心力衰竭与心室重构

芪苈强心抑制心室重构抗心力衰竭

基础与临床研究证据CADHypCMValvLVDRemodelingLowEFArrhythmiasDeathPumpFailureCHFSymptomsNonCardiacFactorsVentricularRemodelingafterInfarctionandinDiastolicandSystolicHeartFailureNeurohormonalmodelofHFPrimarytargetsoftreatmentinHF气阳虚乏脉络瘀阻尿少水肿络息成积心室重构、心脏扩大气虚不能运血阳虚不能化水

“气分”（神经体液调节异常）

“水分”（钠水滁留）

“血分”（血流动力学异常）

益气温阳黄芪、附子、人参、桂枝活血通络丹参、红花利水消肿

葶苈子、泽泻、香加皮标本兼治强心、利尿、扩血管缓解心慌气短、不能平卧、尿少水肿症状抑制RASS与交感神经减少心室重构

与RASS、交感神经系统激活导致心室重构为慢性心衰病机新概念相吻合脉络学说指导慢性心衰病机、有效组方及作用研究[CellularImmunology2009,260:52-55]ResultsTheeffectofQiliqiangxinontheechocardiographicandhemodynamicparametersintheinfarctedhearts.g/kg/dayfor4weeksforRatsTheratioofTNF-a/IL-10ininfarctedmyocardialtissuewasreversedbyQiliqiangxin.Conclusion:QiliqiangxinimprovescardiacfunctionofratswithMIthroughregulationthebalancebetweenTNF-aandIL-10.12[JCardiovascPharmacol,2012,59(3):268-280]QLinhibitsmyocardialinflammationandcardiomyocytedeathandpromotescardiomyocyteproliferation,leadingtoanamelioratedcardiacremodelingandfunctioninamousemodelofpressureoverload.ThepossiblemechanismsmayinvolveinhibitionofangiotensinIItype1receptorandactivationofErbBreceptors.Conclusion:QL:0.6mg/kg/dayfor4weeksformice[Americanjournalofhypertension,2012,25,250-260]02QLQXdownregulatethecardiacchymasesignalingpathwayandchymase-mediatedangIIproduction.01QLQXimprovesbothsystolicanddiastoliccardiacfunctioninSHRs.Conclusion:临床试验注册临床研究简介LiX,ZhangJ,HuangJ,MaA,YangJ,LiW,WuZ,YaoC,ZhangY,YaoW,ZhangB,GaoR.AMulticenter,Randomized,Double-Blind,Parallel-Group,Placebo-ControlledStudyoftheEffectsofQiliQiangxinCapsulesinPatientsWithChronicHeartFailure.JAmCollCardiol.2013;62(12):1065-1072.

BNP/NT-proBNP可用于指导

心衰的治疗心衰患者治疗后BNP/NT-proBNP与基线相比下降达到或超过30%，表明治疗奏效如未下降或下降未达标甚至继续走高，则表明治疗效果不佳，应继续增强治疗的力度。中国心力衰竭诊断和治疗指南2014中华心血管病杂志2014(42):2生物标志物及应用情况推荐类别证据水平利钠肽HF的诊断或排除非卧床，急性IAHF的预后非卧床，急性IA达到GDMT目标非卧床IIaB指导急性失代偿性HF治疗急性IIbC心肌损伤标志物附加危险分层急性，非卧床IA心肌纤维化标志物附加危险分层非卧床IIbB急性IIbA

2013ACCF/AHAHFGuideline生物

标志物测定建议GDMT,Guideline-DirectedMedicalTherapy;指南导向药物治疗2013ACCF/AHAGuidelinefortheManagementofHeartFailure.E-PublishedonJune5,2013,availableat:[aStudyDesignNT-proBNP的水平变化及下降超过30%的比例两组NYHA心功能分级描述和比较LVEF、LVED、6MWD基线与第12周随访变化趋势明尼苏达生活质量量表评分变化趋势心血管复合事件药物不良事件EDITORIALCOMMENT

—CARDIOTONICMODULATIONINHEARTFAILURE:INSIGHTSFROMTRADITIONALCHINESEMEDICINE

—让衰竭的心脏更加强劲-中国传统医学给我们的启示EditorialComment（述评）-byTangWHW,HuangYItisconceivablethatinthefutureifqiliqiangxinprovestoprovidemorbidityandmortalitybenefitsinrigorousclinicaltrials,itwillfundamentallychallengetheexistingfoundationofscientificinquirybaseduponthepreciseunderstandingofpharmacodynamicsofdrugtherapies.可以想象的是，如果芪苈强心胶囊在未来高质量的临床研究中提供更多关于其对受试者发病率、死亡率益处的证据，那么它将从根本上挑战现有的关于药物效应动力学研究的科学观念。EditorialComment（述评）-byTangWHW,HuangYYetevenatpresent,thepromisingresultsreportedbyLiandcolleaguesmayhavealreadyopenedtheopportunitytoexplorewiththelatesttechnologieshowsynergisticinteractionsamongactiveTCMingredientscanbenefitthesyndromeofheartfailure.Thisisachallengethatweshouldallwarmlyembrace.现如今，这项富有前景的研究表明李及他的研究同事们已经打开了一扇如何利用最新科技研究传统中药活性成分在心力衰竭治疗中协同作用的大门。这是一个挑战，对此我们应该热烈拥抱。临床研究证据级别：由高到低1.随机对照研究2.前瞻性非随机对照研究3.回顾性对照研究4.非对照研究或历史对照研究5.荟萃分析6.病例报道7.评论，教授或其他专家意见

ProfessorJosephS.AlpertEditor-in-Chief,AmericanJournalofMedicine2013.7.19Nanjing（中华心血管病杂志2014(42):2）对芪苈强心临床试验结果进行了描述（参考文献58）中国心力衰竭诊断和治疗指南2014dayMISacrifice07142121dWorkingmodel:AMIremodelingOurwork:（我们的研究）Project1:TraditionalChineseMedicationQiliqiangxinattenuatescardiacremodelingafteracutemyocardialinfarctioninmiceUnpublisheddataResultsSaline+shamSaline+MIQL+MIQL+ShamUnpublisheddataRemoteRemoteRemoteRemoteBorderInfarctBorderInfarctBorderBorderUnpublisheddataSaline+ShamSaline+MIQL+MIUnpublisheddataReversalexperiments-PPARaPPARgUnpublisheddataMI+QL+PPARgInhibitorMI+QL+PPARgActivatorMI+QLUnpublisheddataPGC1aCb-ActinPPARaQMQM+PPARgInhibitorPPARgDUnpublisheddataFutureworkMISacrifice071421312418dday0123dayMISacrifice3dAcutephaseRemodelingphaseUnpublisheddataSaline+MIQL+MIUnpublisheddataAcutephase(TTCStaining)NMQMMISacrifice71421312418dABBPPARaPPARg1PGC-1ab-actinProject2:ThemataboliceffectsofQLQXonH9C2(invitro)UnpublisheddataBasalOxidativeMetabolismPeakOxidativeMetabolismFigure1:OxidativeMetabolismindicatedbyoxygenconsumptionofH9C2myocytestreatedwithQLatdifferenttimeanddoseAMitochondrialUncouplingMetabolicRelianceBCBasalGlycolysisPeakGlycolysisFigure2:GlycolysisMetabolismindicatedbyoxygenconsumptionofH9C2myocytestreatedwithQLatdifferenttimeanddoseABFigure3:MitochondrialContentmeasuredbymicroscopyandflowcytometryControllQL(48hr)MitotrackerMitotrackerMergeMergeMitochondrialcontentAB待发表文章:TraditionalChineseMedicationQiliqiangxinattenuatescardiacremodelingafteracutemyocardialinfarctiontargetingPPARR已于3月31号向哈佛大学医学院附院心内科主任、新英格兰副主编托尼教授汇报过研究结果受到好评。临床意义作为预防心肌梗死后心室重构导致心衰的治疗策略之一？（B阶段）（RAS/BB）QiliqiangxininHeartFailUre：AssESsmentofReductioninMorTalityProfXinliLiTheFirstAffiliatedHospitalwithNanjingMedicalUniversityonbehalfoftheInvestigatorsStudyDesignTherapeuticregimen:enrolledpatientswithHF

aregivenoralmedicationtreatmentaccordingtoDiagnosisandTreatmentGuidelinesofHF