益气升陷法在病毒性心肌炎中的应用与研究

【作者】 曹洪欣； 郭书文； 张华敏； 朱海燕； 王喜军； 李廷利； 谢宁； 田颜； 刘寨华； 赵静； 徐慧；

【机构】 中国中医研究院； 黑龙江中医药大学；

【摘要】 从临床入手根据疾病发生发展,在研究病毒性心肌炎（viral myocarditis,VMC） 证候演变的基础上,深入研究了 VMC 大气下陷证的证候特征、演变规律及益气升陷法的应用,证实了益气升陷法疗效的可靠性。VMC 证候变化受多种因素影响。大气下陷与 VMC 发生发展密切相关,大气下陷证是 VMC 常见证候,其证候特征表现为咽中拘急或胸中坠胀, 大气下陷由轻至重有虚-陷-蝎的病理演变。临床对照研究此法治疗 VMC,总显效率为 76．1%,充分体现了中医药的治疗优势。同时,利用膜片钳、RT-PCR 等技术,从抗心律失常的离子机制、心肌损伤的凋亡机制、病情迁延的柯萨奇病毒 RNA 持续感染及心室重构与心功能等方面全面揭示益气升陷法的作用机理。实验证实该法通过对心室肌细胞 I_Na、I_kl、 I_?的抑制和对 I_Ca的激活,使心肌动作电位在多个环节延长,从而发挥其抗心律失常的作用；能调控 c-myc、Bcl-2、INOS 基因表达及抑制 TNF-α、IL-6、IFN-γ炎性介质释放,达到抗心肌细胞凋亡、减轻炎性反应与心肌损伤作用；能逐渐清除柯萨奇病毒 RNA 于心肌内形成的持续感染状态,防止向慢性期乃至心肌病演变；可改善心室重构及心功能,延缓心功能不全的发生与进展。更多还原

【Abstract】 On the basis of study on syndrome change of viral myocarditis （VMC）,the theme study furtherly syndrome characteristic and change of pectoral qi collapse and application of invigorating qi and ascending qi thera- py collapse to VMC through clinical observation.Collapse of pectoral qi is a common pathologic change of VMC and also has a close relationship with its invasion and development.Syndrome characteristic of Collapse of pectoral qi is pharynx constriction and straining feeling in the chest.The total effectual rate is 76.1% by application of this ther- apy on treatment to VCM.To discover the mechanism of therapy of invigorating qi and ascending qi collapse,we use photoelectric microscope,in situ terminal label,immunohistochemical method,ELISA,FCM,signal analysis RT-PCR and cell patch clamp etc.These experiments show the following results.1 The therapy of Invigorating qi and ascending qi collapse has a better effect on antiarrhythmia.The main ionic mechanism is to block I_Na.I_kl,I_? and increase I_Ca which make APD belonged at several links.2 The genes of c-myc,Bcl-2,INOS participate the reg- ulation of myocardial cellular apeptosis.The levels of TNF-α,IL-6,IFN-γ show dynamic changes simultaneously. All these factors affact the occurrence of inflammation.The therapy of invigorating qi and ascending qi collapse has the function of adjusting the abnormal expression of these factors.3 The therapy can clear CVB-RNA in myocardiac ,better its damage to myocaniium and has a better effect on prevent VCM develop to chronic period and sequla.4 The therapy of invigorating qi and ascending qi collapse could suppress the chronic proliferation of myocardial colla- gen significantly,improve ventricular reconstruction and the cardiac function.This therapy also can decreases the plasma concentration of Ang Ⅱ,ALD,ET,ANP significantly and suppress the expression of AT-1 receptor,regu- late the balance of RAS system and release hormone of endocrine,retard the occurrence and development of CHF.更多还原