| Purpose:To sum up traditional Chinese Medicine understanding and treatment of chronic heart failure of tutor,and investigate the efficacy and mechanism of Tonifying qi and strengthening heart in chronic heart failure rats,and consummate the theory of Chinese Medicine of chronic heart failure.Materials and methods:1.To sum up TCM theory and treatment of chronic heart failure by clinical study with teacher.2.Articles of comprehensive search for randomized controlled trials of Tonifying qi and strengthening heart method in the treatment of heart failure from 12,2005 to 11,2016 were searched,and analysised by Review Manager 5.3 software.3.120 adult male SD rats were selected and 20 rats as the control group,and 100 Wistar rats were establish the rat model of chronic heart failure with coronary ligation combined with starvation and randomly divided into model group,low dose group,middle dose group and high dose group,Lodin group.All groups were treated with the appropriate drug treatment.Hemodynamic parameters,cardiac morphology,serum Ang concentration and levels of myocardial tissue ACE,AT1,TGF-?1,collage I and Periostin and were compared.Results:1.Understanding of chronic heart failure with Chinese Medicine including the theory,the law,the prescription,and the medicine of tutor were summed up,the tutor belived that the name of"heart failure"has not been put forward in TCM,but it can be treated on syndrome differentiation refer to the existing diseases of traditional Chinese Medicine such as"Asthma","phlegm","edema","palpitation","heart attack","chest attack",this disease is located in the heart,and closely related to the lung and kidney,involving the liver and spleen.The etiology and pathogenesis of traditional Chinese medicine are"deficiency","blood stasis"and"phlegm and retained fluid",which is based on Qi deficiency.The method of Tonifying qi and strengthening heart(supplementing qi,strengthening heart and activating blood and promoting diuresis)is used to treat the chronic heart failure.2.nine articles were collected,one of them mentioned double blind method,the age,the quality of the literatures in two of them did not mention,and the quality of literature was not high.Clinical efficacy forest map consolidation effect OR=3.82,Z=5.96(P<0.00001), 95%CI(2.46,5.93),this means the clinical efficiency has obvious advantages in the treatment of heart failureusing"Tonifying qi and strengthening heart"method.LVEF forest map consolidation effect OR=7.57,Z=6.45(P<0.00001),95%CI(5.27,9.87),this means that compared with the control group,levels of LVEF were higher by using"Tonifying qi and strengthening heart"in treatment of heart failure,LVEDD forest map consolidation effect OR=-4.70,Z=4.27(P<0.0001),95%CI(-6.85,-2.54),this means that compared with the control group,levels of LVEDD by using"Tonifying qi and strengthening heart"method in treatment of heart failure were lower.3.Compared with the control group,the levels of LVSP,~+dp/dtmax and~-dp/dtmax in the model group were lower,levels of left ventricular end diastolic pressure(LVEDP)and heart rate(HR)were higher,with statistical significance(P<0.01).Compared with the model group,the levels of LVSP,~+dp/dtmax and~-dp/dtmax in the model group were lower,levels of left ventricular end diastolic pressure(LVEDP)and heart rate(HR)were higher in low dose of Tonifying qi and strengthening heart decoction group,middle dose of Tonifying qi and strengthening heart decoction group,high dose of Tonifying qi and strengthening heart decoction group,and lotensin group,with statistical significance(P<0.05,P<0.01).Compared with low dose of Tonifying qi and strengthening heart decoction group,levels of LVSP,~+dp/dtmax and~-dp/dtmax in the model group were lower,levels of left ventricular end diastolic pressure(LVEDP)and heart rate(HR)were higher in middle dose of Tonifying qi and strengthening heart decoction group,high dose of Tonifying qi and strengthening heart decoction group,and lotensin group,with statistical significance(P<0.05,P<0.01).Compared with middle dose of Tonifying qi and strengthening heart decoction group,levels of LVSP,~+dp/dtmax and~-dp/dtmax in the model group were lower,levels of left ventricular end diastolic pressure(LVEDP)and heart rate(HR)were higher in high dose of Tonifying qi and strengthening heart decoction group,and lotensin group,with statistical significance(P<0.05,P<0.01).There was no significant difference between the high dose of Tonifying qi and strengthening heart decoction group,and lotensin group(P>0.05).Compared with the control group,the rats in the model group were significantly lower(P<0.01),and there was no significant difference in weight between the rest groups(P>0.05).Compared with the model group,levels of weight were higher in middle dose of Tonifying qi and strengthening heart decoction group,high dose of Tonifying qi and strengthening heart decoction group,and lotensin group,with statistical significance(P<0.05,P<0.01).Compared with the control group,the left ventricular mass index was higher in the model group(P<0.01),compared with the model group,the left ventricular mass index were lower in low dose of Tonifying qi and strengthening heart decoction group,middle dose of Tonifying qi and strengthening heart decoction group,high dose of Tonifying qi and strengthening heart decoction group,and lotensin group,with statistical significance(P<0.05,P<0.01).There were no significant difference between the middle dose of Tonifying qi and strengthening heart decoction group,high dose of Tonifying qi and strengthening heart decoction group,and lotensin group(P>0.05).Compared with the control group,the concentration of serum Ang?was higher in the model group(P<0.01).Compared with the model group,the concentration of serum Ang?were lower in high dose of Tonifying qi and strengthening heart decoction group,and lotensin group(P<0.01),Compared with the high dose of Tonifying qi and strengthening heart decoction group,the concentration of Ang?in lotensin group was lower,and the difference was statistically significant(P<0.01).Compared with the control group,the expression of ACE and AT1 protein in the model group were higher,which was statistically significant(P<0.01).Compared with the model group,the expression of ACE protein in myocardial tissue of rats with were lower,and lotensin group<middle dose and high dose of Tonifying qi and strengthening heart decoction group<low dose of Tonifying qi and strengthening heart decoction group,with statistical significance(P<0.05,P<0.01).Compared with the model group,AT1 protein expression level in rats were lower,and lotensin group<high dose of Tonifying qi and strengthening heart decoction group<low dose of Tonifying qi and strengthening heart decoction groupof Tonifying qi and strengthening heart decoction group.Compared with the control group,the expression level of TGF-?1protein was significantly higher in the model group(P<0.01),compared with the model group,the myocardial tissue of rats TGF-?1 expression level decreased,the Lotensin group<high dose of Tonifying qi and strengthening heart decoction group<middle dose and low dose of Tonifying qi and strengthening heart decoction group,with statistical significance(P<0.01).Compared with the control group,the expression level of Periostin and collage?protein in myocardial tissue of model group was higher,which was statistically significant(P<0.01),compared with the model group,the expression of Periostin protein in myocardial tissue of rats decreased,and Lotensin group<high dose of Tonifying qi and strengthening heart decoction group<Yiqiqiangxin Decoction low dose group,with statistical significance(P<0.01),Compared with the model group,Tonifying qi and strengthening heart decoction,high dose group,Lotensin group collage 1 protein expression level is low,the Lotensin group<Yiqiqiangxin Decoction high dose group<Yiqiqiangxin Decoction low dose group,with statistical significance(P<0.01).Conclusions:1.The mechanism of chronic heart failure in TCM were"deficiency","blood stasis"and "phlegm and retained fluid",and tonifying qi and strengthening heart method was established based on it,and it tonifying qi and strengthening heart method was effective in the treatment of chronic heart failure.2.Meta analysis confirmed that compared with conventional therapy,Yiqiqiangxin method combined with conventional therapy in the treatment of heart failure can significantly improve the LVEF,reduce the LVEDD,so as to improve the ventricular function,has a better clinical curative effect.3.Tonifying qi and strengthening heart decoction can reduce serum Ang II in heart failure rats and inhibit the expression of TGF-?1,ACE,AT1,collagen I and Periostin proteins,and play a role in inhibiting the development of myocardial fibrosis,delaying left ventricular remodeling and improving cardiac function,and it maybe due to inhibit angiotensin II-transforming growth factor-myocardial fibrosis pathway. |
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