参附注射液调节TLR3和TLR4表达改善心肌缺血再灌注后患者心脏功能的研究  

Study on Shenfu Injection regulating TLR3 and TLR4 to improve cardiac function in patients with acute myocardial ischemia-reperfusion

作　　者：蔡新勇[1] 孙德明 王云霞[1] 邵靓 朱虹岷[1] 黄笑 董选忠 梅松波 肖斌 杨旭 章黎思 CAI Xinyong;SUN Deming;WANG Yunxia(Department of Cardiology,Jiangxi Provincial People's Hospital,Nanchang 330000,China;Jiangxi Wannian County Hospital of traditional Chinese Medicine,Shangrao 335500,China)

机构地区：[1]江西省人民医院心血管内科,南昌330000 [2]江西省上饶市万年县中医院内二科,上饶335500 [3]江西乐平市第二医院心内科,乐平3333000 [4]深圳瑞奥康晨生物科技有限公司,深圳518000 [5]江西省鄱阳县人民医院心内科,鄱阳333100

出　　处：《江西医药》2020年第11期1575-1579,共5页Jiangxi Medical Journal

基　　金：江西省中医药科技计划项目,编号2019A292;江西省青年科学基金项目,编号20171BAB215005。

摘　　要：目的探讨参附注射液对急性心肌缺血再灌注患者心功能的保护作用。方法选取2019年8月-2020年1月江西省人民医院收治的100例行急诊冠脉缺血再灌注患者作为研究对象,将其随机分为对照组(50例)和治疗组(50例)。对照组采用国际PCI术后标准治疗方案(阿司匹林+氯吡格雷/替格瑞洛+β受体阻滞剂+ACEI或ARB+他汀类+安慰剂),治疗组则在常规治疗的基础上加用参附注射液,两组分别连续治疗一个月,比较两组患者外周血单个核细胞中Toll样受体mRNA水平和蛋白水平的表达,以及信号通路因子MyD88,TRIF-β和下游终端炎症因子IFN-,IP-10,TNF-和IL-8,以及一个月前后患者基线资料对比(主要是NT-proBNP和心脏超声)。结果两组患者术后TLR3和TLR4 mRNA和蛋白水平、信号通路因子水平和下游终端炎症因子水平比较,差异无统计学意义(P>0.05);对照组治疗1个月后的mRNA和蛋白水平与术后比较,差异无统计学意义(P>0.05);治疗组治疗1个月后的mRNA和蛋白水平均低于术后及对照组,信号通路因子和下游终端炎症因子水平低于术后及对照组,差异有统计学意义(P<0.05)。两组患者基线资料及术后的NT-proBNP和心脏超声比较,差异无统计学意义(P<0.05);对照组1个月后的NT-proBNP和心脏超声与术后比较,差异无统计学意义(P>0.05);治疗组1个月后的NT-proBNP和心脏超声显著优于术后及对照组,差异有统计学意义(P<0.05)。两组患者在治疗期间均未发生明显的药物不良反应。结论行急诊冠脉缺血再灌注患者加用参附注射液可以减少Toll样受体识别,下调下游信号及炎症因子,显著减少心肌组织损伤,同时改善心衰患者心脏功能,有效缓解患者不适症状,这为急性心肌缺血再灌注患者的治疗提供了新的策略和方法。Objective To explore the protective effect of Shenfu Injection on cardiac function in patients with acute myocardial ischemia-reperfusion.Methods From August 2019 to January 2020,100 patients with acute coronary ischemia-reperfusionadmitted to Jiangxi people's hospital were randomly divided into standard treatment group(50 cases)and Shenfu Injection enhanced control group(50 cases).The standard treatment group adopted the international standard treatment plan after PCI(aspirin+clopidogrel/ticagrelor+βreceptor blocker+ACEI or ARB+statins+placebo),and the Shenfu strengthening group added Shenfu Injection on the basis of conventional treatment.The two groups were treated for one consecutive months,respectively.The expression of Toll like receptor mRNA and protein level,as well as the signal level in peripheral blood mononuclear cells of the two groups were compared Channel factors MyD88,TRIF-βand downstream inflammatory factors IFN-β,IP-10,TNF-αand IL-8,as well as baseline data comparison of patients before and after three months(mainly NT proBNP and echocardiography).Results There was no significant difference in the levels of TLR3 and TLR4 mRNA and protein,signal pathway factor and downstream inflammatory factor between the two groups(P>0.05);there was no significant difference in the levels of mRNA and protein between the standard treatment group and the standard treatment group after 1 months(P>0.05);the levels of mRNA and protein were lower than the standard treatment group after 1 months The levels of signal pathway factor and downstream terminal inflammatory factor in the treatment group were lower than those in the standard treatment group(P<0.05).There was no significant difference in baseline data and postoperative ntprobnp and echocardiography between the two groups(P>0.05);there was no significant difference in NT proBNP and echocardiography between the standard treatment group and the standard treatment group after 1 months(P>0.05);there was significant difference in NT proBNP and echocardiography b

关 键 词：参附 TOLL样受体 心肌缺血 再灌注损伤 

分 类 号：R541.4[医药卫生—心血管疾病]