健心汤联合沙库巴曲缬沙坦钠片治疗慢性心力衰竭阳气亏虚血瘀证临床研究
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R541.6

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浙江省医学会临床医学专项资金项目(2022ZYC-A182)


Clinical Study of Jianxin Decoction Combined with Sacubitril Valsartan Sodium Tablets in the Treatment of Chronic Heart Failure with Syndrome of Yang Qi Depletion and Blood Stasis
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    摘要:

    目的:观察健心汤联合沙库巴曲缬沙坦钠片治疗慢性心力衰竭阳气亏虚血瘀证的临床疗效。方法: 采用随机数字表法将中国人民解放军陆军第七十二集团军医院收治的122例慢性心力衰竭阳气亏虚血瘀证患者 分为对照组、观察组各61例。对照组给予沙库巴曲缬沙坦钠片治疗,观察组给予健心汤联合沙库巴曲缬沙坦 钠片治疗。比较2 组治疗前后中医证候积分、心室重构指标[右心室内径(RVD)、左心室舒张末期内 径(LVEDD)、左心室射血分数(LVEF)、血清微小RNA-30a (miR-30a) ]、血管内皮功能指标[一氧化 氮(NO)、内皮素(ET)、降钙素基因相关肽(CGRP)、一氧化氮合酶(NOS) ]、心肌损伤指标[心型脂肪酸结 合蛋白(H-FABP)、乳酸脱氢酶、N末端B型利钠肽原(NT-proBNP) ]、美国纽约心脏病协会(NYHA) 心功 能分级,并评估2组临床疗效及不良反应发生情况。结果:治疗后,观察组总有效率90.16%,高于对照组 75.41%(P<0.05)。治疗后,2组NYHA心功能分级轻于治疗前(P<0.05),且观察组NYHA心功能分级较对 照组减轻(P<0.05)。治疗后,2组中医证候积分、LVEDD、miR-30a、ET、H-FABP、乳酸脱氢酶、NT-proBNP水 平均较治疗前降低(P<0.05),RVD、LVEF、NO、CGRP、NOS水平均升高(P<0.05);观察组中医证候积 分、LVEDD、miR-30a、ET水平及心肌损伤指标均低于对照组(P<0.05),RVD、LVEF、NO、CGRP、NOS 水平高于对照组(P<0.05)。2组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:健心汤联合沙 库巴曲缬沙坦钠片治疗慢性心力衰竭阳气亏虚血瘀证疗效确切,能改善患者心室重构和血管内皮功能,减轻心 肌损伤,安全性较高。

    Abstract:

    Abstract:Objective:To observe the clinical efficacy of the combination use of Jianxin Decoction and Sacubitril Valsartan Sodium Tablets on chronic heart failure with syndrome of yang qi depletion and blood stasis. Methods:A total of 122 patients with chronic heart failure with syndrome of yang qi depletion and blood stasis admitted to the 72nd Army Group Hospital of the Chinese People's Liberation Army were divided into the control group and the observation group according to the random number table method, with 61 cases in each group. The control group was treated with Sacubitril Valsartan Sodium Tablets, whereas the observation group was given Jianxin Decoction combined with Sacubitril Valsartan Sodium Tablets. The traditional Chinese medicine (TCM) syndromes scores, and ventricular remodeling indexes [right ventricular diameter (RVD), left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fractions (LVEF) and serum micro RNA-30a (miR-30a)], endothelial function indexes [nitric oxide (NO), endothelin (ET), calcitonin gene related peptide (CGRP) and nitric oxide synthase (NOS)], and myocardial injury indexes [heart-fatty acid binding protein (H-FABP), lactate dehydrogenase and N terminal pro-Btype natriuretic peptide (NT-proBNP)], New York Heart Association (NYHA) cardiac function grading were compared before and after treatment,and the clinical efficacy and occurrence of adverse reactions in both groups were evaluated. Results: After treatment, the total effective rate was 90.16% in the observation group,which was higher than 75.41% in the control group (P<0.05). The NYHA cardiac function grading in the two groups after treatment was milder than that before treatment (P<0.05), and the NYHA cardiac function grading in the observation group was relieved compared to the control group (P<0.05). After treatment, the TCM syndromes scores and levels of LVEDD, miR-30a, ET, H-FABP, lactate dehydrogenase and NT-proBNP in the two groups were reduced compared with those before treatment (P<0.05),while the levels of RVD,LVEF,NO,CGRP and NOS were elevated (P<0.05),and the TCM syndromes scores and levels of LVEDD, miR-30a, ET and myocardial indexes in the observation group were lower (P<0.05),while the levels of RVD,LVEF,NO,CGRP and NOS were higher than those in the control group (P<0.05). There was no significant difference being found in the comparison of incidence of adverse reactions between the two groups (P>0.05). Conclusion: The combination use of Jianxin Decoction and Sacubitril Valsartan Sodium Tablets has a definite curative effect on chronic heart failure with syndrome of yang qi depletion and blood stasis, which can improve the ventricular remodeling and endothelial function of patients,and reduce the myocardial injury,with high safety.

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郑毅敏,张帅,向科发,吴峰,周巍,俞峰.健心汤联合沙库巴曲缬沙坦钠片治疗慢性心力衰竭阳气亏虚血瘀证临床研究[J].新中医,2024,56(18):44-49

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  • 在线发布日期: 2024-09-27
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