心力衰竭與心室重構(gòu)

芪藶強(qiáng)心抑制心室重構(gòu)抗心力衰竭

基礎(chǔ)與臨床研究證據(jù)CADHypCMValvLVDRemodelingLowEFArrhythmiasDeathPumpFailureCHFSymptomsNonCardiacFactorsVentricularRemodelingafterInfarctionandinDiastolicandSystolicHeartFailureNeurohormonalmodelofHFPrimarytargetsoftreatmentinHF氣陽(yáng)虛乏脈絡(luò)瘀阻尿少水腫絡(luò)息成積心室重構(gòu)、心臟擴(kuò)大氣虛不能運(yùn)血陽(yáng)虛不能化水

“氣分”（神經(jīng)體液調(diào)節(jié)異常）

“水分”（鈉水滁留）

“血分”（血流動(dòng)力學(xué)異常）

益氣溫陽(yáng)黃芪、附子、人參、桂枝活血通絡(luò)丹參、紅花利水消腫

葶藶子、澤瀉、香加皮標(biāo)本兼治強(qiáng)心、利尿、擴(kuò)血管緩解心慌氣短、不能平臥、尿少水腫癥狀抑制RASS與交感神經(jīng)減少心室重構(gòu)

與RASS、交感神經(jīng)系統(tǒng)激活導(dǎo)致心室重構(gòu)為慢性心衰病機(jī)新概念相吻合脈絡(luò)學(xué)說(shuō)指導(dǎo)慢性心衰病機(jī)、有效組方及作用研究[CellularImmunology2009,260:52-55]ResultsTheeffectofQiliqiangxinontheechocardiographicandhemodynamicparametersintheinfarctedhearts.g/kg/dayfor4weeksforRatsTheratioofTNF-a/IL-10ininfarctedmyocardialtissuewasreversedbyQiliqiangxin.Conclusion:QiliqiangxinimprovescardiacfunctionofratswithMIthroughregulationthebalancebetweenTNF-aandIL-10.12[JCardiovascPharmacol,2012,59(3):268-280]QLinhibitsmyocardialin?ammationandcardiomyocytedeathandpromotescardiomyocyteproliferation,leadingtoanamelioratedcardiacremodelingandfunctioninamousemodelofpressureoverload.ThepossiblemechanismsmayinvolveinhibitionofangiotensinIItype1receptorandactivationofErbBreceptors.Conclusion:QL:0.6mg/kg/dayfor4weeksformice[Americanjournalofhypertension,2012,25,250-260]02QLQXdownregulatethecardiacchymasesignalingpathwayandchymase-mediatedangIIproduction.01QLQXimprovesbothsystolicanddiastoliccardiacfunctioninSHRs.Conclusion:臨床試驗(yàn)注冊(cè)臨床研究簡(jiǎn)介L(zhǎng)iX,ZhangJ,HuangJ,MaA,YangJ,LiW,WuZ,YaoC,ZhangY,YaoW,ZhangB,GaoR.AMulticenter,Randomized,Double-Blind,Parallel-Group,Placebo-ControlledStudyoftheEffectsofQiliQiangxinCapsulesinPatientsWithChronicHeartFailure.JAmCollCardiol.2013;62(12):1065-1072.

BNP/NT-proBNP可用于指導(dǎo)

心衰的治療心衰患者治療后BNP/NT-proBNP與基線(xiàn)相比下降達(dá)到或超過(guò)30%，表明治療奏效如未下降或下降未達(dá)標(biāo)甚至繼續(xù)走高，則表明治療效果不佳，應(yīng)繼續(xù)增強(qiáng)治療的力度。中國(guó)心力衰竭診斷和治療指南2014中華心血管病雜志2014(42):2生物標(biāo)志物及應(yīng)用情況推薦類(lèi)別證據(jù)水平利鈉肽HF的診斷或排除非臥床，急性IAHF的預(yù)后非臥床，急性IA達(dá)到GDMT目標(biāo)非臥床IIaB指導(dǎo)急性失代償性HF治療急性IIbC心肌損傷標(biāo)志物附加危險(xiǎn)分層急性，非臥床IA心肌纖維化標(biāo)志物附加危險(xiǎn)分層非臥床IIbB急性IIbA

2013ACCF/AHAHFGuideline生物

標(biāo)志物測(cè)定建議GDMT,Guideline-DirectedMedicalTherapy;指南導(dǎo)向藥物治療2013ACCF/AHAGuidelinefortheManagementofHeartFailure.E-PublishedonJune5,2013,availableat:[aStudyDesignNT-proBNP的水平變化及下降超過(guò)30%的比例兩組NYHA心功能分級(jí)描述和比較LVEF、LVED、6MWD基線(xiàn)與第12周隨訪變化趨勢(shì)明尼蘇達(dá)生活質(zhì)量量表評(píng)分變化趨勢(shì)心血管復(fù)合事件藥物不良事件EDITORIALCOMMENT

—CARDIOTONICMODULATIONINHEARTFAILURE:INSIGHTSFROMTRADITIONALCHINESEMEDICINE

—讓衰竭的心臟更加強(qiáng)勁-中國(guó)傳統(tǒng)醫(yī)學(xué)給我們的啟示EditorialComment（述評(píng)）-byTangWHW,HuangYItisconceivablethatinthefutureifqiliqiangxinprovestoprovidemorbidityandmortalitybenefitsinrigorousclinicaltrials,itwillfundamentallychallengetheexistingfoundationofscientificinquirybaseduponthepreciseunderstandingofpharmacodynamicsofdrugtherapies.可以想象的是，如果芪藶強(qiáng)心膠囊在未來(lái)高質(zhì)量的臨床研究中提供更多關(guān)于其對(duì)受試者發(fā)病率、死亡率益處的證據(jù)，那么它將從根本上挑戰(zhàn)現(xiàn)有的關(guān)于藥物效應(yīng)動(dòng)力學(xué)研究的科學(xué)觀念。EditorialComment（述評(píng)）-byTangWHW,HuangYYetevenatpresent,thepromisingresultsreportedbyLiandcolleaguesmayhavealreadyopenedtheopportunitytoexplorewiththelatesttechnologieshowsynergisticinteractionsamongactiveTCMingredientscanbenefitthesyndromeofheartfailure.Thisisachallengethatweshouldallwarmlyembrace.現(xiàn)如今，這項(xiàng)富有前景的研究表明李及他的研究同事們已經(jīng)打開(kāi)了一扇如何利用最新科技研究傳統(tǒng)中藥活性成分在心力衰竭治療中協(xié)同作用的大門(mén)。這是一個(gè)挑戰(zhàn)，對(duì)此我們應(yīng)該熱烈擁抱。臨床研究證據(jù)級(jí)別：由高到低1.隨機(jī)對(duì)照研究2.前瞻性非隨機(jī)對(duì)照研究3.回顧性對(duì)照研究4.非對(duì)照研究或歷史對(duì)照研究5.薈萃分析6.病例報(bào)道7.評(píng)論，教授或其他專(zhuān)家意見(jiàn)

ProfessorJosephS.AlpertEditor-in-Chief,AmericanJournalofMedicine2013.7.19Nanjing（中華心血管病雜志2014(42):2）對(duì)芪藶強(qiáng)心臨床試驗(yàn)結(jié)果進(jìn)行了描述（參考文獻(xiàn)58）中國(guó)心力衰竭診斷和治療指南2014dayMISacrifice07142121dWorkingmodel:AMIremodelingOurwork:（我們的研究）Project1:TraditionalChineseMedicationQiliqiangxinattenuatescardiacremodelingafteracutemyocardialinfarctioninmiceUnpublisheddataResultsSaline+shamSaline+MIQL+MIQL+ShamUnpublisheddataRemoteRemoteRemoteRemoteBorderInfarctBorderInfarctBorderBorderUnpublisheddataSaline+ShamSaline+MIQL+MIUnpublisheddataReversalexperiments-PPARaPPARgUnpublisheddataMI+QL+PPARgInhibitorMI+QL+PPARgActivatorMI+QLUnpublisheddataPGC1aCb-ActinPPARaQMQM+PPARgInhibitorPPARgDUnpublisheddataFutureworkMISacrifice071421312418dday0123dayMISacrifice3dAcutephaseRemodelingphaseUnpublisheddataSaline+MIQL+MIUnpublisheddataAcutephase(TTCStaining)NMQMMISacrifice71421312418dABBPPARaPPARg1PGC-1ab-actinProject2:ThemataboliceffectsofQLQXonH9C2(invitro)UnpublisheddataBasalOxidativeMetabolismPeakOxidativeMetabolismFigure1:OxidativeMetabolismindicatedbyoxygenconsumptionofH9C2myocytestreatedwithQLatdifferenttimeanddoseAMitochondrialUncouplingMetabolicRelianceBCBasalGlycolysisPeakGlycolysisFigure2:GlycolysisMetabolismindicatedbyoxygenconsumptionofH9C2myocytestreatedwithQLatdifferenttimeanddoseABFigure3:MitochondrialContentmeasuredbymicroscopyandflowcytometryControllQL(48hr)MitotrackerMitotrackerMergeMergeMitochondrialcontentAB待發(fā)表文章:TraditionalChineseMedicationQiliqiangxinattenuatescardiacremodelingafteracutemyocardialinfarctiontargetingPPARR已于3月31號(hào)向哈佛大學(xué)醫(yī)學(xué)院附院心內(nèi)科主任、新英格蘭副主編托尼教授匯報(bào)過(guò)研究結(jié)果受到好評(píng)。臨床意義作為預(yù)防心肌梗死后心室重構(gòu)導(dǎo)致心衰的治療策略之一？（B階段）（RAS/BB）QiliqiangxininHeartFailUre：AssESsmentofReductioninMorTalityProfXinliLiTheFirstAffiliatedHospitalwithNanjingMedicalUniversityonbehalfoftheInvestigatorsStudyDesignTherapeuticregimen:enrolledpatientswithHF

aregivenoralmedicationtreatmentaccordingtoDiagnosisandTreatmentGuidelinesofHF