目的：基于所建立的R值综合评价法，多指标综合评价调补肺肾（补肺健脾、补肺益肾、益气滋肾）三法对慢性阻塞性肺疾病（COPD）合并右心室重塑的疗效及机制的纠正作用。方法：基于前期研究数据，选取以下指标：①右心室组织形态学指标：右心肥大指数（RVHI），心肌肌节长度，心肌线粒体体密度（Vv）、比表面（δ）、比膜面（δm），心脏小动脉线粒体Vv、δ、δm；②右心室重塑机制：右心组织内皮素-1（ET-1）、转化生长因子-β （TGF-β）、血管内皮生长因子（VEGF）、碱性成纤维细胞生长因子（bFGF）、基质金属蛋白酶-9（MMP-9）和组织金属蛋白酶抑制剂-1（TIMP-1）。采用R值综合评价法，多指标综合评价调补肺肾三法对COPD合并右心室重塑的效果及对其机制的纠正作用。结果：①右心室重塑的改善作用：第20周，纠正强度依次为补肺健脾、补肺益肾、氨茶碱、益气滋肾。第32周和综合20、32周，纠正强度均依次为补肺健脾、补肺益肾、益气滋肾、氨茶碱。其中综合20、32周补肺健脾的纠正强度较氨茶碱显著（P<0.01）。各治疗组第32周时仍维持第20周状态，表示各治疗组均有较好的远后效应。②右心室重塑机制的纠正作用：第20周，综合纠正强度依次为补肺健脾、补肺益肾、氨茶碱、益气滋肾，其中补肺健脾的纠正强度较氨茶碱、益气滋肾显著（P<0.01）；补肺益肾的纠正强度较益气滋肾显著（P<0.05）。第32周，纠正强度依次为益气滋肾、氨茶碱、补肺健脾、补肺益肾。综合20、32周，纠正强度依次为补肺健脾、补肺益肾、益气滋肾、氨茶碱。调补肺肾三法和氨茶碱第32周时仍维持第20周纠正强度，表示各治疗方案均有较好的远后效应。结论：本研究经R值综合评价法发现调补肺肾三法可改善COPD合并右心室重塑状态，调节心脏重塑相关因子的表达，以补肺健脾较显著，且均有较好的远后效应。

This study was aimed to evaluate the efficacy of Tiao-Bu Fei-Shen therapies (i.e., Bu-Fei Jian-Pi, Bu-Fei Yi-Shen, Yi-Qi Zi-Shen) on cardiac remodeling of chronic obstructive pulmonary disease(COPD) rats and its mechanisms according to the R-value comprehensive evaluation method. Based on the database of previous experiment of COPD rats, R-value comprehensive evaluation method was used to evaluate the indexes as fellows to discuss efficacy of Tiao-Bu Fei-Shen therapies on cardiac remodeling of COPD rats. ① Indicators of right ventricular morphologic indexes: right ventricular hypertrophy index(RVHI), cardiac muscle sarcomere lengths, bulk density of myocardial mitochondria (Vv), surface area (δ), membrane surface (δm), Vv, δ, δm of heart mitochondria; ② Indicators of mechanisms: right ventricular endothelin-1(ET-1), transforming growth factor-beta (TGF-β), vascular endothelial growth factor (VEGF), basic fibroblast growth factor(bFGF), matrix metalloproteinase-9(MMP-9) and tissue inhibitor of metalloproteinase-1(TIMP-1). The results showed that the sequence of improving effect of right ventricular remodeling at week 20 was Bu-Fei Jian-Pi, Bu-Fei Yi-Shen, aminophylline, and Yi-Qi Zi-Shen; at week 32 and the integrated week 20 and week 32, the sequence of effect was Bu-Fei Jian-Pi, Bu-Fei Yi-Shen, Yi-Qi Zi-Shen, and aminophylline. At integrated week 20 and week 32, Bu-Fei Jian-Pi had significant better intensity correcting effect than aminophylline(P < 0.01). There was no difference between week 20 and week 32. It showed that each treatment group had good long-term effect. For the mechanism of correcting effect on right ventricular remodeling, at week 20, the sequence of comprehensive effect was Bu-Fei Jian-Pi, Bu-Fei Yi-Shen, aminophylline, and Yi-Qi Zi-Shen. And Bu-Fei Jian-Pi had better effect compared with aminophylline and Yi-Qi Zi-Shen (P < 0.01); Bu-Fei Yi-Shen had better effect than Yi-Qi Zi-Shen (P < 0.05). At week 32, the sequence of effect was Yi-Qi Zi-Shen, aminophylline, Bu-Fei Jian-Pi, and Bu-Fei Yi-Shen. At the integrated week 20 and week 32, the sequence of effect was Bu-Fei Jian-Pi, and Bu-Fei Yi-Shen, Yi-Qi Zi-Shen, and aminophylline. Until week 32, the correcting effect of Tiao-Bu Fei-Shen therapies and aminophylline still maintained the same level as at week 20. It indicated that each treatment plan had good long-term effect. It was concluded that Tiao-Bu Fei-Shen therapies can improve the cardiac remodeling of COPD rats and expression of related factors in the cardiac remodeling through the R-value comprehensive evaluation method. And the effect of Bu-Fei Jian-Pi was obvious with good long-term effect.

国家自然科学基金委重点项目（81130062）：调补肺肾三法调控多维分子网络治疗COPD的作用及远后效应，负责人：李建生。