真武汤合桂枝茯苓丸治疗阳虚水泛型慢性心力衰竭的疗效及网络药理学研究  

Efficacy of Zhenwu Decoction Plus Guizhi Fuling Pills in the Treatment of Chronic Heart Failure with the Syndrome of Fluid Retention due to Yang Deficiency and Its Network Pharmacological Study

作　　者：李中政 郭进建[1] LI Zhong-Zheng;GUO Jin-Jian(The Second People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine,Fuzhou 350003 Fujian,China)

机构地区：[1]福建中医药大学附属第二人民医院,福建福州350003

出　　处：《广州中医药大学学报》2024年第7期1701-1713,共13页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：福建省科学技术厅自然科学基金面上项目(编号:2020J01248)。

摘　　要：【目的】观察真武汤合桂枝茯苓丸治疗阳虚水泛型慢性心力衰竭(CHF)患者的临床疗效并运用网络药理学探究其作用机制。【方法】将64例阳虚水泛型CHF患者随机分为治疗组和对照组,每组各32例。对照组给予西医规范的基础治疗,治疗组在对照组的基础上加用真武汤合桂枝茯苓丸治疗,疗程为4周。观察2组患者治疗前后中医证候积分、超声心动图检测指标、 6 min步行试验(6MWT)距离、明尼苏达心衰生活质量调查问卷(MLHFQ)评分以及血清氨基末端脑钠肽前体(NT-proBNP)、网膜素1(Omentin-1)水平的变化情况,并比较2组患者的中医证候疗效。使用网络药理学方法从相关数据库获取真武汤合桂枝茯苓丸的活性成分、靶点与CHF疾病靶点,得到交集靶点后构建交集靶点蛋白质相互作用网络并进行富集分析,以此预测真武汤合桂枝茯苓丸治疗CHF的作用机制。【结果】(1)治疗4周后,治疗组的总有效率为90.62%(29/32),对照组为71.87%(23/32),组间比较(χ^(2)检验),治疗组的中医证候疗效明显优于对照组(P<0.05)。(2)治疗后,2组患者的气短/喘息、心悸、畏寒肢冷、面浮肢肿、乏力、唇甲紫暗、面色晦暗、尿少、咳嗽等各项中医证候评分及总积分均较治疗前降低(P<0.01),且治疗组对气短/喘息、畏寒肢冷、面浮肢肿、乏力、唇甲紫暗、面色晦暗、尿少等7项中医证候评分及总积分的降低幅度均明显优于对照组(P<0.05或P<0.01)。(3)治疗后,2组患者的左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)均较治疗前降低(P<0.01),左室射血分数(LVEF)均较治疗前升高(P<0.01),且治疗组对LVEDD、LVESD的降低幅度及对LVEF的升高幅度均明显优于对照组(P<0.01)。(4)治疗后,2组患者的6MWT距离均较治疗前升高(P<0.01),MLHFQ积分均较治疗前降低(P<0.01),且治疗组对6MWT距离的升高幅度及对MLHFQ积分的降低幅度均明显优于对照组(P<0.01)�Objective To observe the clinical efficacy of Zhenwu Decoction plus Guizhi Fuling Pills in the treatment of patients with chronic heart failure(CHF) of fluid retention due to yang deficiency type,and to explore its therapeutic mechanism by network pharmacology.Methods A total of 64 cases of CHF patients with fluid retention due to yang deficiency type were randomly divided into treatment group and control group,with 32 cases in each group.The control group was given the basic western medicine treatment,and the treatment group was treated with Zhenwu Decoction plus Guizhi Fuling Pills on the basis of treatment for the control group.The course of treatment lasted for 4 weeks.The changes of traditional Chinese medicine(TCM) syndrome scores,echocardiographic parameters,distance of 6-minute walking test(6MWT),Minnesota Living with Heart Failure Questionnaire(MLHFQ) score,and serum levels of N-terminal pro-brain natriuretic peptide(NT-proBNP) and omentin-1 in the two groups were observed before and after treatment.After treatment,the efficacy for TCM syndrome was compared between the two groups.The active components,component targets and CHF disease targets of Zhenwu Decoction plus Guizhi Fuling Pills were obtained from the relevant databases by using the network pharmacological methods.After the intersection targets were obtained,the intersection target protein-protein interaction network was constructed and the enrichment analysis was carried out to predict the therapeutic mechanism of Zhenwu Decoction plus Guizhi Fuling Pills for CHF.Results(1) After 4 weeks of treatment,the total effective rate of the treatment group was 90.62%(29/32),and that of the control group was 71.87%(23/32).The intergroup comparison(tested by chi-square test) showed that the efficacy for TCM syndrome in the treatment group was significantly superior to that in the control group(P<0.05).(2)After treatment,the scores of TCM syndromes such as shortness of breath/wheezing,palpitation,aversion to cold and cold limbs,facial edema and edema of lim

关 键 词：阳虚水泛证 慢性心力衰竭 真武汤 桂枝茯苓丸 网膜素1 网络药理学 生活质量 炎症反应 心脏负荷 心室重构 

分 类 号：R259.416[医药卫生—中西医结合]