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目的:观察参桂益心汤对慢性心力衰竭患者外周血单核细胞Toll样受体4/核转录因子-κB(TLR4/NF-κB)信号通路的影响。方法:124例慢性心力衰竭患者按随机数字表法分为对照组(50例)和治疗组(74例),对照组给予西医常规药物治疗,治疗组在对照组基础上加用参桂益心汤,每日1剂,疗程4周。比较两组治疗前后心功能,包括心率(HR),左室射血分数(LVEF),左室舒张末期内径(LVDD),6 min步行实验距离(6 m WT);测定两组治疗前后外周血单核细胞TLR4,NF-κB及肿瘤坏死因子-α(TNF-α),白细胞介素-6(IL-6),白细胞介素-1β(IL-1β)mRNA和蛋白表达;患者出院后随访6~18个月,观察两组再住院率、病死率及再住院次数。结果:与对照组比较,治疗组总有效率明显升高(P<0.05);与对照组比较,治疗组HR,LVDD明显降低,LVEF,6 m WT明显增加(P<0.05);治疗组较对照组TLR4,NF-κB,TNF-α,IL-6,IL-1βmRNA和蛋白表达明显降低(P<0.05);二组患者均较治疗前好转(P<0.05)。治疗组再住院率、病死率及再住院次数较对照组明显降低(P<0.05)。结论:参桂益心汤能够抑制慢性心力衰竭患者外周血单核细胞TLR4/NF-κB信号通路,抑制炎症,改善患者心功能。
Objective: To observe the effect of Shen Gui Yi Xin Tang on Toll-like Receptor 4 / NF-κB signal transduction pathway in peripheral blood mononuclear cells in patients with chronic heart failure. Methods: One hundred and twenty-four patients with chronic heart failure were divided into control group (n = 50) and treatment group (n = 74) according to random number table. The control group was given routine western medicine treatment. Soup, 1 day, 4 weeks treatment. Heart rate (HR), left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVDD) and 6-min walking distance (6 m WT) were compared between the two groups before and after treatment. The expression of TLR4, NF-κB and TNF-α, IL-6 and IL-1β mRNA and protein in monocytes were observed. The patients were followed up From 6 to 18 months, the rehospitalization rate, case fatality rate and rehospitalization rate were observed in both groups. Results: Compared with the control group, the total effective rate of the treatment group was significantly increased (P <0.05). Compared with the control group, the HR and LVDD of the treatment group were significantly decreased, while the LVEF and 6 m WT were significantly increased (P <0.05) The mRNA and protein expressions of TLR4, NF-κB, TNF-α, IL-6 and IL-1β in the control group were significantly decreased (P <0.05). The rehospitalization rate, case fatality rate and number of rehospitalization in the treatment group were significantly lower than those in the control group (P <0.05). Conclusion: Gui Guixi Decoction can inhibit TLR4 / NF-κB signaling pathway in peripheral blood mononuclear cells in patients with chronic heart failure, inhibit inflammation and improve cardiac function.