目的 探讨益气复脉方治疗气虚血瘀型阵发性房颤患者疗效及对患者血清 L 型钙通道 β2 (CACNB2) 与微 小 RNA-499 (miR-499)水平的影响。方法 选取 2020 年 2 月-2022 年 2 月启东市中医院收治的 110 例气虚血瘀型阵发性房颤患者,采用随机、非盲法将其分为对照组与试验组,每组各 55 例。对照组(脱落 2 例,纳入 53 例)采取常规治疗(口服达比加群酯胶囊及胺碘酮片),试验组(脱落 1 例,纳入 54 例)在对照组基础上联合益气复脉方(党参 15 g、法半夏 9 g、黄连 10 g、鬼箭羽 15 g、川芎 15 g、丹参 30 g、赤芍 15 g、白芍 15 g、炙甘草 10 g、磁石 30 g、远志 10 g,乏力甚者加生黄芪补气治本,胸闷甚者加郁金、香附等行气开郁)治疗;4 周为 1 个疗程,两组患者均治疗 1 个疗程。评估两组临床疗效及安全性。比较两组治疗前后房颤发作次数、房颤发作持续时间及主要症状改善情况。比较两组治疗前后血清 CACNB2 与miR-499 水平。结果 试验组治疗总有效率显著高于对照组(P<0.05)。治疗后,两组患者房颤发作次数及持续时间均显著低于本组治疗前(P<0.05),试验组患者房颤发作次数及持续时间均显著低于对照组(P<0.01)。治疗后,两组患者心悸、气短、胸闷、头晕和乏力等症状积分均显著低于本组治疗前(P<0.05),试验组患者心悸、气短、胸闷、头晕和乏力等症状积分均显著低于对照组 (P<0.01)。治疗后,两组患者血清 CACNB2 高于本组治疗前 (P<0.05),试验组患者血清CACNB2 水平显著高于对照组(P<0.01)。治疗后,两组患者血清 miR-499 水平明显低于本组治疗前(P<0.05),试验组患者血清 miR-499 低于对照组(P<0.05)。两组患者治疗期间均未发生严重不良反应。结论 益气复脉方可有效上调阵发性房颤患者血清 miR-499 表达及降低 CACNB2 表达,改善患者临床症状,减少房颤发作次数,缩短单次发作持续时间,提高气虚血瘀型阵发性房颤临床疗效。

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

南通市科学技术局科研立项课题(JCZ2022062)