The Clinical Research And Experiments Of XINSHUAI Formula Granules Ⅰ In Chronic Heart Failure

BackgroundChronic Heart Failure(Chronic Heart Failure,CHF referred to as heart failure ) is a complex syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventride to fill with or eject blood.In China,the heart failure hospitalization rates over accounted for 20%of the same period cardiovascular disease,the mortality rate accounted for 40%,suggesting a serious prognosis.Therefore the treatment of heart failure is a clinical important issue.Traditional cardiac,vasodilative,diuretic drugs may be activated neuroendocrine system, failed to block the process of myocardial remodeling,and even likely to accelerate the process of myocardial remodeling,so in the near future to improve the clinical condition of patients at the same time,but should not reduce their death,or even anti-are likely to increase the risk of death.By angiotensin-converting enzyme inhibitor(ACEI) as the cornerstone of modern treatment of heart failure by reducing sympathetic nervous system(SNS) activity,inhibiting the renin - angiotensin - aldosterone system(RAAS) activation,which has impacted off the progress of cardiac remodeling and improve cardiac function results.Traditional Chinese medicine in accordance with the heart failure pathogenesis characteristics,not only the deficiency of heart-Yang and kidney-Yang but also retention of fluid within the body and blood Stagnation,developed Onyang diuresis,huoxuehuayu Dafa treatment of heart failure, for some,the severe heart failure patients can often do a good short-term efficacy.However, there is no long-term treatment in patients with heart failure out of the troubled high mortality rate.Chinese medicine theory holds that material belong to Yin,Yang is function.In the process of cardiac remodeling,myocardial apoptosis,the material reduced Yin lost in the first place,and ultimately Yin impairment involve Yang,,so that the function rreduced Yang dysfunction..Normal decrease in the number of myocardial cells,reflects the Yin impairment, while the remaining myocardial cells hypertrophy,Chinese medicine consider that it is phlegm,stagnant blood,such as fluid vapor suspended in the outcome of evil.Cardiac myocyte apoptosis and cardiac myocyte hypertrophy,myocardial structure and function is the main reason for change.Based on the above theory with long-term clinical practice,Professor Li Qiyi developed XinShuai Formula granulesⅠ(referred to as XinShuaiⅠ) through the overall conditioning,multi-target,multi-link acting on the neuroendocrine system,as well as neurohumoral factors,inhibition ventricular remodeling and the role of anti-heart failure. Research purposesFirst,to study XinShuaiⅠin patients with chronic heart failure(referred to as heart failure rats) on clinical symptoms,6-minute walk test and plasma brain natriuretic peptide levels. Second,to study XinShuaiⅠin rats with chronic heart failure(referred to as heart failure rats) to improve hemodynamic parameters,as well as the renin - angiotensin - aldosterone system, atrial natriuretic peptide,endothelin and other related indicators,and explore its mechanism, so as to clinical application XinShuaiⅠto provide experimental basis,better services for the vast number of patients with heart failure.Research contents and methodsFirst,.the part of clinical research1,methods51 cases of heart failure patients will be randomly divided into treatment group 26 cases and 25 cases of the control group,two groups with reference to basic treatment of the Chinese Medical Association of Cardiovascular Branch regarding "Chronic systolic heart failure treatment recommendations," the standard treatment,The treatment group oral XinShuaiⅠ1 bag per day,at 2 times service,the control group oral placebo 1 bag per day,at 2 times service.4 weeks for a course of treatment,observation time of 6 treatments.Compared between the two groups after treatment signs and symptoms,quality of life score,brain natriuretic peptide,New York cardiac function grade,6 minute walking test and general effect.2,resultThe two groups after treatment at signs and symptoms,brain natriuretic peptide,6-minute walk test and general efficacy has significant differences.3,conclusionXinShuaiⅠin patients with heart failure significantly improved clinical symptoms,improve clinical efficacy,improvement in plasma brain natriuretic peptide levels,6 minute walking test to improve the role,suggesting XinShuaiⅠhas better long-term efficacy.in patients with heart failure.Second,the part of animal experiments1.model and group methods:By Fletcher,act of SD rats with left main coronary artery ligation,sham-operated group, after thoracotomy,non-coronary artery ligation.Indoor farming,the law of the lighting,free eating and drinking water,rearing four weeks.Random number table,after the successful model rats were randomly divided into 4 groups,each 15,and the other set of normal rats 15 as blank control group and 15 of the sham-operated group,for a total of 6 groups.After the success of the beginning of model experiments.Specific sub-cases as follows:Normal control group(Con):do not build a normal rat model,daily irrigation 3ml distilled water for 4 weeks.Sham-operated group(Sha):distilled water daily irrigation 3ml,for 4 weeks. Model group(CHF):determined after modeling success,the daily irrigation of distilled water 3ml,for 4 weeks.Captopril group(Cap):determined after modeling success,the daily irrigation captopril 0.016g/Kg,for 4 weeks.XinShuaiⅠof low-dose group(XS1):determined after modeling success,the daily irrigation of XinShuaiⅠ12g crude drug / kg,for 4 weeks.XinShuaiⅠof high-dose group(XS2):determined after modeling success,the daily irrigation of XinShuaiⅠ36g crude drug / kg,for 4 weeks.Observation of animals in each group during the treatment appearance,movement,loss of appetite,and edema,cyanosis and other symptoms.Said daily feed and water consumption. Week that the body weight of rats.After 4 weeks,administration of each rat orbital venous blood 4ml for RIAand then proceed the determination of cardiac function and hemodynamic monitoring.To each rat was dissected,check integrity of the heart,after washing with normal saline add liquid nitrogen cans,preserved under test.2.experimental methodsExperimental rats and recorded the following experimental results:determination of hemodynamic and cardiopulmonary weight,determination of plasma renin activity(PRA), plasma angiotensinⅡ(AngⅡ),plasma aldosterone(ALD),A-type natriuretic peptide(ANP) and plasma endothelin(ET).Against the role of contraction of heart failure rats superior mesenteric artery by phenylephrine and detection of the extent of myocardial fibrosis.3.results(1) XinShuaiⅠon heart failure rats hemodynamicsCompared with model group,XinShuaiⅠof high-dose group and captopril group can increase heart failure in rats LVSP,dp / dt max(P＜0.01),significantly decreased LVEDP(P＜0.05～0.01),and XinShuaiⅠof high-dose group and the captopril group compared with no significant difference(P＞0.05).XinShuaiⅠof high-dose group and captopril group can t～dp / dt max decreased(P＜0.05～0.01),XinShuaiⅠmay granules stronger role in high-dose group(P＜0.05).XinShuaiⅠof low-dose group of heart failure in rats with heart failure LVSP significantly improve(P＜0.05),t～dp / dt max decreased significantly(P＜0.01).At the same time,the captopril group,XinShuaiⅠhigh and low dose groups of heart failure in rats with SAP were significantly higher(P＜0.05～0.01),XinShuaiⅠseems to particles of high-dose group of the strongest role.(2) XinShuaiⅠon heart failure rats in heart,lung impactCompared with model group,XinShuaiⅠof high-dose group and captopril group are able to increase left ventricular weight and LV / BW(P＜0.05～0.01),and XinShuaiⅠ high-dose group was significantly(P＜0.05).XinShuaiⅠof low-dose group and captopril group are able to inhibit the right ventricular hypertrophy(P＜0.01),XinShuaiⅠof low-dose group of particles at the same time can reduce the lung index(P＜0.05).(3) XinShuaiⅠon heart failure rats in renin - angiotensin - aldosterone system,atrial natriuretic peptide,endothelinRAAS is activated in rats with heart failure,compared with the normal group,PRA,AngⅡ,ALD levels was significantly enhance(P＜0.01).Of drug-treated group after treatment, PRA,AngⅡ,ALD levels were significantly decreased(P＜0.01),of which XinShuaiⅠof high-dose group of heart failure the most significant decline.The levels of plasma ANP in Heart failure rats,after treatment of XinShuaiⅠand captopril,the levels of ANP has been picked up,but without statistical significance.Heart failure rats plasma ET levels significantly increased(P＜0.01),after treatment of drug-treated group,plasma ET levels have declined on average(P＜0.05～0.01),of which XinShuaiⅠof high-dose group is most obvious.(4) XinShuaiⅠagainst the contraction of heart failure rats superior mesenteric artery by phenylephrineHeart failure rats superior mesenteric artery response to phenylephrine increased(P＜0.05), and XinShuaiⅠand captopril groups are clearly against the hcontraction of heart failure rats superior mesenteric artery by phenylephrine(P＜0.01).(5) Detection of the extent of myocardial fibrosis in heart failure rats The extent of myocardial fibrosis in XinShuaiⅠof high and low dose groups and the captopril group were all less than model group,the extent of myocardial fibrosis in the captopril group is less than the model group,higher than high-dose group.4.conclusionXinShuaiⅠcan improve hemodynamic parameters significantly in heart failure rats,improve in varying degrees on renin - angiotensin - aldosterone system,atrial natriuretic peptide, endothelin and other related indicators,of the total,the high-dose group is more as significant. In addition,XinShuaiⅠcan can reduce the extent of myocardial fibrosis...