| 黄连温胆汤加减调控TMAO生成对CHD合并AF患者脂质炎症网络的影响 |
| Effect of Modified Huanglian Wendan Decoction on Regulating TMAO Production and the Lipid-Inflammatory Network in Patients with Coronary Heart Disease Complicated by Atrial Fibrillation |
| DOI： |
| 中文关键词: 黄连温胆汤 氧化三甲胺 CHD 心房颤动 脂代谢 炎症网络 |
| 英文关键词: Huanglian Wendan Decoction Trimethylamine N-oxide Coronary heart disease Atrial fibrillation Lipid metabolism Inflammatory network |
| 基金项目:湖北省中医药科研项目 |
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| 中文摘要: |
| 目的:观察黄连温胆汤加减调控TMAO生成对CHD合并AF患者脂质炎症网络的影响。方法:选择湖北省中医院2023年3月-2025年3月收治的120例CHD合并AF患者,对照组拟给予西医常规治疗,观察组加用黄连温胆汤加减口服进行治疗,对比两组疗效及脂质炎症网络相关指标。结果:①治疗后,观察组TMAO水平[(3.62±1.24)μmol/L]显著低于对照组[(4.78±1.72)μmol/L](P＜0.05)；②治疗后,观察组TC[(4.83±0.61)mmol/L]、TG[(1.72±0.42)mmol/L]、LDL-C[(1.81±0.27)mmol/L]水平显著低于对照组[(5.67±0.73)mmol/L]、[(2.31±0.55)mmol/L]、[(2.44±0.33)mmol/L](P＜0.05),HDL-C[(1.37±0.21)mmol/L]显著高于对照组[(1.09±0.19)mmol/L](P＜0.05)；③治疗后,观察组hs-CRP[(3.57±0.48)mg/L]、IL-6[(5.38±0.45)pg/L]、TNF-α[(9.69±1.26)pg/L]显著低于对照组[(5.42±0.63)mg/L]、[(7.72±0.73)pg/L]、[(13.89±1.89)pg/L](P＜0.05)；④治疗后,观察组MDA[(4.64±1.18)nmol/mL]显著低于对照组[(5.91±1.43)nmol/mL],SDO[(96.88±10.73)U/mL]显著高于对照组[(88.15±11.96)U/mL](P＜0.05)；⑤治疗后,观察组平均心室率[(69.77±5.35)bpm]、伴发心电图异常(12例)、室早(3例)、快速心室率(1例)、ST-T改变(2例)、长R-R间期例数(2例)均显著低于对照组(P＜0.05)；⑥治疗4周后,两组中医证候积分较前下降,观察组下降幅度更大,观察组中医证候积分为[(15.25±2.26)分],显著低于对照组[(19.61±2.98)分](P＜0.01),治疗12周后,两组中医证候积分继续较前下降,观察组下降幅度更大,观察组中医证候积分为[(11.61±1.87)分],显著低于对照组[(14.85±2.16)分](P＜0.01)；⑤观察组心血管事件发生率显著低于对照组(χ2=3.15, P＜0.05),两组不良反应发生率无统计学差异(χ2=0.94, P＞0.05)。结论:在西医常规治疗基础上加用黄连温胆汤加减,能有效降低CHD合并AF患者血清TMAO水平,显著改善血脂谱,减轻炎症反应和氧化应激,改善心室率及心电图异常,降低中医证候积分,并减少心血管事件发生率,安全性良好,值得临床推广。 |
| 英文摘要: |
| Objective:To investigate the effect of modified Huanglian Wendan Decoction (HLWDD) on trimethylamine N-oxide (TMAO) production and the lipid-inflammatory network in patients with coronary heart disease (CHD) complicated by atrial fibrillation (AF).Methods: A total of 120 CHD-AF patients admitted to Hubei Provincial Hospital of Traditional Chinese Medicine (March 2023–March 2025) were enrolled. The control group received conventional Western therapy, while the observation group received additional oral modified HLWDD. Therapeutic efficacy and relevant indicators were compared.Results:①Post-treatment TMAO levels were significantly lower in the observation group [(3.62±1.24) μmol/L vs. control: (4.78±1.72) μmol/L; P＜0.05].②The observation group exhibited markedly reduced TC [(4.83±0.61) mmol/L], TG [(1.72±0.42) mmol/L], and LDL-C [(1.81±0.27) mmol/L], alongside elevated HDL-C [(1.37±0.21) mmol/L] versus controls [TC: (5.67 ± 0.73) mmol/L; TG: (2.31 ± 0.55) mmol/L; LDL-C: (2.44±0.33) mmol/L; HDL-C: (1.09±0.19) mmol/L] (P＜0.05).③Inflammatory markers (hs-CRP, IL-6, TNF-α) were significantly lower in the observation group [hs-CRP: (3.57±0.48) mg/L; IL-6: (5.38±0.45) pg/L; TNF-α: (9.69±1.26) pg/L] than controls [hs-CRP: (5.42±0.63) mg/L; IL-6: (7.72±0.73) pg/L; TNF-α: (13.89±1.89) pg/L] (P＜0.05).④Oxidative stress improved in the observation group, with lower MDA [(4.64±1.18) nmol/mL] and higher SOD [(96.88±10.73) U/mL] versus controls [MDA: (5.91±1.43) nmol/mL; SOD: (88.15±11.96) U/mL] (P＜0.05).⑤Electrocardiographic parameters significantly favored the observation group: reduced mean ventricular rate [(69.77±5.35) bpm], fewer arrhythmias (12 cases of ECG abnormalities; 3 PVCs; 1 rapid ventricular rate; 2 ST-T changes; 2 long R-R intervals) (P＜0.05).⑥At 4 and 12 weeks, TCM symptom scores decreased more substantially in the observation group [4w: (15.25±2.26) vs. control (19.61±2.98); 12w: (11.61 ± 1.87) vs. control (14.85±2.16)] (P＜0.01).⑦Cardiovascular event incidence was lower in the observation group [1.96% (1/51; 1 non-fatal MI)] than controls [9.43% (5/53; 3 HF exacerbations; 2 strokes)] (χ2 = 3.15, P＜0.05). Adverse events showed no intergroup difference in hepatic/renal dysfunction (P＞0.05); 2 cases of transient gastrointestinal discomfort (HLWDD-related) resolved after dosing adjustment.Conclusion:Adjunct modified HLWDD effectively reduces serum TMAO, ameliorates dyslipidemia, attenuates inflammation and oxidative stress, improves ventricular rate/ECG parameters, lowers TCM symptom scores, and decreases cardiovascular events with favorable safety in CHD-AF patients, warranting clinical adoption. |
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