消心痹方联合卡维地洛治疗肥厚型心肌病的临床研究
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摘要
目的观察消心痹方联合卡维地洛治疗肥厚型心肌病(HCM)的疗效及对病人心功能、胰岛素样生长因子-1(IGF-1)、B型脑钠肽(BNP)水平的影响。方法选取我院收治的124例HCM病人,随机分为观察组和对照组,各62例。两组均给予营养心肌、利尿等常规治疗,对照组在常规基础上给予卡维地洛治疗,观察组在对照组治疗基础上联合消心痹方治疗。观察并比较两组中医证候积分、临床疗效、血液流变学,使用彩色多普勒超声诊断仪检测室间隔厚度(IVST)、左心室后壁厚度(LVPWT)及左心室舒张末期内径(LVEDD)和左心室收缩末期内径(LVESD),并检测IGF-1、BNP水平。结果治疗后,两组中医证候积分较治疗前均显著降低,且观察组低于对照组(P<0.05);观察组总有效率显著高于对照组,差异有统计学意义(90.32%与75.81%,P<0.05);治疗后,两组全血黏度高切值、血浆黏度、全血黏度低切值、血红细胞比容显著低于治疗前,且观察组低于对照组(P<0.05);治疗后,两组IVST、LVPWT显著低于治疗前(P<0.05),LVEDD、LVESD显著高于治疗前(P<0.05),且观察组改善优于对照组,差异有统计学意义(P<0.05);治疗后,两组IGF-1、BNP水平显著低于治疗前(P<0.05),且观察组低于对照组,差异有统计学意义(P<0.05)。结论消心痹方联合卡维地洛能有效改善HCM病人心功能和IGF-1、BNP水平,提高临床疗效。
Objective To observe curative effect of Xiaoxinbi Fang combined with carvedilol in the treatment of hypertrophic cardiomyopathy(HCM)and its influence on cardiac function,insulin-like growth factor-1(IGF-1),and type-B brain natriuretic peptide(BNP) levels of the patients.Methods One hundred and twenty four patients with HCM were randomly divided into the observation group and the control group,62 cases in each group.All patients were given routine treatment.On the basis of that,the control group were given carvedilol treatment,the observation group were combined with Xiaoxinbi Fang and carvedilol.Traditional Chinese medicine(TCM) symptom score,clinical efficacy,and hemorheology were observed and compared between groups.Ventricular septal thickness(IVST),left ventricular posterior wall thickness(LVPWT),left ventricular end diastolic diameter(LVEDD),and left ventricular end systolic diameter(LVESD) were detected by color Doppler ultrasound diagnostic apparatus,and IGF-1 and BNP levels were tested and compared between groups.Results The scores of TCM syndromes in the observation group and the control group were significantly lower than those before treatment(P<0.05),and the scores of the observation group were lower than those of the control group(P<0.05).The total effective rate of the observation group was significantly higher than that of the control group(P<0.05).There were statistical differences between the two groups(P<0.05).The high blood viscosity,plasma viscosity,whole blood viscosity,low hematocrit,and hematocrit were significantly lower in the observation group and the control group than before treatment(P<0.05),the observation group were lower than those of the control group(P<0.05).IVST and LVPWT of the observation group and the control group were significantly lower than those before the treatment(P<0.05),and the LVEDD and LVESD were significantly higher than those before the treatment(P<0.05),there were statistical differences between the observation group and the control group(P<0.05).The levels of IGF-1 and BNP in the observation group and the control group were significantly lower than those before the treatment(P<0.05),and the observation group were lower than those of the control group(P<0.05).Conclusion Xiaoxinbi Fang combined with carvedilol can effectively improve cardiac function and IGF-1 and BNP levels of patients with HCM,and improve clinical efficacy.
Objective To observe curative effect of Xiaoxinbi Fang combined with carvedilol in the treatment of hypertrophic cardiomyopathy(HCM)and its influence on cardiac function,insulin-like growth factor-1(IGF-1),and type-B brain natriuretic peptide(BNP) levels of the patients.Methods One hundred and twenty four patients with HCM were randomly divided into the observation group and the control group,62 cases in each group.All patients were given routine treatment.On the basis of that,the control group were given carvedilol treatment,the observation group were combined with Xiaoxinbi Fang and carvedilol.Traditional Chinese medicine(TCM) symptom score,clinical efficacy,and hemorheology were observed and compared between groups.Ventricular septal thickness(IVST),left ventricular posterior wall thickness(LVPWT),left ventricular end diastolic diameter(LVEDD),and left ventricular end systolic diameter(LVESD) were detected by color Doppler ultrasound diagnostic apparatus,and IGF-1 and BNP levels were tested and compared between groups.Results The scores of TCM syndromes in the observation group and the control group were significantly lower than those before treatment(P<0.05),and the scores of the observation group were lower than those of the control group(P<0.05).The total effective rate of the observation group was significantly higher than that of the control group(P<0.05).There were statistical differences between the two groups(P<0.05).The high blood viscosity,plasma viscosity,whole blood viscosity,low hematocrit,and hematocrit were significantly lower in the observation group and the control group than before treatment(P<0.05),the observation group were lower than those of the control group(P<0.05).IVST and LVPWT of the observation group and the control group were significantly lower than those before the treatment(P<0.05),and the LVEDD and LVESD were significantly higher than those before the treatment(P<0.05),there were statistical differences between the observation group and the control group(P<0.05).The levels of IGF-1 and BNP in the observation group and the control group were significantly lower than those before the treatment(P<0.05),and the observation group were lower than those of the control group(P<0.05).Conclusion Xiaoxinbi Fang combined with carvedilol can effectively improve cardiac function and IGF-1 and BNP levels of patients with HCM,and improve clinical efficacy.
引文
[1] 赵敏,马丹,刘巍,等.常规药物加心区交感神经阻滞术治疗肥厚型心肌病的临床研究[J].东南大学学报(医学版),2016,35(2):205-207.
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[10] 宋丽芬,皮林,赵晓静,等.扩张型心肌病心衰患者采用曲美他嗪治疗对改善LVEF、LVEDD、CO水平的作用[J].中国医药导刊,2016,18(2):183-185.
[11] 孙立勤,陈杰,于春艳,等.曲美他嗪对肥厚型心肌病伴室性心律失常的影响[J].心脑血管病防治,2012,12(2):158-160.
[12] 付鹏,黄志东,谢丹.养心氏片治疗扩张型心肌病心力衰竭的疗效观察[J].世界中医药,2014,9(5):577-578;582.
[13] 段班燕,何圆圆,党书毅,等.卡维地洛对非梗阻性肥厚型心肌病患者心室重构的影响[J].医学研究杂志,2013,42(8):133-135.
[14] 王西涛.麝香保心丸联合曲美他嗪治疗老年缺血性心肌病心力衰竭临床研究[J].中医学报,2014,29(9):1371-1372.
[15] 黄瑞霞,张建军,王仁平,等.益气解毒活血通络法对缺血性心肌病患者心功能的影响[J].河南中医,2015,35(10):2366-2368.
[16] 宋清富,席琼,张磊.中西医结合治疗心肌病的临床疗效观察[J].中国地方病防治杂志,2016,31(7):815;818.
[17] 张大炜,戴梅,周旭升,等.消心痹方联合西药对肥厚型心肌病患者中医症状及左室功能的影响[J].中医杂志,2016,57(15):1313-1316.
[18] 侯喜,徐宏遵,时小环,等.益气活血养心安神方剂辅治扩张型心肌病对心肺功能的影响[J].临床合理用药杂志,2015,8(1):51-52.
[19] 王淑枝.中医辨证治疗和中西医结合治疗缺血性心肌病的效果体会[J].当代医学,2014,20(26):152-153.
[20] 吴玲明.自拟益气养心活血汤治疗心肌病49例[J].光明中医,2014,29(8):1661-1662.
[2] 李松,覃松柏,江倩,等.卡维地洛对非梗阻性肥厚型心肌病患者心室重构的疗效观察[J].医学理论与实践,2017,30(5):656-657.
[3] 张大炜,戴梅,周旭升,等.辨证辨病结合以消心痹方治疗肥厚型心肌病的疗效观察[J].国际中医中药杂志,2013,35(10):918-919.
[4] 惠汝太.肥厚型心肌病的诊断与治疗进展[J].中华心血管病杂志,2007,35(1):82-85.
[5] 国家中医药管理局.中医病症诊断疗效标准[M].南京:南京大学出版社,1994:107-109.
[6] 中华人民共和国卫生部.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:228-229.
[7] 丁乐群.卡维地洛对扩张型心肌病患者心功能及心室重构的影响[J].浙江中西医结合杂志,2013,23(7):542-544.
[8] 陈海波,赵统兵.血清胰岛素样生长因子-1与肥厚型心肌病左室肥厚的相关性研究[J].深圳中西医结合杂志,2003,9(4):244-245.
[9] 张剑,吴翔.血清BNP和cTnI与肥厚型心肌病患者室性心律失常发生的关系[J].江苏医药,2014,40(24):2976-2978.
[10] 宋丽芬,皮林,赵晓静,等.扩张型心肌病心衰患者采用曲美他嗪治疗对改善LVEF、LVEDD、CO水平的作用[J].中国医药导刊,2016,18(2):183-185.
[11] 孙立勤,陈杰,于春艳,等.曲美他嗪对肥厚型心肌病伴室性心律失常的影响[J].心脑血管病防治,2012,12(2):158-160.
[12] 付鹏,黄志东,谢丹.养心氏片治疗扩张型心肌病心力衰竭的疗效观察[J].世界中医药,2014,9(5):577-578;582.
[13] 段班燕,何圆圆,党书毅,等.卡维地洛对非梗阻性肥厚型心肌病患者心室重构的影响[J].医学研究杂志,2013,42(8):133-135.
[14] 王西涛.麝香保心丸联合曲美他嗪治疗老年缺血性心肌病心力衰竭临床研究[J].中医学报,2014,29(9):1371-1372.
[15] 黄瑞霞,张建军,王仁平,等.益气解毒活血通络法对缺血性心肌病患者心功能的影响[J].河南中医,2015,35(10):2366-2368.
[16] 宋清富,席琼,张磊.中西医结合治疗心肌病的临床疗效观察[J].中国地方病防治杂志,2016,31(7):815;818.
[17] 张大炜,戴梅,周旭升,等.消心痹方联合西药对肥厚型心肌病患者中医症状及左室功能的影响[J].中医杂志,2016,57(15):1313-1316.
[18] 侯喜,徐宏遵,时小环,等.益气活血养心安神方剂辅治扩张型心肌病对心肺功能的影响[J].临床合理用药杂志,2015,8(1):51-52.
[19] 王淑枝.中医辨证治疗和中西医结合治疗缺血性心肌病的效果体会[J].当代医学,2014,20(26):152-153.
[20] 吴玲明.自拟益气养心活血汤治疗心肌病49例[J].光明中医,2014,29(8):1661-1662.