| 毛晓波,王诗奇,毛奕,曾秋棠,李裕舒.大黄对急性心肌梗死伴泵衰竭患者肠道屏障功能的影响[J].,2012,32(8):1046-1050 |
| 大黄对急性心肌梗死伴泵衰竭患者肠道屏障功能的影响 |
| Effects of Rhubarb on the Intestinal Barrier Function of Patients with Acute Myocardial Infarction-Heart Failure |
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| DOI： |
| 中文关键词: 大黄 心肌梗死 心力衰竭 肠道屏障 |
| 英文关键词:rhubarb acute myocardial infarction heart failure intestinal barrier |
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| 中文摘要: |
| 目的明确急性心肌梗死伴泵衰竭(acute myocardial infarction-heart failure,AMI-HF)患者肠道屏障功能状态并比较大黄及质子泵抑制剂(proton pump inhibitor,PPI)——泮托拉唑的治疗效果。方法选择2008年5月—2010年4月华中科技大学同济医学院附属协和医院心内科监护室住院急性心肌梗死(acute myocardial infarction,AMI)患者107例,其中47例AMI不伴泵衰竭患者作为对照组,将60例AMI-HF患者随机分为泮托拉唑组(30例,泮托拉唑+常规治疗)和大黄组(30例,大黄+常规治疗)。3组均治疗至发病后第14天。所有患者每天查大便潜血试验,比较各组患者发病后第14天消化道出血发生率;比较各组患者治疗前后血清氨基末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)、血清D-乳酸、血浆谷氨酰胺(glutamine,Gln)、内毒素和细胞因子[高敏C反应蛋白(high sensitive C reaction protein,hsCRP)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-10(interleukin-10,IL-10)]水平及心功能。结果 3组阿司匹林、氯吡格雷、低分子肝素、ACEI/ARB、他汀类、胰岛素、抗生素使用例数比较差异无统计学意义。两个给药组β受体阻滞剂使用例数明显低于对照组,利尿剂使用例数明显高于对照组,差异均有统计学意义(P<0.05)。3组患者消化道出血发生例数比较差异无统计学意义(P=0.413)。治疗前与对照组比较,两个给药组Gln、射血分数(EF)均降低,NT-proBNP、D-乳酸、内毒素、hsCRP、TNF-α及IL-10均升高,差异均有统计学意义(P<0.01)。两个给药组间各指标比较,差异无统计学意义(P>0.05)。与本组治疗前比较,泮托拉唑组治疗后NT-proBNP、D-乳酸、内毒素、hsCRP、TNF-α及IL-10降低,差异均有统计学意义(P<0.01),Gln浓度、EF无明显变化(P>0.05)。大黄组治疗后Gln、EF升高,且高于对照组,血NT-proBNP、D-乳酸、内毒素、hsCRP、TNF-α及IL-10均降低,且低于对照组,差异均有统计学意义(P<0.01,P<0.05)。结论 AMI-HF患者存在肠道屏障功能受损和内毒素血症,大黄除预防消化道出血外,还可通过改善肠道屏障功能,减少内毒素血症,抑制炎症反应,改善心功能。 |
| 英文摘要: |
| Objective To clarify the intestinal barrier function(IBF) state of patients with acute myocardial infarction-heart failure(AMI-HF),and to compare the therapeutic effects of rhubarb and Pantoprazole(proton pump inhibitor).Methods Enrolled were 107 AMI patients from ICU,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology from May 2008 to April 2010.Of them,47 AMI patients without HF were recruited as the control group,while 60 AMI-HF patients were randomly assigned to the rhubarb group(30 cases,treated by rhubarb+Pantoprazole) or the Pantoprazole group(30 cases,treated by Pantoprazole +routine treatment).All patients were treated till the 14 th day of the onset.The fecal occult blood(FOB) test was performed daily.The occurrence of the digestive tract hemorrhage on the 14th day after onset was compared.The N-terminal pro-brain natriuretic peptide(NT-proBNP),serum D-lactic acid,plasma glutamine(Gln),endotoxin and cytokines [high sensitive C reaction protein(hsCRP),tumor necrosis factor-α(TNF-α),interleukin-10(IL-10)],and heart function were compared among the three groups before and after treatment.Results There was no statistical difference in the case number of using aspirin,clopidogel,low molecular weight heparin,ACEI/ARB,statins,insulin,and antibiotics among the 3 groups.The case number of using β-blocker was obviously lower in the two medication groups than in the control group(P<0.05).The case number of using diuretics was obviously higher in the two medication groups than in the control group(P<0.05).There was no statistical difference in the incidence of digestive tract hemorrhage(P=0.413).Compared with the control group before treatment,Gln and ejection fraction(EF) were both lowered,NT-proBNP,D-lactic acid,endotoxin,hsCRP,TNF-α,and IL-10 increased in the two medication groups(P<0.01).There was no statistical difference in each index between the two medication groups(P>0.05).Compared with before treatment,NT-proBNP,D-lactic acid,endotoxin,hsCRP,TNF-α,and IL-10 decreased in the Pantoprazole group(P<0.01),and no obvious change in Gln or EF was found(P>0.05).Gln and EF increased in the rhubarb group after treatment,and they were higher than those of the control group.Blood NT-proBNP,D-lactic acid,endotoxin,hsCRP,TNF-α,and IL-10 decreased in the rhubarb group after treatment,showing statistical difference when compared with the control group(P<0.01,P<0.05).Conclusions Impaired IBF and endotoxemia existed in AMI-HF patients.Rhubarb not only could prevent the digestive tract hemorrhage,but also could reduce endotoxemia,inhibit inflammatory reactions,and improve the heart function through ameliorating the IBF. |
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