稳律平悸颗粒对心房颤动心肌纤维化干预效应的CMR T1 mapping定量评估
Quantitative Assessment of CMR T1 Mapping on the Interventional Effects of Wenlü Pingji Granule on Myocardial Fibrosis and Atrial Fibrillation
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摘要: 目的 运用心脏磁共振纵向弛豫时间（CMR T1 mapping）定量评估稳律平悸颗粒对心房颤动气阴两虚证患者左心室心肌纤维化的干预效应。方法 选取2017年3月至2019年11月符合纳入标准的房颤气阴两虚证患者43例（持续性房颤17例、阵发性房颤26例），随机分为西药治疗对照组（20例）和经验方稳律平悸颗粒治疗中药组（23例），治疗及观察周期24周。采用CMR T1 mapping成像定量评估治疗后左心室心肌纤维化，ELISA法检测血清白介素-18（IL-18）、肿瘤坏死因子-α（TNF-α）、超氧化物歧化酶（SOD）、丙二醛（MDA）、肝激酶B1（LKB1）水平和纤维化指标基质金属蛋白酶2（MMP-2）、Ⅲ型前胶原氨基末端肽（PⅢNP）以评估房颤纤维化上游氧化炎症相关因子的变化。结果 中药组阵发性房颤患者房颤的复发次数和复发率均低于对照组（P<0.05）。中药组治疗后T1值和ECV均明显下降（P<0.01），血清MMP-2、PⅢNP、IL-18、TNF-α、MDA 水平显著降低（P<0.01），SOD和LKB1水平显著升高（P<0.01），优于西药对照组（P<0.01）。结论 稳律平悸颗粒有助于阵发性房颤患者窦律维持、减少复发，可抑制房颤气阴两虚证患者心肌纤维化，机制可能与抑制上游氧化炎症级联有关。
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关键词:
- 稳律平悸颗粒 /
- 心房颤动 /
- 气阴两虚证 /
- 心肌纤维化 /
- 心脏磁共振纵向弛豫时间定量成像
Abstract: OBJECTIVE To observe the quantitative assessment of cardiac magnetic resonance longitudinal relaxation time (CMR T1 mapping) on the interventional effect of Wenlü Pingji Granule on patients with atrial fibrillation (deficiency of both qi and yin) in terms of left ventricular myocardial fibrosis. METHODS 43 patients with atrial fibrillation with deficiency of qi and yin syndrome who met the inclusion criteria from March 2017 to November 2019， including 17 cases of persistent atrial fibrillation and 26 cases of paroxysmal atrial fibrillation. They were randomly divided into western medicine control group (20 cases) and Chinese medicine group (23 cases) applied with Wenlü Pingji Granule. The treatment and observation period was 24 weeks. The left ventricular myocardial fibrosis after treatment was quantitatively assessed by CMR T1 mapping imaging. ELISA was applied to detect serum interleukin 18 (IL-18)， tumor necrosis factor-α (TNF-α)， superoxide dismutase (SOD)， malondialdehyde (MDA)， liver kinase B1 (LKB1) levels and fibrosis indicator matrix metalloproteinase-2 (MMP-2)， pre-collagen amino terminal peptide Ⅲ (PⅢ NP) so as to assess the changes of upstream oxidative inflammation-related factors in atrial fibrillation fibrosis. RESULTS The number of recurrence frequency and rate of atrial fibrillation in patients with paroxysmal atrial fibrillation in the Chinese medicine group were lower than those in the control group (P<0.05). The T1 value and ECV were significantly decreased (P<0.01)， serum MMP-2， PⅢ NP， IL-18， TNF-α and MDA levels were significantly decreased (P<0.01) and SOD and LKB1 levels were significantly increased (P<0.01) after treatment in the Chinese medicine group， which were better than those in the western medicine control group (P<0.01). CONCLUSION Wenlü Pingji Granule can keep Sinus rhythm maintenance and reduce recurrence in patients with paroxysmal atrial fibrillation， as well as inhibit myocardial fibrosis in atrial fibrillation patients with deficiency of qi and yin syndrome. The mechanism may be related to the inhibition of the upstream oxidative inflammatory cascade. -
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