丁宇　赵殿臣　赏楠

摘要 目的：研究黃芪保心汤对慢性心力衰竭模型大鼠心室重构及内质网应激凋亡的抑制作用。方法：选取健康雄性SD级大鼠60只进行研究，将其按照随机抽签法等分成干预组、对照组以及模型组，每组20只。干预组与模型组大鼠建立慢性心力衰竭模型，对照组大鼠予以假手术处理。造模成功后，干预组予以黄芪保心汤干预，模型组、对照组大鼠予以等量生理盐水注射干预。比较3组大鼠干预4周后的心功能，血清NT-proBNP、ST2水平，心肌细胞凋亡率以及Bcl-2、Bax、Caspase-3蛋白表达水平。结果：模型组大鼠左室射血分数（LVEF）、左心室短轴缩短率（FS）、每搏输出量（SV）水平显著低于对照组，而左室收缩末期直径（LVESD）、左室舒张末内径（LVEDD）水平显著高于对照组;干预组大鼠LVEF、FS、SV水平显著高于模型组，且LVESD、LVEDD水平显著低于模型组（均P<0.05）。模型组大鼠NT-proBNP、ST2水平均显著高于对照组，而干预组大鼠N端脑钠肽前体（NT-proBNP）、基质裂解素2（ST2）水平均显著低于模型组（均P<0.05）。模型组大鼠的心肌细胞凋亡率显著高于对照组，而干预组大鼠的心肌细胞凋亡率显著低于模型组（均P<0.05）。模型组大鼠心肌Bcl-2蛋白表达水平显著低于对照组，而Bax以及Caspase-3蛋白表达水平显著高于对照组;干预组大鼠心肌Bcl-2蛋白表达水平显著高于模型组，且Bax以及Caspase-3蛋白表达水平显著低于模型组（均P<0.05）。结论：黄芪保心汤可有效抑制慢性心力衰竭模型大鼠心室重构及内质网应激凋亡，其主要作用机制可能和影响心肌Bcl-2、Bax以及Caspase-3蛋白表达有关。

关键词 慢性心力衰竭;动物实验;黄芪保心汤;心室重构;内质网应激凋亡;心功能;N端脑钠肽前体;基质裂解素2

Abstract Objective：To investigate the inhibitory effect of Huangqi Baoxin decoction on ventricular remodeling and endoplasmic reticulum stress apoptosis in rats with chronic heart failure.Methods：Sixty healthy male SD rats were selected for the study，and then randomly divided into a intervention group，a control group and a model group，with 20 rats in each.The rats in the intervention group and the model group were treated with sham surgery.After successful modeling，Huangqi Baoxin Decoction was given to the intervention group，and rats in the model group and control group were injected with equal amount of saline.Cardiac function，levels of serum NT-proBNP and ST2，apoptosis rate of cardiomyocytes，expression levels of bcl-2，Bax and caspase-3 were compared after 4 weeks of intervention among the three groups.Results：The levels of LVEF，FS and SV in the model group were significantly lower than those in the control group，while the levels of LVESD and LVEDD were significantly higher than those in the control group; The levels of LVEF，FS and SV in the intervention group were significantly higher than those in the model group，and the levels of LVESD and LVEDD were significantly lower than those in the model group（P<0.05）.The levels of NT-proBNP and ST2 in the model group were significantly higher than those in the control group，while the levels of NT-proBNP and ST2 in the intervention group were significantly lower than those in the model group（P<0.05）.The apoptosis rate of cardiomyocytes in the model group was significantly higher than that in the control group，while that in the intervention group was significantly lower than that in the model group（P<0.05）.The expression level of bcl-2 protein in the model group was significantly lower than that in the control group，while the expression level of Bax and caspase-3 protein was significantly higher than that in the control group.The expression level of bcl-2 protein in rats in the intervention group was significantly higher than that in the model group，and the expression level of Bax and caspase-3 protein was significantly lower than that in the model group（P<0.05）.Conclusion：Huangqi Baoxin decoction can inhibit ventricular remodeling and endoplasmic reticulum stress apoptosis in rats with chronic heart failure，and its main mechanism may be associated with the expression of bcl-2，Bax and caspase-3 in myocardium.

Keywords Chronic heart failure; Animal experiments; Huangqi Baoxin decoction; Ventricular remodeling; Endoplasmic reticulum stress apoptosis; Cardiac function; N-terminal forebrain natriuretic hormone; Matrix lysin 2

中图分类号：R285.5文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.18.010

随着近年来人们生活水平的不断提高以及人口老龄化问题的日益凸显，慢性心力衰竭的发病率正呈逐年升高趋势，该病患者预后普遍较差，5年生存率不足50%[1-2]。心室重构乃是慢性心力衰竭的发病基础，其主要表现包括心肌纤维化，其和心肌梗死、瓣膜病以及心肌疾病等密切相关，往往是由过度的心室负荷和（或）心肌成活细胞大量减少导致[3-4]。心室重构的分子机制相对复杂，细胞凋亡、胚胎基因以及蛋白的再编码等因素均可能增加心室重构的发生。……