Background

Heart failure (HF) is the terminal stage of multiple cardiovascular diseases, with high mortality and morbidity. More and more studies have proved that gut microbiota may play a role in the process of HF, which is expected to become a new therapeutic target. The combination of traditional Chinese and Western medicine has vast therapeutic potential of complementation against HF.

Purpose

This manuscript expounds on the research progress of mechanisms of gut microbiota participating in the occurrence and prognosis of HF and the role of integrative traditional Chinese and Western medicine from 1987 to 2022. The combination of traditional Chinese and Western medicine in the prevention and treatment of HF from the perspective of gut microbiota has been discussed.

Methods

Studies focusing on the effects and their mechanisms of gut microbiota in HF and the role of integrative traditional Chinese and Western medicine were identified and summarized, including contributions from February 1987 until August 2022. The investigation was carried out in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. We searched PubMed, Embase, Cochrane Library, CNKI, Wanfang, and VIP databases up to April 2023 by using the relevant keywords and operators.

Results

A total of 34 articles were finally included in this review.16 RCTs and 13 basic researches, and 3 clinical research studies involving 7 relevant outcome indicators(cardiac function evaluation index, changes in gut microbiota, inflammatory factors, metabolites of gut microbiota, serum nutritional index protein, quality of life score, intestinal permeability and all-cause mortality). Compared with healthy controls, serum TNF-α and TMAO levels were significantly higher in patients with heart failure [MD = 5.77, 95%CI(4.97, 6.56), p < 0.0001; SMD = 1.92, 95%CI(1.70, 2.14), p < 0.0001]. Escherichia coli and Thick-walled bacteria increased significantly [SMD = -0.99, 95%CI(-1.38, -0.61), p < 0.0001, SMD = 2.58, 95%CI(2.23, 2.93), p < 0.0001];The number of bacteroides and lactobacillus decreased [SMD = -2.29, 95%CI(-2.54, -2.04), p < 0.0001; SMD = -1.55, 95%CI(-1.8, -1.3), p < 0.0001]. There was no difference in bifidobacterium [SMD = 0.16, 95%CI(-0.22, 0.54), p = 0.42]. In the published literature, it is not difficult to see that most of the results are studied and proved based on animal experiments or clinical trials, involving the cellular level, while the mechanism and mode of action of the molecular biology of traditional Chinese medicine are less elaborated, which is related to the characteristics of multi-components and multi-targets of traditional Chinese medicine. The above are the shortcomings of published literature, which can also be the direction of future research.

Conclusion

Heart failure patients have decreased beneficial bacteria such as Bacillus mimics and Lactobacillus in the intestinal flora and increased harmful flora like thick-walled flora. And increase the inflammatory response of the body and the expression of trimethylamine oxide (TMAO) in the serum. And The prevention and treatment of integrative traditional Chinese and Western medicine against heart failure based on gut microbiota and its metabolites is a promising research direction.

中文翻译：

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肠道菌群与中西医结合防治心力衰竭

背景

心力衰竭（HF）是多种心血管疾病的终末期，具有较高的死亡率和发病率。越来越多的研究证明肠道菌群可能在心力衰竭的发生过程中发挥作用，有望成为新的治疗靶点。中西医结合治疗心力衰竭具有巨大的互补治疗潜力。

目的

本文阐述了1987年至2022年肠道菌群参与心力衰竭发生及预后的机制及中西医结合作用的研究进展。中西医结合在心力衰竭防治中的作用从肠道菌群的角度进行了讨论。

方法

对肠道菌群对心力衰竭的影响及其机制以及中西医结合作用的研究进行了识别和总结，包括1987年2月至2022年8月的贡献。调查是按照《心力衰竭》的首选报告项目进行的。系统评价和荟萃分析 (PRISMA) 指南。我们使用相关关键词和运算符检索了截至2023年4月的PubMed、Embase 、Cochrane Library 、CNKI、万方和VIP数据库。

结果

最终纳入34篇文章。随机对照试验16项，基础研究13项，临床研究3项，涉及7个相关结局指标（心功能评价指标、肠道菌群变化、炎症因子、肠道菌群代谢物、血清营养）指数蛋白质、生活质量评分、肠道通透性和全因死亡率）。与健康对照相比，心力衰竭患者血清TNF-α和TMAO水平显着升高[MD = 5.77, 95%CI(4.97, 6.56), p< 0.0001；SMD = 1.92，95%CI（1.70，2.14），p< 0.0001]。大肠杆菌和厚壁细菌显着增加 [SMD = -0.99, 95%CI(-1.38, -0.61),p< 0.0001, SMD = 2.58, 95%CI(2.23, 2.93), p < 0.0001];拟杆菌和乳酸菌数量减少[SMD = -2.29, 95%CI(-2.54, -2.04), p < 0.0001; SMD = -1.55，95%CI（-1.8，-1.3），p < 0.0001]。双歧杆菌没有差异[SMD = 0.16, 95%CI(-0.22, 0.54), p  = 0.42]。在已发表的文献中，不难看出，大部分结果都是基于动物实验或临床试验来研究和证明，涉及细胞水平，而分子生物学的机制和作用方式中药阐述较少，这与中药多成分、多靶点的特点有关。以上是已发表文献的不足，也可以作为未来研究的方向。

结论

心力衰竭患者肠道菌群中模拟芽孢杆菌、乳酸菌等有益菌减少，厚壁菌群等有害菌群增多。并增加机体的炎症反应和血清中氧化三甲胺（TMAO）的表达。而基于肠道菌群及其代谢产物的中西医结合防治心力衰竭是一个很有前景的研究方向。