Quantitative evaluation on the effect of Lujiao prescription on cardiac function of patients with congestive heart failure / 中国组织工程研究

ABSTRACT

BACKGROUND: Congestive heart failure (CHF) is the clinical syndrome of all kinds of heart disease on the serious or final stage. About half of patients with organic heart disease will have heart failure that has a high incidence rate and mortality. The survival of heart failure was inferior to that of malignant tumor.OBJECTIVE: To confirm the clinical effect of Lujiao prescription on CHF and elucidate its possible mechanism.DESIGN: A control observation on CHF patients.SETTING: Department of Cardiovasology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine.PARTICIPANTS: A total of 60 patients with CHF were selected from the department of cardiovasology in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from January 1996 to December 1998. There were 31 male and 29 female. Included criteria: ①All of patients were consistent with Framinham diagnostic criteria. ② Above Ⅲ degree by New York Heart Association(NYHA). ③ Three months case history. ④Accept quantity sufficient diuretic and vasodilating agent (exclude angiotensin converting enzyme inhibitor ). ⑤ Left ventricle hypertrophy was proved by echocardiogram or chest X-ray. ⑥ Differentiation of symptoms and signs of Traditional Chinese Medicine refers to asthenia syndrome of differentiation of symptoms and signs of Traditional Chinese Medicine (1986, Researching Association of Chinese integrated medicine) General state of health and basic disease of the patients in the two groups were not significant deviation.METHODS: 60 patient s of CHF were randomly divided into Lujiao prescription group(n=40) and Digoxin group (n=20) at the rate of 2:1. Lujiao prescription group: Orally liquid decoction of Lujiao Prescription 35 mL (1 mL contain crude drug 1.6 g) Bid. po. Course of treatment: 4 weeks. Digoxin group: Digoxin tablet, 0.125-0.25 mg, qd. po. course of treatment: 4 weeks.After 4-week treatment, the patients' clinical effect, integrals of the symptoms of renal deficiency, classification of function capacity of the NYHA,Lee's heart failure score, heart rate(HR), myocardium oxygen consumption (MOC), proportion of heart to chest, echocardiogram, measurement of plasma angitention Ⅱ (Ang Ⅱ ) and plasma atrial natriuretic factor (ANF) were observed.MAIN OUTCOME MEASURES: ① The total clinic effective rate. ②Integrals of the symptoms of renal deficiency. ③ Classification of function capacity of the NYHA. ④ Lee's heart failure score. ⑤HR and MOC. ⑥The proportion of heart to chest. ⑦ Ejection fraction(EF), cardic output (CO), interventricular septal thickness (IVST), posterior wall thickness (PWT) and left ventricular mass index (LVMI) through echocardiogram. ⑧The measurement of plasma Ang Ⅱ and plasma ANF.RESULTS:Totauy 60 patients entered the final analysis. ① The total clinical effective rate of the Lujiao prescription group was 90 %, which showed no significant difference from the Digoxin group (90 %, P ＞ 0.05).② Improvement was significantly observed in the integrals of the symptom of renal deficiency of the patients in the Lujiao prescription group after treatment (P ＜ 0.01), but which was not significant in the Digoxin group(P＞ 0.05). ③ It was found that classification of functional capacity of NYHA between Lujiao prescription group and Digoxin group after treatment was obviously decreased (P ＜ 0.01). ④ Lee's heart failure score of patients in Lujiao prescription group and Digoxin group after treatment was decreased (P ＜ 0.01). ⑤Myocardium oxygen consumption and HR of the patients in the Lujiao prescription group and Digoxin group after treatment was decreased (P ＜ 0.01). ⑥ The proportion of heart to chest between Lujiao prescription group and Digoxin group after treatment was decreased (P ＜ 0.01).⑦ EF and CO were increased by Lujiao prescription and by Digoxin (P＜ 0.01,vs pretreatment, respectively). IVST, PWT, LVMI of Lujiao prescription group after treatment were obviously decreased (P ＜ 0.01), while those of the Digoxin group were not obviously decreased (P ＞ 0.05). ⑧ Thlevel of plasma Ang Ⅱ of the patients in the Lujiao prescription group after treatment were obviously decreased (P ＜ 0.01), while that of the Digoxin group were not obviously decreased (P ＞ 0.05). The level of plasma ANF was decreased by Lujiao prescription and by digoxin(P ＜ 0.01, vs pretreatment, respectively).CONCLUSION: There is increasing cardiac constriction power and regressing left ventricular hypertrophy of patients with CHF by Lujiao prescription. The therapeutical effect of Lujiao prescription for CHF is better than that of Digoxin. The effect may be related to the regulation of circular or local endocrine(plasma Ang Ⅱ and ANF) disorder.