李欣春 梁昊 胡志希 胡思远 钟森杰 李琳 李杰 简维雄 郭志华

〔摘要〕 目的 研究參附注射液和参麦注射液对高血压心力衰竭大鼠的疗效差异，通过“以方测证”理论推测高血压心衰大鼠所属中医证型。方法 将60只Dahl盐敏感性大鼠分为对照组、模型组、参附组和参麦组，每组15只，对照组使用低盐饲料，其余三组使用8%NaCl高盐饲料喂养大鼠20周并予以相应干预，检测大鼠血清氨基末端脑钠肽前体（n-terminal pro-brain natriuretic peptide， NT-proBNP），彩色超声多普勒检测大鼠左室射血分数（left ventricular ejection fraction， LVEF）和左室短轴缩短率（left ventricular fractional shortening， LVFS）及观察HE染色心肌细胞。结果 与对照组比较，模型组LVEF和LVFS值均降低（P<0.05），NT-proBNP值升高（P<0.01）；与模型组比较，参附组LVEF和LVFS值明显降低（P<0.05），NT-proBNP值升高（P<0.01）；参麦组LVFS值升高（P<0.05），NT-proBNP值降低（P<0.01）；与参附组比较，参麦组LVEF和LVFS值均升高（P<0.05）。结论 参麦注射液对高血压心衰大鼠的疗效显著，参附注射液对高血压心衰大鼠无效；高血压心衰大鼠模型不属于心阳虚证，最可能是心气阴虚证；LVEF值保留及血压升高可能是应用参附注射液的禁忌指标。

〔关键词〕 高血压；心力衰竭，方证对应；大鼠动物模型；中医证型

〔中图分类号〕R285.5；R541.3 〔文献标志码〕A 〔文章编号〕doi：10.3969/j.issn.1674-070X.2018.08.003

〔Abstract〕 Objective To investigate the traditional Chinese medicine （TCM） syndrome types in rats with hypertensive heart failure based on the theory of "Syndrome Differentiation Through Formula" by investigating the clinical efficacy of Shenfu injection versus Shenmai injection in rats with hypertensive heart failure. Methods A total of 60 Dahl salt sensitive rats were equally and randomly divided into control group， model group， Shenfu injection group （Shenfu group）， and Shenmai injection group （Shenmai group）. The control group was fed with low-salt feed， while the other three groups were fed with high-salt （8% NaCl） feed for 20 weeks and given respective interventions. The serum level of N-terminal-pro-brain natriuretic peptide （NT-proBNP） was measured. The left ventricular ejection fraction （LVEF） and the left ventricular fractional shortening （LVFS） were determined by color Doppler ultrasound. And the myocardial cells with HE staining was observed under an electron microscope. Results Compared with the control group， the model group had significantly decreased LVEF and LVFS （P<0.05） and a significantly increased serum level of NT-proBNP （P<0.01）. Compared with the model group， the Shenfu group had significantly decreased LVEF and LVFS （P<0.05） and a significantly increased serum level of NT-proBNP （P<0.01）； the Shenmai group had a significantly increased LVFS （P<0.05） and a significantly decreased serum level of NT-proBNP （P<0.01）. Compared with the Shenfu group， the Shenmai group had significantly increased LVEF and LVFS （P<0.05）. Conclusion In rats with hypertensive heart failure， Shenmai injection has significant clinical efficacy， while Shenfu injection has no effect. The rat model of hypertensive heart failure is not identified as heart-Yang deficiency syndrome and is most likely to be heart-Qi and Yin deficiency syndrome. The preserved LVEF and increased blood pressure may be the contraindications for Shenfu injection.

〔Keywords〕 hypertension； heart failure； syndrome differentiation through formula； rat model； traditional Chinese medicine syndrome type

心力衰竭（心衰）是多种心脏病的终末期阶段，发病率高[1-2]，随年龄增加呈明显上升趋势，5年存活率与恶性肿瘤相仿，是严重威胁老年人健康的危重病、多发病[3]。尽管医疗技术飞速发展，但心衰的病死率和住院率依然居高不下[4]。

临床研究表明[5]参附注射液治疗舒张性心力衰竭疗效显著，并提出治疗机制可能与改善心肌重构、抑制神经内分泌过度激活有关；然而又有临床研究提出[6]，参麦注射液治疗气阴两虚型舒张性心力衰竭有确切的疗效；且多项研究表明二者在心力衰竭治疗上均表现出一定优势，比单纯西药治疗效果更佳[7-8]。

但是，参附注射液在临床上常用于治疗阳虚证、阴竭阳脱证患者；参麦注射液临床上广泛用于气阴两虚型患者；参附注射液和参麦注射液适应中医证型不同。……