益气温阳活血方对心肌梗死患者骨髓干细胞动员作用和心功能的影响

Effect of Yiqi Wenyang Huoxue Recipe on Bone Marrow Stem Cells’ Mobilization and Its Influence on Heart Function in Patients with Myocardial Infarction

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中文关键词: 急性心肌梗死干细胞动员益气温阳活血方心功能

英文关键词:acute myocardial infarction stem cell mobilization Yiqi Wenyang Huoxue Recipe heart function

基金项目:

作者	单位
杨庆有	广州中医药大学第一临床医学院
赵立诚	广州中医药大学第一临床医学院

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中文摘要:

目的观察益气温阳活血方对心肌梗死患者骨髓干细胞的动员作用及心功能的影响。方法60例急性心肌梗死患者按数字表法随机分为治疗组和对照组,每组30例,两组患者均给予标准治疗:低分子肝素钙0.4 mL皮下注射,每12 h 1次,连用7天,阿司匹林肠溶片0.1 g,每日1次,培哚普利片4 mg,每日1次,阿托伐他汀钙10 mg,每日1次,如无禁忌症则连续使用,治疗组加服益气温阳活血方（人参10 g黄芪15 g制附子5 g毛冬青30 g益母草10 g）每天1剂,水煎服200 mL,早晚各100 mL,连用10天,观察两组患者外周血CD₃₄⁺细胞数量变化情况,在发病3周末QRS记分法预测心肌梗死面积,超声心动图检测左室射血分数（left ventricular ejection fraction,LVEF）、左室收缩末期容积指数（left ventricular end-systolic volume index,LVESVI）、左室舒张末期容积指数（left ventricular end-diastolic volume index,LVEDVI）以及室壁运动积分指数（wall motion score index,WMSI）等指标。结果治疗组第5天和第10天,外周血CD₃₄⁺细胞（分别为48.26±5.74和34.18±6.70）,明显高于入院即刻（20.33±6.01）,也高于同时刻对照组（分别为22.45±5.31和19.89±5.93）,差异有统计学意义（P<0.01）。第21天,治疗组QRS积分（2.68±0.41）和梗死面积（22.54±2.49）%比对照组[分别为3.96±0.34;（29.38±2.59）%]为低,LVEF（0.59±0.07）比对照组（0.50±0.07）显著升高,治疗组LVESVI（27.47±7.86）、LVEDVI（68.92±11.52）和WMSI（2.10±0.11）与对照组（分别为36.71±8.85;78.46±13.16;2.98±0.12）比较,差异有统计学意义（P<0.01）结论益气温阳活血方具有良好的干细胞动员作用,可以减少心肌梗死面积,改善心功能。

英文摘要:

Objective To observe the effect of Yiqi Wenyang Huoxue Recipe （YWHR） on bone marrow stem cells’ mubilization and heart function of myocardial infarction （MI） patients.Methods Sixty acute MI patients were equally assigned to the treatment group and the control group randomly according to the numeration table. Standard therapy composed of subcutaneous injection of 0.4 mL low molecular heparin every 12 h for 7 successive days combined with continuously orally taken of enteric-coated aspirin tablets 0.1 g,Perindopril 4 mg and Atorvas- turin 10 mg once a day （if there was no contraindieation）,was given to all patients. But to the treatment group, one dose of YWHR was given every day additionally,which consisted of Panax ginseng 10 g,Radix Astragali 15 g, Radix Aconiti lateralis preparata 5 g,Radix Ilex pubeseeus 30 g and Herbal Leonuri 10 g for 10 successive days. The change of CD₃₄⁺ cells’ count was observed.The infarcted area size was estimated with QRS scoring system at the end of the 3rd week after nnset,and the heart function parameters,including left ventricular ejection fraction （LVEF）,left ventricular end-systolic volume index （LVESVI）,left ventricular end-diastolic volume index （LV- EDVI） and wall motion score index （WMSI）,were measured with ultrasonic cardiogram. Results On the fifth and tenth day,the peripheral CD₃₄⁺ cell count in the treatment group （48.26±5.74 and 34.18±6.70） were sig- nificantly higher than that on the day of admission （20.33±6.01）,also higher than the corresponding count in the control group （22.45±5.31 and 19.89±5.93）,showing statistical difference （P<0.01）.The QRS score （2.68±0.41 ）and infarcted area （22.54±2.49）% in the treatment group were lower than those in the control group （3.96±0.34 and 29.38±2.59） respectively. Comparison of heart function parameters between groups showed that LVEF （0.59±0.07 vs 0.50±0.07） was higher LVEDVI （68.92±11.52 vs 78.46±13.16）, LVESVI （27.47±7.86 vs 36.71±8.85）,and WMSI （2.10±0.11 vs 2.98±0.12） were lower in the treatment group than those in the control group respectively,also showing statistical difference （all P<0.01）.Conclu- sion YWHR has a good effect on bone marrow stem cell mobilization,it can reduce the infarcted area and improve the heart function of patients with acute MI.

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