| BACKGROUND:Volume overload is the main reason of hospitalized patients with the most acute decompensated heart failure(ADHF)and diuretic is the most common drug to correct volume overload and to alleviate congestion symptoms currently.However,diuretic resistance and electrolyte disorders,activation of neuroendocrine system have became inevitable defects of diuretic.FQ-16 ultrafiltration device can effectively correct volume overload,relieving edema and congestion symptoms,and has no significant effect on neuroendocrine hormone.Clinical study has found that the symptoms of positive Qi deficiency are common in patients with heart failure after UF treatment and warming yang and replenishing qi,tonifying qi and yin(tonifying qi and strengthening the body resistance)can improve the adverse reactions of patients.At present,no research has been done on the use of metabonomics in the treatment of heart failure by ultrafiltration.OBJECTIVE:1We want to explore the validity and security of tonifying qi and strengthening the body resistance on ultrafiltration treatment in patients with heart failure.2We use metabonomics technology to find out the difference of endogenous substances in patients with heart failure before and after ultrafiltration,and explore the metabolic regulation mechanism of blood ultrafiltration intervention on heart failure.It may provide a basis for further exploring the internal mechanism of the treatment of heart failure with the method of tonifying qi and strengthening the body resistance.METHODS:1We retrospectively observed 34 patients with ADHF who meets the criteria for the ultrafiltration treatment from January 2015 to December 2017.The patients were divided into two groups,one is ultrafiltration group of 13cases,another is tonifying qi and strengthening the body resistance group of 21 cases.They were observed for 10 days.We observed the curative effect indexs such as NT-proBNP,dyspnea severity score,hs-CRP at three points(before and after UF,treatment for 10 days)and weight,syndrome integral,heart function at two points(before UF,treatment for 10 days).We observed the safety indicators such as ion(potassium,sodium,chlorine),HCT,creatinine and urea nitrogen at three points(before and after UF,treatment for 10 days)within the group and between groups and the incidence of adverse reactions.2We collected 17 patients with ultrafiltration to extract the peripheral venous blood 5ml of the patients before and after the UF.Comparing and analysising metabolite spectrum before and after the UF through LC/MS are to test the metabolic model and to screen symbolic metabolism group.RESULTS:1 Clinical Research1.1 Curative effect indexsNT-proBNP:there was no statistical difference between the two groups.The tonifying qi and strengthening the body resistance group had no statistical difference at 3 observation points and pairwise comparison of 3 observation points.There were significant differences in ultrafiltration group at 3 observation points.The index of NT-proBNP before ultrafiltration and treatment for 10 day,after ultrafiltration and treatment of 10 days in UF group had significant differences.Dyspnoea severity score:there was no statistical difference between the two groups.There were significant differences at 3 observation points and pairwise comparison of 3 observation points in both groups.hs-CRP:there was no statistical difference between the two groups.There was no significant difference at 3 observation points and pairwise comparison of 3 observation points in both groups.Weight:there was no significant difference between the two groups.Both groups had statistical difference before ultrafiltration and 10 days for treatment.The score of symptoms:the difference between the two groups was statistically significant.Both groups had statistical difference before ultrafiltration and 10 days of treatment.Improvement of cardiac function:the efficiency of tonifying qi and strengthening the body resistance group was better than the ultrafiltration group,but there was no statistical difference.1.2 Safety indicatorsThere was no statistical difference between the two groups of ion(potassium,sodium,chlorine),HCT,creatinine and urea nitrogen.There was no statistical difference between the 3 observation time points and the 3 observation time points of tonifying qi and strengthening the body resistance group and the ultrafiltration group.The incidence of adverse reactions in tonifying qi and strengthening the body resistance group was lower than that in ultrafiltration group.2MetabonomicsThe metabolic profile before and after the blood ultrafiltration can be clearly distinguished and 17 potential biomarkers related to heart failure in Yang deficiency syndrome were identified through metabonomics.After ultrafiltration,the content of hypoxanthine,inosine,symmetric two methyl arginine,GPEtn(16:0/0:0),and GPEtn(18:0/0:0)increased after blood ultrafiltration.The content of amino acids,sphingomyelin,acetyl carnitine and phospholipids decreased.CONCLUSIONS:Compared with ultrafiltration,Chinese medicine combined with blood ultrafiltration can effectively improve the clinical symptoms and can be more safe.The main metabolic pathways of blood ultrafiltration include purine metabolism,sphingolipid metabolism,energy metabolism,phospholipid metabolism and so on. |
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