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目的:探讨黄芪合剂对扩张型心肌病(DCM)室性心律失常长期疗效及相关机制。方法:选择65例稳定性DCM室性心律失常患者,根据病毒学检查结果分为阳性组(36例)和阴性组(29例)。在常规治疗基础上,阳性组中有25例接受口服黄芪合剂治疗半年(即阳1亚组),11例拒绝而未接受黄芪口服治疗(即阳2亚组);阴性组中有18例接受黄芪治疗(即阴1亚组),11例未接受黄芪治疗(即阴2亚组)。治疗前后应用Holter检查观察患者室性心律失常变化、心脏彩色超声多普勒评估心脏左室舒末内径(LVEDd)和左室射血分数(LVEF)、ELISA法检测外周血细胞因子IFN-γ、白细胞介素-4(IL-4)与转化生长因子(TGF)-β1水平。结果:阳1亚组和阴1亚组中分别有3例和2例未坚持服用黄芪或失访而退出。与治疗前相比,阳1亚组、阳2亚组、阴1亚组、阴2亚组室性心律失常改善率分别为:54.5%(12/22)、18.2%(2/11)、43.8%(7/16)、27.3%(3/11),阳1亚组与阳2亚组比较,差异有统计学意义(P<0.05);阳1亚组和阴1亚组LVEDd均有缩小(P<0.05)、LVEF均有升高(P<0.05),血IFN-γ和TGF-β1水平显著下降(P<0.01),而IL-4变化无统计学意义;阳2亚组和阴2亚组也有相似表现,但是LVEDd、LVEF和IL-4变化均差异无统计学意义。结论:口服黄芪合剂可以有效控制DCM室性心律失常,其机制可能与降低患者IFN-γ和TGF-β水平、抑制心肌纤维化有关。
Objective: To investigate the long-term effects of Astragalus mongholicus mixture on ventricular arrhythmias in patients with dilated cardiomyopathy (DCM) and its related mechanism. Methods: Sixty-five patients with stable DCM ventricular arrhythmias were divided into positive group (36 cases) and negative group (29 cases) according to the results of virological examination. On the basis of routine treatment, 25 patients in the positive group received oral Astragalus Mixture for six months (ie, Yang 1 subgroup), while 11 patients refused and did not receive Astragalus Oral Administration (ie, Yang 2 subgroup). In the negative group, 18 received Astragalus treatment (ie, Yin 1 subgroup), 11 cases did not receive Astragalus treatment (ie Yin 2 subgroup). The change of ventricular arrhythmia was observed by Holter test before and after treatment. Cardiac left ventricular end-diastolic diameter (LVEDd) and left ventricular ejection fraction (LVEF) were assessed by color Doppler sonography. Peripheral blood cytokine IFN-γ, leukocyte count Interleukin-4 (IL-4) and Transforming Growth Factor (TGF) -beta1 levels. Results: In Yang 1 subgroup and Yin 1 subgroup, 3 cases and 2 cases did not insist on taking astragalus or lost and then quit. Compared with before treatment, the improvement rates of ventricular arrhythmia in Yang 1 subgroup, Yang 2 subgroup, Yin 1 subgroup and Yin 2 subgroup were 54.5% (12/22), 18.2% (2/11) 43.8% (7/16) and 27.3% (3/11) respectively. There was significant difference between Yang 1 subgroup and Yang 2 subgroup (P <0.05) (P <0.05), LVEF increased (P <0.05), the levels of serum IFN-γ and TGF-β1 decreased significantly (P <0.01), but there was no significant difference in IL- Yin 2 subgroup also have similar performance, but there is no significant difference in LVEDd, LVEF and IL-4. Conclusion: Oral Huangqi mixture can effectively control DCM ventricular arrhythmia, which may be related to the reduction of IFN-γ and TGF-β levels and the inhibition of myocardial fibrosis.