2021 年第 4 期 第 16 卷

益气活血汤加味联合美托洛尔对急性心肌梗死患者的治疗效果及对微小RNA-208a和微小RNA-210表达的影响

Curative effect of modified Yiqi Huoxue decoction combined with metoprolol on patients with acute myocardial infarction and the effects on the expressions of microRNA-208a and microRNA-210

作者：成万华杨晓雪蔡红娟王翠茹赵晓倩韩文君王维娜

英文作者：Cheng Wanhua Yang Xiaoxue Cai Hongjuan Wang Cuiru Zhao Xiaoqian Han Wenjun Wang Weina

单位：河北省张家口市第一医院心内科075000

英文单位：

关键词：急性心肌梗死；益气活血汤；美托洛尔；心功能；内皮功能 

英文关键词：Acutemyocardialinfarction;YiqiHuoxuedecoction;Metoprolol;Heartfunction;Endothelialfunction

• 摘要：

• 目的 探究益气活血汤加味联合美托洛尔对急性心肌梗死患者的治疗效果及对微小RNA（miR）-208a和miR-210表达的影响。方法 选取2019年5月至2020年5月于河北省张家口市第一医院接受治疗的急性心肌梗死患者116例，按照随机数字表法分为美托洛尔组、联合治疗组，各58例。美托洛尔组患者在常规治疗基础上使用美托洛尔治疗，联合治疗组在美托洛尔组基础上使用益气活血汤加味治疗，2组均连续治疗2周。比较2组治疗前后心功能指标、氧化应激及内皮功能指标、炎症反应及心肌损伤指标、miR-208a和miR-210表达水平及临床疗效。结果 治疗后，2组左心室后壁厚度水平均较治疗前降低，左心室舒张末期内径、心输出量水平均较治疗前升高，且联合治疗组变化程度大于美托洛尔组［（7.6±1.0）mm比（9.2±1.1）mm、（65±7）mm比（60±6）mm、（4.6±1.2）L/min比（3.9±0.9）L/min］，差异均有统计学意义（均P＜0.05）。治疗后，2组过氧化氢酶、一氧化氮水平较治疗前升高，氧化型低密度脂蛋白、血管紧张素Ⅱ、内皮素1、白细胞介素8、高敏C反应蛋白、心肌肌钙蛋白I、高敏肌钙蛋白I水平均较治疗前降低，且联合治疗组变化程度大于美托洛尔组，差异均有统计学意义（均P＜0.05）。治疗后，2组miR-208a、miR-210表达水平均较治疗前降低，且联合治疗组低于美托洛尔组［（0.61±0.09）比（0.78±0.13）、（0.63±0.11）比（0.85±0.16）］，差异均有统计学意义（均P＜0.05）。联合治疗组总有效率高于美托洛尔组［93.1%（54/58）比79.3%（46/58）］，差异有统计学意义（χ2=4.640，P=0.031）。结论 使用益气活血汤加味联合美托洛尔对急性心肌梗死患者进行治疗，心功能明显提升，氧化应激损伤、炎症反应、心肌损伤严重程度减轻，内皮功能得到改善，miR-208a、miR-210表达受到调控，治疗效果显著。

• Objective To explore the curative effect of modified Yiqi Huoxue decoction combined with metoprolol on patients with acute myocardial infarction and the effects on the expressions of microRNA(miR)-208a and miR-210. Methods From May 2019 to May 2020, 116 patients with acute myocardial infarction who were treated in Zhangjiakou First Hospital, Hebei Province were selected. They were divided into metoprolol group and combined treatment group according to random number table method, with 58 cases in each group. Patients in metoprolol group were treated with metoprolol on the basis of conventional treatment, while patients in combined treatment group were treated with modified Yiqi Huoxue decoction on the basis of metoprolol group. Both groups were treated for 2 weeks. Cardiac function indexes, oxidative stress and endothelial function indexes, inflammatory reaction and myocardial injury indexes, miR-208a and miR-210 expression levels and clinical efficacy were compared between the two groups before and after treatment. Results After treatment, the left ventricular posterior wall thickness decreased, the left ventricular end diastolic diameter and cardiac output increased in both groups, and those degrees of changes in the combined treatment group were greater than those in the metoprolol group［(7.6±1.0)mm vs (9.2±1.1)mm, (65±7)mm vs (60±6)mm, (4.6±1.2)L/min vs (3.9±0.9)L/min］(all P<0.05). After treatment, the levels of catalase and nitric oxide in the two groups were higher than those before treatment, while the levels of oxidized low-density lipoprotein, angiotensin Ⅱ, endothelin-1, interleukin-8, high-sensitivity C-reactive protein, cardiac troponin I and high-sensitivity troponin I in the two groups were lower than those before treatment, and those degrees of changes in the combined treatment group were greater than those in the metoprolol group(all P<0.05). After treatment, the expression levels of miR-208a and miR-210 in the two groups were lower than those before treatment, and those in the combined treatment group were lower than those in the metoprolol group［(0.61±0.09) vs (0.78±0.13), (0.63±0.11) vs (0.85±0.16)］(all P<0.05). The total effective rate of the combined treatment group was higher than that of the metoprolol group［93.1%(54/58) vs 79.3%(46/58)］, and the difference was statistically significant(χ2=4.640， P=0.031). Conclusion The treatment of acute myocardial infarction with modified Yiqi Huoxue decoction combined with metoprolol shows significant improvement of cardiac function, reductions of oxidative stress injury, inflammatory response, severity of myocardial injury, improvement of endothelial function, regulation of the expression of miR-208a and miR-210, and significant therapeutic effect.