| Background:Diabetes mellitus lasting over 5 years can cause cardiac metabolic disorder and microvascular changes,which result in changes in myocardial structure and function,which is also known as the occurrence of diabetic cardiomyopathy.Since 1972,the concept of diabetic cardiomyopathy has been proposed and developed for more than 40 years.Domestic and foreign scholars have conducted a large number of multi-target,multi-angle,multi-channel explorations and researches to investigate the pathogenesis of diabetic cardiomyopathy through animal experiments and on cell molecular level,although the diversity of its pathogenesis has been gradually recognized.A consensus has yet not been reached over its pathogenesis.However,in the past 40 years,there has been no significant development in the formulation of its prevention strategy,which is due to the scarcity of clinical observation cases,so far,there is no global and regional extraction and summarization of clinical large-scale samples of diabetic cardiomyopathy.Therefore,the choice of drug use and the development of the overall program are lagging behind.At present,clinical treatment of the disease is still stagnant in the stage of treatment of background diseases(positively reducing blood glucose,delaying the emergence of complications)and symptomatic treatment,that is,temporary medical relief.However,in clinical practice,owing to the lack of specific noninvasive diagnostic methods(such as serum markers,MRI,etc.)The early diagnosis rate of the disease has been hindered.In the diagnosis of diabetic cardiomyopathy,the myocardial cell biopsy was mentioned,but this technique was rarely used because of its invasive,difficult operation and related adverse reactions.In view of the greater risk of cardiovascular events in diabetic patients than in the general population,and cardiovascular complications are the leading cause of death in diabetic patients,it is of great significance to study diabetic cardiomyopathy.In recent years,based on the unique advantages of traditional Chinese medicine,the TCM syndrome differentiation and holistic thinking are brought into full play in the diagnosis and treatment of diseases,some progresses have been made by traditional Chinese medicine in the treatment of diabetic cardiomyopathy.Therefore,we hope that,on the basis of previous studies,we can explore how Astragalus heart-protecting decoction plays a beneficial role in the treatment of diabetic cardiomyopathy.Objective One:To study 80 patients with diabetic cardiomyopathy who were considered by syndrome differentiation as deficiency of both qi and y in and as heart blood stasis type,in order to observe the clinical effect of Astragalus heart-protecting decoction on the patients with diabetic cardiomyopathy and its effect on TCM syndrome,left ventricular ejection fraction,serum NT-proBNP level,CRP,HbAlc,FFA,SOD,GSH-Px and other indexes.Methods:80 patients were selected and divided by random number table method into two groups,40 patients were assigned for Astragalus heart-protecting decoction Group,and 40 patients were assigned for the basic treatment group,both groups were given conventional anti-heart failure symptomatic treatment,and concurrently,given treatment of reducing blood glucose based on the blood glucose level.On this basis,Astragalus heart-protecting decoction Group was orally administered with Astragalus heart-protecting decoction,the treatment duration of both groups was 3 months.The clinical effect and changes in index like TCM syndrome,left ventricular ejection fraction,serum NT-proBNP level,CRP,HbAlc,FFA,SOD and GSH-Px were observed.Result:1.After treatment,the effective rate of Astragalus heart-protecting decoction Group was 42.5%and its total effective rate was 92.5%;the counterpart of the basic treatment group was 25.0%and 77.5%.the difference between the two groups was statistically significant(P<0.05)2.The TCM syndrome score of both groups after treatment was clearly lower than it was before treatment(P<0.05),and Astragalus heart-protecting decoction Group was lower than the basic treatment group(P<0.05)3.The LVEF of both groups after treatment was clearly improved as compared to it was before treatment(P<0.05),and Astragalus heart-protecting decoction Group was improved more significantly than the basic treatment group was(P<0.05)4.The NT-proBNP level of both groups after treatment was clearly lower than it was before treatment(P<0.05),and Astragalus heart-protecting decoction Group dropped more sharply than the basic treatment group did after treatment,the difference in data was statistically significant(P<0.05)5.The serum CRP level of both groups after treatment was clearly lower than it was before treatment,the difference was statistically significant(P<0.05);compared with the basic treatment group,the CRP level of Astragalus heart-protecting decoction Group dropped more sharply than the basic treatment group did after treatment(P<0.05)6.The level of HbAlC and FFA in both groups after treatment was clearly lower than they were before treatment(P<0.05),and Astragalus heart-protecting decoction Group dropped more sharply(P<0.05)7.The level of SOD?GSH-Px in both groups after treatment was clearly higher than they were before treatment,the difference was statistically significant(P<0.05),compared with the basic treatment group,the CRP level of Astragalus heart-protecting decoction Group had a sharper increase in SOD and GSH-Px level after treatment(P<0.05);Objective Two:To discuss and explore the effect of Astragalus heart-protecting decoction on the myocardial energy metabolism,oxidative stress level and inflammatory factor of diabetic cardiomyopathy rats.Method:80 SD rats were chosen for STZ modeling,50 of them were successfully modeled.The modeled group was randomly divided into 4 groups,respectively,model group,low,medium and high-dose Astragalus heart-protecting decoction group,the blank group and model control group was gavaged with citrate buffer solution,the medication group was gavaged with Astragalus heart-protecting decoction respectively at 7.5g/kg?15g/kg and 30g/kg,once a day over 8 weeks consecutively,when the procedure was finished a ultrasound examination of left ventricle was performed,HE staining for morphological change in myocardial tissue of rats:the changes of blood glucose,triglyceride and total cholesterol in serum were detected,followed by the determination of NT-PROBNP and HS-CRP content in serum by Elisa method and determination of SOD and MDA by Coomassie Blue methodResult:1.Compared with the blank group,the rats in model group had a higher LVEDD and LVESD and lower EF,FS and SV(P<0.01);the medication group had inordinately lower LVEDD and LVESD than the model group,and inordinately higher EF,FS and SV than the model group,and all of the above results were dependent on the drug dose,the high-dose group had the optimum result.2.HE staining revealed:In the model group,the myocardial morphology was larger than that in the blank group.And the myocardial cells were disorderly arranged,indicating that,the modeling was successful.In contrast to the model group,in the drug treatment group,the myocardial cells were arranged more orderly.The high drug-dose group showed the best result.3.Compared with the blank group,the blood glucose and blood lipid of the model group increased obviously,and its blood glucose and blood lipid decreased somewhat as compared with the model group after medication.4.Compared with the blank group,the increase of NT-proBNP and Hs-CRP of the model group was obvious,after medication,the NT-proBNP and Hs-CRP were both significantly decreased as compared with the model group(p<0.05),and the degree of decrease was dose-dependent and the high dose group had the best effect.5.Compared with the blank group,the SOD of the model group decreased,the MDA of it increased,medication can induce an increase in SOD and a decrease in MDA,the change degree was correlated with the dosage,and the high-dose group showed the best performance.Astragalus heart-protecting decoction can improve the metabolic disorder of glucose and lipid in rats with diabetic cardiomyopathy,and improve the cardiac function by regulating oxidative stress factor and alleviating inflammatory reaction.Conclusion:It was found by the animal experiment and clinical observation that,the astragalus heart-protecting decoction can improve the patient DCM condition more effectively on the basis of conventional anti-heart failure and glucose-lowering therapy,the mechanism of astragalus heart-protecting decoction to improve DCM mainly involves regulating blood lipid metabolic disorder,alleviating oxidative stress injury,inhibiting inflammatory reaction and further inhibiting the occurrence and development of myocardial lesions. |
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