参附仙苓汤治疗心衰的临床疗效及网络药理学研究*

作者：陈 颖1，曹 辉1，王仲建1，王允吉1，钱志强2

单位：1.南京中医药大学附属南京医院/南京市第二医院，江苏 南京 210003； 2.泰州市姜堰中医院，江苏 泰州 225500

引用：引用：陈颖，曹辉，王仲建，王允吉，钱志强.参附仙苓汤治疗心衰的临床疗效及网络药理学研究[J].中医药导报,2025,31(12):155-162.

DOI：10.13862/j.cn43-1446/r.2025.12.025

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摘要：

目的：通过临床研究结合网络药理学方法探讨参附仙苓汤治疗心衰的临床疗效和作用机制。方法：将100例心功能分级Ⅱ～Ⅲ级的心衰患者，随机分为对照组和试验组，每组50例。对照组采用常规西药方案治疗，试验组在常规西药治疗的基础上加用参附仙苓汤，疗程为15 d。治疗结束后观察两组患者治疗前后相应指标的变化情况以及临床有效率。（1）心功能指标：左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）、左心室射血分数（LVEF）；（2）血清指标：脑钠肽（BNP）、N端前脑钠肽（NT-proBNP）、白细胞介素-6（IL-6）；（3）6 min步行距离（6MWD）。运用网络药理学方法，从TCMSP数据库中获得参附仙苓汤活性成分及其潜在靶点，利用GeneCards及OMIM数据库筛选心衰的靶点，将共同靶点通过String数据库构建出蛋白质相互作用网络（PPI），利用Cytoscape 3.9.1软件，构建药物-成分-靶点-疾病互作网络；最后进行基因本体（GO）功能分析及京都基因与基因组百科全书（KEGG）通路的富集研究。结果：（1）治疗后，两组患者心功能指标LVEF水平较治疗前均升高，且试验组明显高于对照组（P＜0.05），心功能指标LVESV、LVEDV水平较治疗前均降低，且试验组明显低于对照组（P＜0.05）。（2）治疗后，两组患者6MWD较治疗前均提高，且试验组明显高于对照组（P＜0.05）。（3）治疗后，两组患者血清指标BNP、NT-proBNP、IL-6值较治疗前均降低，且试验组明显低于对照组（P＜0.05）。（4）治疗后,试验组有效率为94.00%（47/50），高于对照组的78.00%（39/50）（P＜0.05）。（5）筛选出了符合标准的多种活性成分（如 Neokadsuranic acid B、Icariside A7等），确定109个药物与HF的交集靶点，构建了相关网络。（6）PPI网络中，IL-6、半胱氨酸蛋白酶-3（CASP3）、6号染色体基因（ESR1）、表皮生长因子受体（EGFR）、B淋巴细胞瘤-2基因（BCL2）等为关键靶点。（7）GO富集显示涉及细胞对化学刺激等多种生物学过程、膜筏等细胞成分及DNA结合转录因子活性等分子功能。（8）KEGG分析富集出化学致癌-受体激活、脂质代谢与动脉粥样硬化等多条信号通路。结论：参附仙苓汤通过多成分、多靶点、多信号通路的作用机制来发挥抑制炎性因子IL-6表达，降低血清中BNP、NT-proBNP值，改善患者心功能指标，提高运动耐力，临床疗效明显。

关键词：心衰；参附仙苓汤；网络药理学；心功能；运动耐力；临床疗效；作用机制

Abstract：Objective: To investigate the clinical efficacy and mechanism of Shenfu Xianling Decoction (参附仙苓汤, SFXLD) in treating heart failure (HF) through clinical study and network pharmacology. Methods: 100 HF patients (NYHA Ⅱ-Ⅲ) were randomly divided into control and experimental groups (50 each). The control group received conventional Western medicine; the experimental group received SFXLD plus conventional medicine for 15 days. Cardiac function (LVEDV, LVESV, LVEF), serum markers (BNP, NT-proBNP, IL-6), 6-minute walk distance (6MWD), and clinical efficacy were observed. Using network pharmacology methods, the active ingredients of SFXLD and their potential targets were obtained from the TCMSP database. Targets related to HF were screened using the GeneCards and OMIM databases. The common targets were used to construct a protein-protein interaction (PPI) network via the STRING database. Subsequently, a drug-component-target-disease interaction network was built using Cytoscape software (version 3.9.1). Finally, Gene Ontology (GO) functional analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment studies were performed. Results: (1) After treatment, the levels of the cardiac function index LVEF increased in both groups compared to pre-treatment levels, and the increase was significantly greater in the experimental group than in the control group (P<0.05). Conversely, the levels of the cardiac function indices LVESV and LVEDV decreased in both groups compared to pre-treatment levels, and the decreases were significantly greater in the experimental group than in the control group (P<0.05). (2) After treatment, the 6MWD improved in both groups compared to pre-treatment, and the improvement was significantly greater in the experimental group than in the control group (P<0.05). (3) After treatment, the serum levels of BNP, NT-proBNP, and IL-6 decreased in both groups compared to pre-treatment levels, and the decreases were significantly greater in the experimental group than in the control group (P<0.05). (4) After treatment, the effective rate in the experimental group was 94.00% (47/50), which was significantly higher than the 78.00% (39/50) in the control group (P<0.05). (5) Multiple active ingredients meeting the criteria (such as Neokadsuranic acid B and Icariside A7) were screened, 109 intersecting targets between the drug and HF were identified, and relevant networks were constructed. (6) In the PPI network, key targets included IL-6, Caspase-3 (CASP3), Estrogen Receptor 1 (ESR1) located on chromosome 6, Epidermal Growth Factor Receptor (EGFR), and B-cell Lymphoma 2 (BCL2). (7) GO enrichment analysis revealed involvement in various biological processes such as cellular response to chemical stimuli, cellular components like membrane rafts, and molecular functions including DNA-binding transcription factor activity. (8) KEGG analysis enriched multiple signaling pathways, including Chemical carcinogenesis-receptor activation, Lipid metabolism and atherosclerosis. Conclusion: SFXLD can improve cardiac function, exercise tolerance, and reduces BNP, NT-proBNP, IL-6 through multi-component, multi-target, multi-pathway mechanisms, showing significant clinical efficacy.

Key words：heart failure; Shenfu Xianling Decoction; network pharmacology; cardiac function; exercise tolerance; clinical efficacy; mechanism of action

发布时间：2026-01-30

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