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.
黄芪对合并代谢综合征的绝经后女性高血压患者无症状左室舒张功能不全的改善作用：一项前瞻性、随机对照试验摘要背景：合并代谢综合征(MetS)的绝经后女性患者心血管死亡率及左室舒张功能不全(LVDD)的发生均升高。此前的研究已证实黄芪(AM)具有多重的保护作用。因此，本研究旨在评估不同剂量AM对合并MetS的绝经后女性高血压患者的左室舒张功能的改善作用。 方法：本研究是一项前瞻性、随机对照试验。纳入了2014年3月至2015年4月之间就诊于兰州大学第二医院的合并MetS的绝经后女性高血压患者。将入选患者随机分为三组：对照组（接受常规药物治疗），AM1组（在常规药物治疗的基础上加用AM胶囊5g/d）及AM2组（在常规药物治疗的基础上加用AM胶囊10g/d）。在治疗前及治疗12个月后，均分别评估超声心动图及临床相关特征。定量资料采用配对t检验、方差分析和多元线性回归分析。 结果：共154名患者纳入最终研究。 在AM2组中，治疗12个月后左室舒张功能相关指标得到了显著的改善，包括舒张早期瓣环速度(E’; 0.065 ± 0.007 m/s vs. 0.061 ± 0.008 m/s, P = 0.014)、充盈早期峰值速度与舒张晚期充盈速度的比值 (E/A; 0.81 ± 0.05 vs. 0.80 ± 0.06, P = 0.012)、E’与舒张晚期瓣环速度的比值(E’/A’; 0.56 ± 0.12 vs. 0.51 ± 0.13, P = 0.048)，以及充盈早期峰值速度与E’的比值 (E/E’; 10.70 ± 1.30 vs. 11.37 ± 1.73, P =0.031)。同时，AM2组患者与治疗前相比，治疗后的E/E’ (10.70 ± 1.30 vs. 11.24 ± 1.56, P =0.021)、充盈波减速时间 (DT; 261.49±44.41 ms vs. 268.74 ± 53.87 ms, P =0.046) 及E’/A’ (0.56 ± 0.12 vs. 0.52 ± 0.13, P =0.019) 也均得到明显的改善。此外，腰围(WC)与E’ (r = 0.472; P = 0.003) 及E’/A’ (r = 0.321; P =0.047)呈正相关。而腰臀比(WHR)又是充盈早期峰值速度 (r = 0.276; P =0.041)、E’ (r = −0.590; P <0.001)、E/E’ (r = 0.454; P = 0.004)及E’/A’ (r = −0.377; P = 0.018)的有效预测指标。 结论：常规药物加用AM治疗可以改善左室舒张功能。而且，WC及WHR可能是LVDD的危险因素。.
Keywords: Astragalus Membranaceus; Hypertension; Left Ventricular Dysfunction; Metabolic Syndrome; Postmenopause.