益气活血方及其拆方对冠心病心力衰竭气虚血瘀证患者心功能及血浆miRNA差异表达的影响  

Effects of Yiqi Huoxue Formula (益气活血方) and its Diassembled Components on Cardiac Function and Plasma miRNA Differential Expression in Coronary Heart Disease and Heart Failure Patients with Qi Deficiency and Blood Stasis Syndrome

作　　者：马腾[1] 李彬 彭广操 王新陆 赵齐飞 王建茹 王永霞 朱明军 赵英强[3] MA Teng;LI Bin;PENG Guangcao;WANG Xinlu;ZHAO Qifei;WANG Jianru;WANG Yongxia;ZHU Mingjun;ZHAO Yingqiang(Henan University of Chinese Medicine,Zhengzhou,450046;The First Affiliated Hospital of Henan University of Chinese Medicine;The Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine)

机构地区：[1]河南中医药大学,河南省郑州市450046 [2]河南中医药大学第一附属医院 [3]天津中医药大学第二附属医院

出　　处：《中医杂志》2022年第7期644-652,共9页Journal of Traditional Chinese Medicine

基　　金：国家重点研发计划(2019YFC1710000,2019YFC1710003);国家中医药管理局中医药循证能力建设项目(2019XZZXXXG003);河南省高校科技创新团队支持计划(13IRTSTHN012);河南省中医药科学研究专项课题(2018JDZX009);河南省中原千人计划-中原名医项目。

摘　　要：目的 探究益气活血方治疗冠心病心力衰竭气虚血瘀证的疗效及可能作用机制。方法 将160例冠心病心力衰竭气虚血瘀证患者随机分为益气活血组、活血组、益气组、对照组,每组40例。各组患者均给予西医规范治疗,在此基础上对照组给予中药模拟剂、益气活血方组给予益气活血方颗粒剂、益气方组和活血方组分别给予益气活血方拆方的益气药颗粒剂和活血药颗粒剂,各组中药颗粒剂均每次半剂口服,早晚各1次,均治疗3个月。治疗前后各组均进行中医证候评分并观察心功能分级分布情况,治疗后采血进行血浆差异miRNA指标筛选,各组两两比较对miRNA差异靶基因进行预测,将差异靶基因再进行GO富集分析、KEGG富集分析。结果 试验过程中各组均有脱落,最终对照组33例,益气组、益气活血组各34例,活血组37例纳入统计分析。与本组治疗前比较,各组治疗后中医证候积分均明显降低,心功能分布差异具有统计学意义(P<0.01);与对照组治疗后比较,益气组、活血组、益气活血组心功能分级分布差异均有统计学意义,益气活血组中医证候积分明显降低(P<0.05或P<0.01);治疗后益气组、活血组、益气活血组组间两两比较,心功能分级分布差异均具有统计学意义(P<0.01)。差异表达miRNA筛选最终共获得5组比较结果,益气组与对照组比较,共有1个miRNA发生了上调,预测未获得目标靶基因;活血组与对照组比较,共有1个miRNA发生了上调,预测得到15个靶基因,涉及的KEGG通路主要为缺氧诱导因子1 (HIF-1)信号通路、磷脂酰肌醇-3-激酶/蛋白激酶B (PI3K-Akt)信号通路等;益气活血组与对照组比较,共有4个miRNA发生了上调,预测得到65个靶基因,涉及的KEGG通路主要为丝裂原活化蛋白激酶(MAPK)信号通路、酪氨酸激酶受体(ErbB)信号通路等;益气活血组与益气组比较,共有1个miRNA发生了上调,预测得到37个靶基因,涉及Objective To explore the effect and the possible mechanism of Yiqi Huoxue Formula(益气活血方,YHF)in the treatment of coronary heart disease and heart failure(CHD-HF)with qi deficiency and blood stasis syndrome.Methods A total of 160 CHD-HF patients with qi deficiency and blood stasis syndrome were randomly divided into YHF group,Huoxue group,Yiqi group,and control group,with 40 patients in each group.All the groups received standard western medicine,and additionally,YHF granules and placebo were administered in the YHF group and control group.The diassembled components Yiqi granules and Huoxue granules were additionally given to the corresponding Yiqi group and Huoxue group.The granules in all groups were taken orally,half a dose each time,once in the morning and in the evening,for three months.The scores of traditional Chinese medicine(TCM)syndromes and heart functional class were assessed.Blood was collected for screening of differential miRNA indicators,and pairwise comparison was performed to predict differentially expressed miRNA target genes.GO enrichment analysis and KEGG enrichment analysis of the differentially expressed miRNA target genes were performed further.Results Except for the dropouts,33 cases in the control group,34 cases in the Yiqi group and YHF group each,and 37 cases in the Huoxue group were included for analysis.After treatment,TCM syndrome score significantly decreased,and the cardiac functional class significantly improved in all groups(P<0.01).Compared to the control group,the other three groups had significantly improved cardiac functional class,and moreover,the YHF group had significantly lower TCM syndrome score(P<0.01 or P<0.05).There were significant differences in the pairwise comparisons of Yiqi group,Huoxue group and YHF group regarding the cardiac functional class after treatment(P<0.01).Finally,five comparison results were obtained from differentially expressed miRNA screening.For comparison between Yiqi group and the control group,one up-regulated miRNA was found,but no

关 键 词：冠心病 心力衰竭 气虚血瘀 微小RNA 益气活血方 心功能 

分 类 号：R259[医药卫生—中西医结合]