The Clinical Study Of Lu Hong Fang On Patients With Coronary Heart Disease And Heart Failure And The Experimental Study Of Paracrine Promoting Myocardial Proliferation In Suckling Rats

Object:1.To investigate the clinical efficacy of Luhongfang(LHF),and to explore its mechanism in patients with heart failure(HF)complicated with yang deficie-ncy and blood stasis syndrome caused by coronary heart disease(CHD).To o-bserve the changes of serum VEGF,IGF-1 and BNP,and to observe the clini-cal symptoms,signs,cardiac function,exercise tolerance,TCM syndrome scores and quality of life of patients.2.To observe the effect of LHF on the paracrine secretion of Sca-1+cardi-omyocytes(CMs)and the PI3K/Akt pathway in neonatal rat CMs,and to anal-yze the mechanism of promoting the proliferation of neonatal rat CMs,and pr-ovide a theoretical basis for LHF in the treatment of HF.Method:Clinic trial:HF patients with CHD complicated with yang deficiency and blood stasis syndrome were collected according to the inclusion criteria.The control group was treated referring to the chronic heart failure(CHF)guidelines,and the trea-tment group was treated with LHF additionally.The following indicators were observed before and after treatment:(1)The levels of BNP,VEGF and IGF-1;(2)cardiac color Doppler:LVEF,LVEDD,LVESD,SV;(3)6 Minutes'Walk Test(6MWT);(4)Minnesota Living with Heart Failure Questionnaire(MLHFQ)scor-e;(5)New York Heart Association(NYHA)grade change and curative effect;(6)TCM syndrome scores.Cell experiment:The experiment was divided into five groups:CMs group,CMs+Sca-1 gro-up,CMs+Sca-1+LY294002 group,CMs+Sca-1+LHF group,CMs+Sca-1+LHF+L Y294002 group.(1)Flow cytometry was used to detect the proliferation of CMs in each group at 24h,48h and 72h(Ki67~+,Brd U~+,H3P~+);(2)ELISA detected VEGF,IGF-1,HGF levels of supernatant liquid;(3)RT-PCR detected the relativ e-e amount of PI3K,AKT m RNA;(4)Western blot detected protein levels of P-I3K,AKT,p-AKT.Result:Clinic trial:(1)LHF down-regulated TCM syndrome scores,MLHFQ scores of HF patie-nts with CHD complicated with yang deficiency and blood stasis syndrome,a meliorated 6MWT,NYHA cardiac function,quality of life and exercise toleranc-e,and the curative effect of the treatment group was better than the control g-roup(P<0.05);(2)in each clinical symptom,the improvement of shortness of breath,cold,limb cold,lip cyanosis,and fatigue were better than the control g-roup(P<0.05);(3)LHF could reduce BNP,improve VEGF,IGF-1 level,supe rior to the control group(P<0.05);(4)LHF could ameliorated LVEDD,LVESD,LVEF and SV levels.Among them,better than the control in ameliorating LV EF and LVESD(P<0.05).Cell experiment:Sca-1+CM cloud promote the proliferation of neonatal r at CMs(Brd U?Ki67?H3P),LHF clould play a synergistic role,at 24h the ef fect is the best(P<0.05);(2)LHF can enhance the paracrine effect of Sca-1+C Ms,increase the levels of VEGF,IGF-1 and HGF(P<0.05);(3)LHF up-regulate d PI3K?Akt protein expression of neonatal rat CMs(P<0.05).Conclusion:1.LHF may improve the levels of VEGF and IGF-1 in HF patients with CHD complicated with yang deficiency and blood stasis syndrome,reduce BNP level,ameliorate TCM symptoms,enhance systolic function,improve heart fun-ction of NYHA and the life quality,increase exercise tolerance of patients.2.LHF can enhance the paracrine effect of Sca-1+CMs,increase the leve-ls of VEGF,IGF-1 and HGF,activate the PI3K/Akt pathway in CMs,promote the proliferation of neonatal rat CMs.