参七汤对急性心肌梗死患者PCI术后IL-10、TGF-β1的影响
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摘要
【目的】探讨参七汤(西洋参、三七)对急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)术后血清抗炎因子的影响。【方法】将60例在佛山市中医院行PCI术后接受入院治疗的AMI患者随机分为试验组和对照组,每组各30例。术后2组患者均按照常规介入术后西医二级预防治疗策略给药,试验组在此基础上加服参七汤治疗。观察2组患者术后7 d再狭窄发生率,术前和术后7 d气虚证、血瘀证的证候积分,以及术前和术后30 min、3 d、7 d血清白细胞介素10(IL-10)、转化生长因子β1(TGF-β1)水平。【结果】(1)术后7 d,试验组的再狭窄发生率为20.00%;对照组为33.33%,试验组的再狭窄发生率显著低于对照组(P<0.05)。(2)术后7 d,试验组血瘀证和气虚证的证候积分均较术前降低(P<0.01),而对照组的证候积分降低均不明显(P>0.05);试验组对血瘀证和气虚证的证候积分的降低作用均明显优于对照组(P<0.01)。(3)术前及术后30min,2组患者血清IL-10、TGF-β1水平比较,差异均无统计学意义(P>0.05)。术后3 d和7 d,2组患者血清IL-10、TGFβ1水平均较术前和术后30 min升高(P<0.05),其中试验组术后3 d的血清IL-10、TGF-β1水平均高于术后7 d(P<0.05);组间比较,试验组术后3 d和7 d的血清IL-10、TGF-β1水平均明显高于对照组(P<0.01)。(4)观察过程中,2组患者均无不良反应发生,患者的凝血功能、肝肾功能等也均未出现异常。【结论】PCI术后患者血管炎症反应导致血管促炎因子、抗炎因子的平衡失调,参七汤可干预促进抗炎因子IL-10、TGF-β1的合成,从而促进血管内皮修复,进而有利于心脏康复。
Objective To investigate the effect of Shenqi Decoction(composed of Radix Panacis Quinquefolii andRadix Notoginseng)on the serum anti-inflammatory factors of patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI). Methods Sixty AMI inpatients after PCI admitted in FoshanHospital of Traditional Chinese Medicine were randomized into trial group and control group,30 cases in eachgroup. The patients of the two groups received the secondary preventive regimen of western medicine after PCI,and additionally the patients of the trial group were treated with Shenqi Decoction orally. The observation indexesincluded the incidence of restenosis 7 days after PCI, the scores of Qi deficiency syndrome and blood stasissyndrome before PCI and 7 days after PCI, and the levels of serum interleukin 10(IL-10)and transforminggrowth factor beta 1(TGF-β1)before PCI,and 30 minutes,3 days and 7 days after PCI. Results(1) Theincidence of restenosis in the trial group(20.00%) was significantly lower than that in the control group(33.33%) 7 days after PCI(P<0.05).(2)The scores of Qi deficiency syndrome and blood stasis syndrome 7days after PCI in the trial group were significantly lower than those before PCI(P<0.01),while the scores of thecontrol group showed no obvious changes(P > 0.05). And the decrease of the scores in the trial group was superiorto that in the control group(P<0.01).(3)There were no significant difference in the serum IL-10 and TGF-β1levels between the two groups before PCI and 30 minutes after PCI(P > 0.05). However,the levels of serum IL-10 and TGF-β1 in the two groups were increased 3,7 days after PCI(P<0.05 compared with those before PCI and30 minutes after PCI),and the levels in the trial group 3 days after PCI were higher than those 7 days after PCI(P < 0.05);the inter-group comparison showed that the serum IL-10 and TGF-β1 levels in the trial group weresignificantly higher than those in the control group 3,7 days after PCI(P < 0.01).(4)During the trial,no adversereaction,abnormal blood coagulation or injured hepatorenal function was found in the two groups. Conclusion Thevascular inflammatory reaction in AMI patients after PCI leads to the imbalance of vascular pro-inflammatory factorsand anti-inflammatory factors. Shenqi Decoction can promote the secretion of anti-inflammatory factors IL-10 andTGF-β1,which can promote the repair of vascular endothelial cells and the recovery of heart function.
Objective To investigate the effect of Shenqi Decoction(composed of Radix Panacis Quinquefolii andRadix Notoginseng)on the serum anti-inflammatory factors of patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI). Methods Sixty AMI inpatients after PCI admitted in FoshanHospital of Traditional Chinese Medicine were randomized into trial group and control group,30 cases in eachgroup. The patients of the two groups received the secondary preventive regimen of western medicine after PCI,and additionally the patients of the trial group were treated with Shenqi Decoction orally. The observation indexesincluded the incidence of restenosis 7 days after PCI, the scores of Qi deficiency syndrome and blood stasissyndrome before PCI and 7 days after PCI, and the levels of serum interleukin 10(IL-10)and transforminggrowth factor beta 1(TGF-β1)before PCI,and 30 minutes,3 days and 7 days after PCI. Results(1) Theincidence of restenosis in the trial group(20.00%) was significantly lower than that in the control group(33.33%) 7 days after PCI(P<0.05).(2)The scores of Qi deficiency syndrome and blood stasis syndrome 7days after PCI in the trial group were significantly lower than those before PCI(P<0.01),while the scores of thecontrol group showed no obvious changes(P > 0.05). And the decrease of the scores in the trial group was superiorto that in the control group(P<0.01).(3)There were no significant difference in the serum IL-10 and TGF-β1levels between the two groups before PCI and 30 minutes after PCI(P > 0.05). However,the levels of serum IL-10 and TGF-β1 in the two groups were increased 3,7 days after PCI(P<0.05 compared with those before PCI and30 minutes after PCI),and the levels in the trial group 3 days after PCI were higher than those 7 days after PCI(P < 0.05);the inter-group comparison showed that the serum IL-10 and TGF-β1 levels in the trial group weresignificantly higher than those in the control group 3,7 days after PCI(P < 0.01).(4)During the trial,no adversereaction,abnormal blood coagulation or injured hepatorenal function was found in the two groups. Conclusion Thevascular inflammatory reaction in AMI patients after PCI leads to the imbalance of vascular pro-inflammatory factorsand anti-inflammatory factors. Shenqi Decoction can promote the secretion of anti-inflammatory factors IL-10 andTGF-β1,which can promote the repair of vascular endothelial cells and the recovery of heart function.
引文
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[5]中国中西医结合学会活血化瘀专业委员会.冠心病血瘀证诊断标准[J].中国中西医结合杂志,2016,36(10):1162.
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[8]郭庆,叶鸿.单药与双联抗血小板治疗对药物洗脱支架植入术后血管内皮功能及炎症因子的影响[J].河北医学,2018,24(2):235.
[9] Cui M D, Pan Z H, Pan L Q. Danggui Buxue extract-loaded liposomes in thermosensitive gel enhance in vivo dermal wound healing via activation of the VEGF/PI3K/Akt and TGF-β/Smads signaling pathway[J]. Evid Based Complement Alternat Med,2017,12:8407249.
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[11]黄嘉文,张卫媛,赵华云,等.参七汤对急性冠脉综合征患者PCI术后hs-CRP及IL-6水平的影响[J].广东医学,2018,39(3):463.
[12] Wu L,Zhang W,Tang Y H,et al. Effect of total saponins of“panax notoginseng root” on aortic intimal hyperplasia and the expressions of cell cycle protein and extracellular matrix in rats[J]. Phytomedicine,2010,17:233.
[13]胡根胜,邵正斌.中医药对冠心病PCI术后炎症因子的影响[J].中医药临床杂志,2017,29(10):1592.
[14] Shao L,Zhang P,Zhang Y,et al. Inflammatory unbalance of TLR3 and TLR4 in PCI patients with or without type 2 diabetes mellitus[J]. Immunol Lett,2014,161(1):81.
[15]郝燕捷,陈莹,薛林,等. IL-10抑制TGF-β1诱导的大鼠心脏成纤维细胞增殖及表型转化[J].基础医学与临床,2015,35(9):1182.
[16] Conen D,Chae C U,Guralnik J M,et al.Influence of blood pressure and blood pressure change on the risk of congestive heart failure in the elderly[J].Swiss Med Wkly,2010,140(13/14):202.
[17] Shi X, Yu W, Liu L, et al. Panax notoginseng saponins administration modulates pro-/anti-inflammatory factor expression and improves neurologic outcome following permanent MCAO in rats[J]. Metab Brain Dis,2017,32:221.
[18]王芳,汤永红,杨科,等.骨髓间充质干细胞移植对大鼠脑缺血损伤和IL-10、TGF-β1表达的影响[J].中国动脉硬化杂志,2016,24(8):788.
[19]崔艳.西洋参茎叶皂苷对局灶性脑缺血大鼠脑组织NGF和TGF-β1含量的影响[D].哈尔滨:黑龙江中医药大学,2010.
[2] Frangogiannis N G. The inflammatory response in myocardial injury,repair,and remodelling[J]. Nat Rev Cardiol,2014,11(5):255.
[3]马玉良. 2012全球心肌梗死统一定义[J].中华心脏与心律电子杂志,2015,3(3):11.
[4]国家食品药品监督管理总局.中药新药临床研究一般原则[S],2015.
[5]中国中西医结合学会活血化瘀专业委员会.冠心病血瘀证诊断标准[J].中国中西医结合杂志,2016,36(10):1162.
[6]中国中西医结合学会心血管学会.冠心病中医辨证标准[J].中国中西医结合杂志,1991,11(5):257.
[7] Zhou F Z,Song W,Yin L H,et al. Effects of remote ischemic preconditioning on myocardial injury and endothelial function and prognosis after percutaneous coronary intervention in patients with acute coronary syndrome[J]. Eur Rev Med Pharmacol Sci,2017,21(20):4642.
[8]郭庆,叶鸿.单药与双联抗血小板治疗对药物洗脱支架植入术后血管内皮功能及炎症因子的影响[J].河北医学,2018,24(2):235.
[9] Cui M D, Pan Z H, Pan L Q. Danggui Buxue extract-loaded liposomes in thermosensitive gel enhance in vivo dermal wound healing via activation of the VEGF/PI3K/Akt and TGF-β/Smads signaling pathway[J]. Evid Based Complement Alternat Med,2017,12:8407249.
[10]郭丛丛.血管内皮功能与冠脉病变程度及PCI术后转归的相关性研究[D].北京:北京中医药大学,2016.
[11]黄嘉文,张卫媛,赵华云,等.参七汤对急性冠脉综合征患者PCI术后hs-CRP及IL-6水平的影响[J].广东医学,2018,39(3):463.
[12] Wu L,Zhang W,Tang Y H,et al. Effect of total saponins of“panax notoginseng root” on aortic intimal hyperplasia and the expressions of cell cycle protein and extracellular matrix in rats[J]. Phytomedicine,2010,17:233.
[13]胡根胜,邵正斌.中医药对冠心病PCI术后炎症因子的影响[J].中医药临床杂志,2017,29(10):1592.
[14] Shao L,Zhang P,Zhang Y,et al. Inflammatory unbalance of TLR3 and TLR4 in PCI patients with or without type 2 diabetes mellitus[J]. Immunol Lett,2014,161(1):81.
[15]郝燕捷,陈莹,薛林,等. IL-10抑制TGF-β1诱导的大鼠心脏成纤维细胞增殖及表型转化[J].基础医学与临床,2015,35(9):1182.
[16] Conen D,Chae C U,Guralnik J M,et al.Influence of blood pressure and blood pressure change on the risk of congestive heart failure in the elderly[J].Swiss Med Wkly,2010,140(13/14):202.
[17] Shi X, Yu W, Liu L, et al. Panax notoginseng saponins administration modulates pro-/anti-inflammatory factor expression and improves neurologic outcome following permanent MCAO in rats[J]. Metab Brain Dis,2017,32:221.
[18]王芳,汤永红,杨科,等.骨髓间充质干细胞移植对大鼠脑缺血损伤和IL-10、TGF-β1表达的影响[J].中国动脉硬化杂志,2016,24(8):788.
[19]崔艳.西洋参茎叶皂苷对局灶性脑缺血大鼠脑组织NGF和TGF-β1含量的影响[D].哈尔滨:黑龙江中医药大学,2010.