated AMPK （p-AMPK）， phosphorylated dynamic-related protein 1（p-Drp1）， mitochondrial fission protein 1（Fis1）， mitochondrial fission factor （MFF）， optic atrophy protein 1（OPA1）. ResultCompared to the sham group， the left ventricular end diastolic diameter （LVIDd） and left ventricular end systolic diameter （LVIDs） were significantly increased in model group （P<0.01）， while the left ventricular short axis shortening rate （LVFS） and left ventricular ejection fraction （LVEF） were significantly decreased （P<0.01）. There were inflammatory cell infiltration and obvious pathological injury in myocardial tissue. ROS， MDA levels and myocardial cell apoptosis rate were significantly increased （P<0.01）， SOD level， ATP content， and membrane potential were significantly decreased （P<0.01）. The activity of mitochondrial respiratory chain complexes （Ⅰ-Ⅳ） was significantly decreased （P<0.01）. Levels of p-Drp1， Fis1， MFF proteins were significantly up-regulated （P<0.01）， while Sirt3， p-AMPK， OPA1 proteins level were significantly down-regulated （P<0.01）. Compared with model group， LVIDd and LVIDs were significantly decreased （P<0.01）， LVEF and LVFS were significantly increased （P<0.01）. Inflammatory cell infiltration and pathological damage of myocardial tissue were significantly relieved. ROS， MDA levels and myocardial cell apoptosis rate were significantly decreased in Linggui Zhugantang group and Captopril group （P<0.01）， SOD level， ATP content， and membrane potential significantly increased （P<0.01）. The activity of mitochondrial respiratory chain complexes （Ⅰ-Ⅳ） increased significantly （P<0.01），and p-Drp1， Fis1， MFF protein levels were significantly down-regulated （P<0.01）， Sirt3， p-AMPK， OPA1 protein were significantly up-regulated （P<0.01）. ConclusionLinggui Zhugantang can alleviate oxidative stress and apoptosis damage of myocardial cells， maintain mitochondrial function stability， and its effect may be related to mitochondrial mitosis fusion and Sirt3/AMPK signaling pathway.
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ObjectiveTo investigate the possible mechanism of Shenqi Jianxin Formula （参芪健心方） in the treatment of chronic heart failure （CHF） from the perspective of pyroptosis. MethodsFifty-two rats were randomly divided into sham operation group （n=8） and modeling group （n=44）. In the modeling group， the anterior descending branch of the left coronary artery was ligated to construct CHF rat model. Forty successfully-modelled rats were randomly divided into model group， Entresto group， Shenqi Jianxin Formula group， MCC950 group and the combination group （Shenqi Jianxin Formula plus MCC950）， with 8 rats in each group. In Shenqi Jianxin Formula group， 7.4 g/（kg·d） of Shenqi Jianxin Formula was given by gavage， while in Entresto group， 68 mg/（kg·d） of Entresto suspension was given by gavage； in MCC950 group， MCC950 was injected intraperitoneally with 10 mg/kg once every other day， and in the combination group， 7.4 g/（kg·d） of Shenqi Jianxin Formula was given by gavage， and MCC950 was injected intraperitoneally with 10 mg/kg once every other day； 10 ml/（kg·d） of saline was given by gavage in the sham operation group and the model group. After 3 weeks of continuous intervention， serum brain B-type natriuretic peptide （BNP）， creatine kinase isoenzyme MB （CK-MB）， interleukin 1β （IL-1β）， and interleukin 18 （IL-18） levels were detected by ELISA； HE staining and MASSON staining were used to observe pathological changes in rat myocardium. Except for the Entresto group， western blot technique was used to detect the expression of NOD-like receptor protein 3 （NLRP3）， caspase-1， and apoptosis-associated speck-like protein possessing a caspase-recruiting domain （ASC）； RT-PCR was used to detect the expression of NLRP3 and caspase-1 mRNA. ResultsCompared with the sham operation group， HE staining of rats in the model group showed obvious myocardial injury， while MASSON staining showed increased area of collagen fibrosis， and serum BNP， CK-MB， IL-1β， IL-18， myocardial tissue NLRP3， caspase-1， ASC protein expression and NLRP3， caspase-1 mRNA expression were all elevated （P＜0.05）. Compared with those in the model group， cardiomyocyte injury of rats and collagen fibrosis area were reduced， and serum BNP， CK-MB， IL-1β， and IL-18 contents were all reduced in Shenqi Jianxin Formula group， Entresto group， MCC950 group， and the combination group； except for Entresto group， myocardial tissue NLRP3， caspase-1， ASC protein expression and NLRP3， caspase-1 mRNA expression were reduced in the remaining three medication group （P＜0.05）. Compared with Shenqi Jianxin Formula group， the MCC950 group and the combination group showed decreased serum IL-1β and IL-18 content， collagen fibrosis area， myocardial tissue NLPR3， caspase-1 protein expression， and caspase-1 mRNA expression， and decreased ASC and NLRP3 mRNA expression was shown in the combination group （P＜0.05）. Compared with MCC950 group， collagen fibrosis area was reduced， and serum IL-18 content， NLRP3， caspase-1 mRNA expression were reduced in the combination group （P＜0.05）. ConclusionShenqi Jianxin Formula can effectively improve the myocardial injury and heart failure in rats with CHF， and its mechanism may be related to the inhibition of cardiomyocyte pyroptosis through NLPR3/Caspase-1 pathway to reduce the level of intramyocardial inflammation. The combined use of MCC950 with Shenqi Jianxin Formula could more effectively inhibite myocardial pyroptosis， with better therapeutic result than single use of each part.
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OBJECTIVE To evaluate the cost-effectiveness of ivabradine in the treatment of chronic heart failure （CHF） in the context of “Quadruple Therapy” from the perspective of the health system. METHODS Based on real-world cohort data， the Markov model was constructed according to the natural progression of CHF， with a cycle time of 3 months， a study timeframe of 20 years， and a discount rate of 5%. Using quality-adjusted life year （QALY） and incremental cost-effectiveness ratios （ICER） as the output indexes， the cost-utility analysis was used to evaluate the cost-effectiveness of ivabradine in combination with the “Quadruple Therapy” regimen， compared with the “Quadruple Therapy” regimen for the treatment of CHF， and the robustness of the results of the base analysis was verified by univariate sensitivity analysis and probabilistic sensitivity analysis. RESULTS The results of the base analysis showed that the ICER of ivabradine combined with the “Quadruple Therapy” regimen was 165 065.54 yuan/QALY， compared with the “Quadruple Therapy” regimen， which was lower than the willingness-to-pay （WTP） threshold （257 094 yuan/QALY） based on 3 times of China’s gross domestic product （GDP） per capita in 2022. The results of the univariate sensitivity analysis showed that the discount rate had the greatest impact on the robustness of the model. The probabilistic sensitivity analysis showed that the probability that the ivabradine combined with the “Quadruple Therapy” regimen was cost-effective under the WTP threshold in this study was 59.50%. CONCLUSIONS When using 3 times China’s 2022 GDP per capita （257 094 yuan/ QALY） as the WTP threshold， the combination of ivabradine and the “Quadruple Therapy” regimen for treating CHF is cost- effective.
摘要
ObjectiveChronic heart failure （CHF） is the terminal stage of cardiovascular disease. The adverse cardiovascular events of CHF patients with weakness have increased significantly. Traditional Chinese medicine （TCM） has a good effect on CHF. However，there are few reports on the clinical observation of the treatment of CHF with weakness in elderly patients by TCM combined with conventional health-preserving exercises. This study aimed to explore the clinical efficacy of Qiangxin decoction combined with Baduanjin in the treatment of elderly patients with CHF and weakness. MethodSixty CHF patients with Qi deficiency，blood stasis，and water retention syndrome admitted to the Cardiovascular Department of the First Affiliated Hospital of Guangxi University of Chinese Medicine from January 2020 to December 2021 were enrolled. The patients in the control group were treated with conventional western medicine according to the guidelines，while those in the treatment group received additional Qiangxin decoction and Baduanjin exercise based on the therapeutic protocol of the control group. The levels of serum N-terminal B-type brain natriuretic peptide precursor （NT-proBNP），creatine kinase （CK），lactate dehydrogenase （LDH），free fatty acid （FFA），left ventricular ejection fraction （LVEF），left ventricular end-diastolic dimension （LEVDD），6-minute walk distance （6MWD），Minnesota Living with Heart Failure Questionnaire （MLHFQ）， and Tilburg Frailty Indicator （TFI） scores of the two groups were observed before and one month after treatment. At the same time，the re-admission within three months was compared between the two groups. ResultThere was no significant difference between the two groups in terms of the general data and the therapeutic indexes before treatment. After treatment，the NT-proBNP，CK，LDH，FFA，LVEDD，MLHFQ， and TFI scores of the two groups were lower than those before treatment（P<0.05，P<0.01）， and the LVEF and 6MWD were higher（P<0.05，P<0.01）. The efficacy of the treatment group was superior to that of the control group after treatment （P<0.05，P<0.01）. The re-admission rate within three months in the treatment group was 7.1% （2/28）， lower than 30.8% （8/26） in the control group （χ2=4.897，P<0.05）. ConclusionQiangxin decoction combined with Baduanjin is helpful to improve the body energy metabolism，heart function，quality of life，and weakness level of elderly CHF patients with weakness， and reduce the rate of re-admission.