改善代谢综合征绝经后高血压女性无症状性左心室舒张功能障碍：一项前瞻性、开放标签、随机对照试验。
Improving Asymptomatic Left Ventricular Diastolic Dysfunction in Postmenopausal Hypertensive Women with Metabolic Syndrome: A Prospective, Open-Labeled, Randomized Controlled Trial.
机构信息
Department of Cardiology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu 730000, China.
出版信息
Chin Med J (Engl). 2018 Mar 5;131(5):516-526. doi: 10.4103/0366-6999.226077.
BACKGROUND
Postmenopausal women with metabolic syndrome (MetS) have increased cardiovascular morbidity and left ventricular diastolic dysfunction (LVDD). The various protective effects of astragalus membranaceus (AM) have been described in previous studies. Therefore, this study aimed to evaluate the effects of different doses of AM on diastolic function in postmenopausal hypertensive women with MetS.
METHODS
This was a prospective, randomized controlled study. The postmenopausal hypertensive patients with MetS were enrolled from Lanzhou University Second Hospital from March 2014 to April 2015. Patients were divided into three groups: control group (received conventional medical treatment), AM Group 1 (received AM capsules at 5 g/d additionally), and AM Group 2 (received AM capsules at 10 g/d additionally). Echocardiographic and clinical characteristics were evaluated before and 12 months after treatment. Quantitative data were analyzed using unpaired t-test, analysis of variance, and multiple linear regression analysis.
RESULTS
A total of 154 patients were subjected to final analysis. In the AM Group 2, significant improvements were noted in diastolic function 12 months after treatment than those of the control group, including the early diastolic mitral annular velocity (E'; 0.065 ± 0.007 m/s vs. 0.061 ± 0.008 m/s, P = 0.014), the ratio of the early diastolic mitral peak flow velocity to the late diastolic mitral peak flow velocity (E/A; 0.81 ± 0.05 vs. 0.80 ± 0.06, P = 0.012), the ratio of E' to the late diastolic mitral annular velocity (E'/A'; 0.56 ± 0.12 vs. 0.51 ± 0.13, P = 0.048), and the ratio of the early diastolic mitral peak flow velocity (E) to E' (E/E'; 10.70 ± 1.30 vs. 11.37 ± 1.73, P = 0.031). After treatment, E/E' (10.70 ± 1.30 vs. 11.24 ± 1.56, P = 0.021), deceleration time (DT; 261.49 ± 44.41 ms vs. 268.74 ± 53.87 ms, P = 0.046), and E'/A' (0.56 ± 0.12 vs. 0.52 ± 0.13, P = 0.019) values improved more significantly than those of AM Group 2 before treatment. Besides, waist circumference was positively correlated with E' (r = 0.472; P = 0.003) and E'/A' (r = 0.321; P = 0.047). In addition, the waist-to-hip ratio was a significant predictor of DT (r = 0.276; P = 0.041), E' (r = -0.590; P < 0.001), E/E' (r = 0.454; P = 0.004), and E'/A' (r = -0.377; P = 0.018).
CONCLUSIONS
Conventional medical plus AM therapy improved diastolic function. Moreover, WC and WHR might be risk factors for LVDD.
CHINESE CLINICAL TRIAL REGISTER
ChiCTR-TRC-11001747. http://www.chictr.org.cn/showprojen.aspx?proj=7798.
背景
患有代谢综合征（MetS）的绝经后女性心血管发病率和左心室舒张功能障碍（LVDD）增加。黄芪（AM）的各种保护作用在以前的研究中已有描述。因此，本研究旨在评估不同剂量的 AM 对绝经后高血压合并 MetS 女性舒张功能的影响。
方法
这是一项前瞻性、随机对照研究。从 2014 年 3 月至 2015 年 4 月，从兰州大学第二医院招募绝经后高血压合并 MetS 患者。患者分为三组：对照组（接受常规药物治疗）、AM 组 1（加用 AM 胶囊 5g/d）和 AM 组 2（加用 AM 胶囊 10g/d）。治疗前和治疗 12 个月后评估超声心动图和临床特征。使用配对 t 检验、方差分析和多元线性回归分析定量数据。
结果
共有 154 例患者进行了最终分析。在 AM 组 2 中，与对照组相比，治疗 12 个月后舒张功能明显改善，包括早期舒张二尖瓣环速度（E'；0.065±0.007m/s 比 0.061±0.008m/s，P=0.014）、早期舒张二尖瓣峰流速与晚期舒张二尖瓣峰流速比值（E/A；0.81±0.05 比 0.80±0.06，P=0.012）、E'与晚期舒张二尖瓣环速度比值（E'/A'；0.56±0.12 比 0.51±0.13，P=0.048）和早期舒张二尖瓣峰流速与 E'的比值（E/E'；10.70±1.30 比 11.37±1.73，P=0.031）。治疗后，E/E'（10.70±1.30 比 11.24±1.56，P=0.021）、减速时间（DT；261.49±44.41ms 比 268.74±53.87ms，P=0.046）和 E'/A'（0.56±0.12 比 0.52±0.13，P=0.019）值的改善明显优于 AM 组 2 治疗前。此外，腰围与 E'（r=0.472；P=0.003）和 E'/A'（r=0.321；P=0.047）呈正相关。此外，腰臀比是 DT（r=0.276；P=0.041）、E'（r=-0.590；P<0.001）、E/E'（r=0.454；P=0.004）和 E'/A'（r=-0.377；P=0.018）的显著预测因子。
结论
常规药物联合 AM 治疗可改善舒张功能。此外，WC 和 WHR 可能是 LVDD 的危险因素。
临床试验注册
ChiCTR-TRC-11001747。http://www.chictr.org.cn/showprojen.aspx?proj=7798.
Zotero 插件