调脾护心方对急性心肌梗死的临床疗效观察及动物实验研究
本文选题:调脾护心方 + 急性心肌梗死 ; 参考:《安徽中医药大学》2016年硕士论文
【摘要】:目的:观察调脾护心方对急性ST段抬高型心肌梗死(STEMI)的临床疗效,心肌酶肌钙蛋白I(c Tn I)、肌酸激酶同工酶(CK-MB)、肌红蛋白(MYO)的变化程度及药物不良反应,以及实验观察对急性心肌梗死大鼠的肌钙蛋白T(c Tn T)、乳酸脱氢酶(LDH)、CK-MB,脑钠肽(BNP),Ca2+-Mg2+ATP酶、Na1+-K1+ATP酶的比较及光镜下心肌细胞的病理学观察,阐述调脾护心方对STEMI的临床疗效及改善心肌能量代谢作用环节及机制,为调脾护心方治疗临床冠心病提供理论和实验依据。方法:1.临床观察:选择40例入选患者,中医辨证符合入选标准的冠心病STEMI患者,采用随机的分组方法,把上述40例患者,分为治疗组和对照组。两组均给予符合临床冠心病STEMI治疗方案的方法治疗。治疗组在原有西药治疗的基础上,同时加服调脾护心方(颗粒剂)。两组疗程均为2周。于治疗2周后观察中医证候积分值,并检测血清c Tn I、CK-MB、MYO,BNP、LVEF(左室射血分数,单位%)水平变化及药物不良反应情况。2.动物实验:(1)将64只实验大鼠编号后随机分为4组,即调脾护心方高、低剂量治疗组、盐酸曲美他嗪对照组、模型手术组,每组均16只,同时选取16只相同类型大鼠作为正常对照组。(2)实验后采取HE染色制作各组大鼠的心肌标本,光镜下观察AMI心肌细胞的病理变化;(3)采用增强化学发光法测定实验后各组大鼠的血清c Tn T、CK-MB、LDH、BNP水平;(4)采用免疫组织化学法,检测实验药物干预后各组大鼠心肌组织中的Ca2+-Mg2+ATP酶、Na1+-K1+ATP酶含量;(5)所有实验结果数据均依照SPSS 18.0软件输入数据,再进行统计学处理。结果:临床观察:1、通过SPSS软件分析治疗组和对照组的中医证候积分,发现两组之间的中医证候积分无显著性差异(p0.05),两组分别给予试验设定治疗方案治疗后,发现两组的中医证候积分有如下变化,治疗组的中医证候积分较对照组下降明显(p0.01)。2、治疗前两组c Tn I、CK-MB、MYO、BNP、LVEF水平无显著性差异(p0.05),治疗后发现,治疗组的c Tn I、CK-MB、MYO水平较对照组显著降低(p0.01)。3、治疗前统计学分析得出治疗组与对照组BNP、LVEF指标无显著性差异(p0.05)。治疗后,治疗组较对照组的BNP的下降更明显(p0.01),治疗组的LVEF较对照组明显增高(p0.01)。4、临床观察期间未发现调脾护心方明显的药物不良反应。动物实验:1.本实验结束后对各组大鼠的心肌酶的变化观察整理分析,发现模型对照组、曲美他嗪组、调脾护心方高、低剂量组与正常对照组比较均有明显的升高(P0.01);但曲美他嗪组、调脾护心方高剂量中药组、调脾护心方低剂量组与模型对照组比较,这三组的心肌酶均下降明显(P0.01);而调脾护心方高剂量组、调脾护心方低剂量组与曲美他嗪组比较发现,调脾护心方高剂量组心肌酶与曲美他嗪组较为接近(P0.05),而调脾护心方低剂量组与曲美他嗪组比较,心肌酶有较大差异(P0.05)。2.本实验中发现实验后各组大鼠的BNP水平与正常对照组比较均有明显升高(P0.01),其中模型对照组BNP的水平最高。而调脾护心方高剂量组、调脾护心方低剂量组、曲美他嗪组的BNP水平较模型对照组有明显的差异(P0.01),其中调脾护心方高剂量组与曲美他嗪组BNP较为接近(P0.05),调脾护心方低剂量组的BNP水平与调脾护心方低剂量组、曲美他嗪组比较有差异(P0.05)。3.实验结束后发现模型对照组大鼠心肌细胞呈空泡样改变,坏死心肌细胞核不明显,镜下可见大量心肌纤维化表现,边缘散在存活心肌,排列不规则。调脾护心方高剂量组与曲美他嗪组中心肌细胞均有不同程度的坏死,但整体情况明显优于模型对照组而低于正常对照组。调脾护心方低剂量组则可见视野区偏暗,心肌细胞存活数、心肌排列紧密度、胞核完整度均较调脾护心方高剂量组、曲美他嗪组低。4.实验后经过对各组大鼠的Ca2+-Mg2+ATP酶、Na1+-K1+ATP酶的比较发现,其余四组Ca2+-Mg2+ATP酶、Na1+-K1+ATP酶的活力高于模型对照组(P0.01)。曲美他嗪组、调脾护心方高剂量中药组、调脾护心方低剂量中药组与模型对照组Ca2+-Mg2+ATP酶、Na1+-K1+ATP酶的比较,发现有差异(P0.01)。调脾护心方高剂量中药组、调脾护心方低剂量中药组之间的Ca2+-Mg2+ATP酶、Na1+-K1+ATP酶比较也有统计学差异性(P0.05)。曲美他嗪组与调脾护心方高剂量中药组的Ca2+-Mg2+ATP酶、Na1+-K1+ATP酶比较无明显差异性(P0.05)。结论:1.调脾护心方可降低STEMI患者的心肌损伤标志物c Tn I、CK-MB、MYO的水平,可改善心肌缺血,减轻患者临床症状。2.调脾护心方可提升STEMI患者的LVEF水平,降低BNP水平,改善心肌梗死后患者的心功能状况。3.调脾护心方可能通过调节AMI模型大鼠心肌细胞内Ca2+-Mg2+ATP酶、Na1+-K1+ATP酶的活性,从而能改善心肌梗死细胞的能量代谢,达到治疗AMI的目的。4.调脾护心方动物实验发现调脾护心方有降低大鼠心肌酶及BNP的效果。5.调脾护心方治疗AMI可能存在药物剂量浓度的关系,在一定范围内加大调脾护心方剂量,可达到治疗AMI的最佳效果。6.临床试验及动物实验均未发现调脾护心方有明显的药物不良作用。
[Abstract]:Objective: To observe the clinical efficacy of Tiao PI Hu Xin Fang on acute ST segment elevation myocardial infarction (STEMI), myocardial enzyme troponin I (C Tn I), creatine kinase isoenzyme (CK-MB), myoglobin (MYO) and drug adverse reactions, as well as experimental observation of cardiac troponin T (C Tn T), lactate dehydrogenase (LDH) in acute myocardial infarction rats. The comparison of brain natriuretic peptide (BNP), Ca2+-Mg2+ATP enzyme, Na1+-K1+ATP enzyme and the pathological observation of cardiac myocytes under light microscope, the clinical effect and the improvement of myocardial energy metabolism in the treatment of STEMI by regulating spleen and heart, and providing theoretical and experimental basis for the treatment of coronary heart disease by regulating spleen and heart prescription. Methods: 1. clinical observation: select 40 patients. Patients with coronary heart disease (STEMI) were divided into the treatment group and the control group. The two groups were divided into the treatment group and the control group. The two groups were all accorded with the clinical coronary heart disease (CAD) treatment scheme. On the basis of the original western medicine treatment, the treatment group was added to the spleen and heart prescription (granule). Two groups of treatment courses were taken. 2 weeks. After 2 weeks of treatment, the TCM syndrome scores were observed and serum C Tn I, CK-MB, MYO, BNP, LVEF (left ventricular ejection fraction, unit%) level and drug adverse reactions were observed in animal experiments: (1) 64 experimental rats were randomly divided into 4 groups, namely, the high, low dose treatment group, and the Trimetazine hydrochloride control group. In the operation group, 16 rats in each group were 16, and 16 rats of the same type were selected as the normal control group. (2) after the experiment, the myocardium specimens of the rats were made by HE staining and the pathological changes of the AMI myocardial cells were observed under light microscope. (3) the serum C Tn T, CK-MB, LDH, BNP level of the rats after the experiment were measured by enhanced chemiluminescence; (4) immunization was adopted. Histochemical method was used to detect the Ca2+-Mg2+ATP enzyme and Na1+-K1+ATP enzyme content in the myocardium of each group after the intervention of the experimental drug; (5) all the experimental data were entered into the data according to the SPSS 18 software, and then the statistical treatment was carried out. Results: clinical observation: 1, the TCM syndrome scores of the treatment group and the control group were analyzed by SPSS software, and two groups were found. There was no significant difference in TCM syndrome score (P0.05). After the treatment of the two groups, the TCM syndrome scores of the two groups were found to have the following changes. The TCM syndrome score of the treatment group was significantly lower than the control group (P0.01).2. There was no significant difference (P0.05) between the two groups of C Tn I before treatment, CK-MB, MYO, BNP and LVEF (P0.05). It was found that the level of C Tn I, CK-MB and MYO in the treatment group was significantly lower than that of the control group (P0.01).3. There was no significant difference in LVEF index between the treatment group and the control group before the treatment (P0.05). After treatment, the treatment group was more obvious than the control group (P0.01), and the treatment group was significantly higher than the control group. No obvious adverse drug reaction was found in the prescription of regulating spleen and heart. 1. after the experiment, the changes of myocardial enzymes in the rats were observed and analyzed. The results showed that the model control group, the Trimetazine group, the spleen and the heart of the heart were high, the low dose group was significantly higher than the normal control group (P0.01); but the Trimetazine group, the spleen and the heart of the heart was high. Compared with the model control group, the myocardial enzymes in the three groups were significantly lower than those in the model control group (P0.01), while the high dose group, the low dose group and the trimetazidine group found that the myocardial enzymes in the high dose group were close to that of the trimetazidine group (P0.05), while the low dose of the spleen and the heart was low. Compared with the group of trimetazidine, there was a significant difference in myocardial enzyme between the group and the trimetazidine group (P0.05).2. in this experiment, it was found that the BNP level of the rats in each group was significantly higher than that in the normal control group (P0.01), and the level of BNP in the model control group was the highest. The high dose group, the low dose of the spleen and the nurse heart prescription, the BNP level of the trimetazidine group were more than the model. There was significant difference between the control group and the control group (P0.01), in which the BNP of the high dose and the trimetazidine group was close (P0.05), the BNP level in the low dose group of the spleen and the heart of the spleen and the low dose group was compared with the low dose group of the regulating spleen and the heart, and the group of the Trimetazine group had a difference (P0.05) after the conclusion of the.3. experiment, the myocardial cells in the model control group were vacuolated. The nucleus of the dead heart muscle was not obvious, and a large number of myocardial fibrosis were found under the microscope, the edge scattered in the surviving myocardium and irregular arrangement. There were different degrees of necrosis in the high dose group and the central muscle cells of the group of Trimetazine, but the overall situation was obviously superior to the model control group. The area of the visual field was dark, the number of cardiac myocytes, the tightness of the myocardium and the integrity of the nucleus were all higher than the high dose group of the spleen and heart control. After the low.4. experiment in the group of trimetazidine, the comparison of the Ca2+-Mg2+ATP enzyme and Na1+-K1+ATP enzyme showed that the other four groups of Ca2+-Mg2+ATP enzymes and Na1+-K1+ATP enzyme activity were higher than those of the model control group (P0.01). In the group of zetazine, the high dose Chinese medicine group of regulating spleen and heart prescription, the comparison of the Ca2+-Mg2+ATP enzyme and Na1+-K1+ATP enzyme in the low dose Chinese medicine group with the model control group and the model control group, found the difference (P0.01). The high dose Chinese medicine group with the spleen and heart prescription, the Ca2+ -Mg2+ATP enzyme between the low dose Chinese medicine group and the low dose of the spleen and the heart of the spleen, and the Na1+-K1+ATP enzyme were also statistically different (P0.0 5). There is no significant difference between the Ca2+-Mg2+ATP enzyme and Na1+-K1+ATP enzyme in the high dose group of the trimetazidine group and the high dose of the spleen and heart prescription (P0.05). Conclusion: 1. the spleen protecting heart can reduce the myocardial damage markers of STEMI patients C Tn I, CK-MB, MYO level, can improve the myocardial ischemia, and reduce the clinical symptoms of the patients with the spleen and heart can improve STEMI patients. The level of LVEF, reduce the level of BNP, improve the cardiac function of patients with myocardial infarction,.3. regulating spleen and protecting heart may improve the activity of Ca2+-Mg2+ATP enzyme and Na1+-K1+ATP enzyme in the myocardial cells of AMI model rats, thus can improve the energy metabolism of myocardial infarction cells, and achieve the purpose of treating AMI by regulating spleen and protecting the heart by regulating spleen and protecting spleen. The effect of Xin Fang on reducing myocardial enzyme and BNP in rats.5. may have the relationship of drug dose concentration in the treatment of AMI by regulating spleen and heart prescription, and adding the dosage of spleen protecting heart in a certain range, the best effect of treating AMI can be achieved,.6. clinical trial and animal experiment have not found obvious adverse drug effects in the prescription of regulating spleen and protecting the heart.
【学位授予单位】:安徽中医药大学
【学位级别】:硕士
【学位授予年份】:2016
【分类号】:R259
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