目的 探討益氣復(fù)脈方治療氣虛血瘀型陣發(fā)性房顫患者療效及對患者血清 L 型鈣通道 β2 (CACNB2) 與微 小 RNA-499 (miR-499)水平的影響。方法 選取 2020 年 2 月-2022 年 2 月啟東市中醫(yī)院收治的 110 例氣虛血瘀型陣發(fā)性房顫患者,采用隨機(jī)、非盲法將其分為對照組與試驗組,每組各 55 例。對照組(脫落 2 例,納入 53 例)采取常規(guī)治療(口服達(dá)比加群酯膠囊及胺碘酮片),試驗組(脫落 1 例,納入 54 例)在對照組基礎(chǔ)上聯(lián)合益氣復(fù)脈方(黨參 15 g、法半夏 9 g、黃連 10 g、鬼箭羽 15 g、川芎 15 g、丹參 30 g、赤芍 15 g、白芍 15 g、炙甘草 10 g、磁石 30 g、遠(yuǎn)志 10 g,乏力甚者加生黃芪補氣治本,胸悶甚者加郁金、香附等行氣開郁)治療;4 周為 1 個療程,兩組患者均治療 1 個療程。評估兩組臨床療效及安全性。比較兩組治療前后房顫發(fā)作次數(shù)、房顫發(fā)作持續(xù)時間及主要癥狀改善情況。比較兩組治療前后血清 CACNB2 與miR-499 水平。結(jié)果 試驗組治療總有效率顯著高于對照組(P<0.05)。治療后,兩組患者房顫發(fā)作次數(shù)及持續(xù)時間均顯著低于本組治療前(P<0.05),試驗組患者房顫發(fā)作次數(shù)及持續(xù)時間均顯著低于對照組(P<0.01)。治療后,兩組患者心悸、氣短、胸悶、頭暈和乏力等癥狀積分均顯著低于本組治療前(P<0.05),試驗組患者心悸、氣短、胸悶、頭暈和乏力等癥狀積分均顯著低于對照組 (P<0.01)。治療后,兩組患者血清 CACNB2 高于本組治療前 (P<0.05),試驗組患者血清CACNB2 水平顯著高于對照組(P<0.01)。治療后,兩組患者血清 miR-499 水平明顯低于本組治療前(P<0.05),試驗組患者血清 miR-499 低于對照組(P<0.05)。兩組患者治療期間均未發(fā)生嚴(yán)重不良反應(yīng)。結(jié)論 益氣復(fù)脈方可有效上調(diào)陣發(fā)性房顫患者血清 miR-499 表達(dá)及降低 CACNB2 表達(dá),改善患者臨床癥狀,減少房顫發(fā)作次數(shù),縮短單次發(fā)作持續(xù)時間,提高氣虛血瘀型陣發(fā)性房顫臨床療效。

Objective To explore the therapeutic effect of Yiqi Fumai Recipe on paroxysmal atrial fibrillation of qi deficiency and blood stasis type and its effect on serum L-type calcium channel β2 (CACNB2) and microRNA-499 (miR-499) levels. Methods A total of 110 patients with paroxysmal atrial fibrillation of qi deficiency and blood stasis type treated in Qidong Hospital of Traditional Chinese Medicine from February 2020 to February 2022 were randomly divided into control group and experimental group, with 55 cases in each group. Patients in control group (two cases of abscission, the remaining 53 cases) were treated with routine treatment (orally administration with Dabigatran Ester Capsules and Amiodarone Tablets), and patients in experimental group (one case of abscission, the remaining 54 cases) were treated with Yiqi Fumai Formula based on control group. Four weeks was a course of treatment, and both groups received one course of treatment. The clinical efficacy and safety of the two groups were evaluated. The frequency of atrial fibrillation attack, duration of atrial fibrillation attack and improvement of main symptoms were compared between the two groups before and after treatment. The levels of serum CACNB2 and microRNA-499 were compared between the two groups before and after treatment. Results The clinical overall effective rate of the experimental group was significantly higher than that of the control group (P<0.05). After treatment, the frequency and duration of atrial fibrillation in two groups were significantly lower than before treatment, and the frequency and duration of atrial fibrillation in experimental group were significantly lower than control group (P<0.01). After treatment, the symptom scores of palpitation, shortness of breath, chest tightness, dizziness and fatigue in the two groups were significantly lower than those before treatment (P<0.01), and the symptom scores of palpitation, shortness of breath, chest tightness, dizziness and fatigue in the experimental group were significantly lower than those in the control group (P<0.05). After treatment, the serum CACNB2 of the two groups after treatment was higher than that before treatment (P<0.01), the serum CACNB2 level in the experimental group was significantly higher than that in the control group (P<0.05), the serum miR-499 level in the two groups was significantly lower than that before treatment (P<0.05), and the serum miR-499 level in the experimental group was lower than that in the control group (P<0.05). No serious adverse reactions occurred in both groups during treatment. Conclusion Yiqi Fumai Formula can effectively up regulate the expression of miR-499 and reduce the expression of CACNB2 in serum of petients with paroxysmal atrial fibrillation, improve its clinical symptoms, reduce the number of episodes of atrial fibrillation, shorten the duration of episodes, and improve the clinical therapeutic effect.

R973

南通市科學(xué)技術(shù)局科研立項課題(JCZ2022062)