黄芪桂枝五物合真武汤加减对慢性心力衰竭(阳气亏虚证)疾病进展和预后的影响
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摘要
目的:评价黄芪桂枝五物合真武汤加减治疗对慢性心力衰竭(CHF)患者疾病进展和预后的影响。方法:将127例CHF患者按随机数字表法分为对照组和观察组,对照组采用依那普利片+美托洛尔片+螺内酯片治疗。观察组在对照组的基础上采用黄芪桂枝五物汤合真武汤加减治疗,每日1剂,疗程3个月,并进行6个月随访,评价NYHA心功能分级、Lee氏心衰评分、6 min步行试验、中医证候评分和生活质量评分和超声心动图,记录疾病进展情况和预后情况。结果:观察组心功能疗效高于对照组,观察组NYHA心功能分级、Lee氏心衰、中医证候和MLHFQ评分均低于对照组,6 min步行距离多于对照组,观察组LVEF、SV、CO和E/A的比值均高于对照组,观察组疾病进展发生率均低于对照组,观察组NT-proBNP、ST2、galectin-3、和肽素水平低于对照组,e GFR高于对照组。结论:黄芪桂枝五物汤合真武汤治疗CHF患者近期能减轻症状、改善心功能、提高患者生活质量和活动能力,远期能稳定病情、控制疾病进展、改善心功能和预后。
Objective: To discuss the influence of adjuvant therapy of Huangqi Guizhi Wuwu decoction combined with Zhenwu decoction in treating chronic cardiac failure( CHF) and influence to progression and prognosis of this disease.Methods: One hundred and twenty-seven CHF patients were randomly divided into control group( 63 cases) and combination group( 64 cases) by random number table. Patients in control group took enalapril tablets,metoprolol tablets,and spironolactone tablets. Based on the treatment in control group,patients in observation group added Huangqi Guizhi Wuwu decoction,1 dose/day. Courses of treatment were 3 months. And 6 months' follow up were made. Before and after treatment,cardiac function according to New York heart disease assocation( NYHA) and 6 minutes' walk test were evaluated and left ventricular ejection fraction( LVEF) and cardiac output( CO) were detected by echocardiogram. Scores of Lee congestive heart failure,TCM symptoms,quality of life and echocardiography were graded. And. progression and prognosis of disease were recorded. Result: The effect of heart function in observation group was higher than that control group. After treatment,scores of NYHA,Lee congestive heart failure,TCM symptoms and MLHFQ were all lower than those in control group. Distance of 6 minutes' walk was longer than that in control group. Levels of LVEF,SV,CO and E/A were higher than those in control group. And levels of NT-pro BNP,ST2,galectin-3 and copeptin were lower than those in control group,level of e GFR was higher than that in control group. Conclusion: Huangqi Guizhi Wuwu decoction combined with Zhenwu decotion on CHF with deficiency of Yang Qi can relieve symptoms,meliorate cardiac function and improve quality of life and activity ability,stable disease and progression of disease,and can also ameliarate heart function and prognosis of disease.
Objective: To discuss the influence of adjuvant therapy of Huangqi Guizhi Wuwu decoction combined with Zhenwu decoction in treating chronic cardiac failure( CHF) and influence to progression and prognosis of this disease.Methods: One hundred and twenty-seven CHF patients were randomly divided into control group( 63 cases) and combination group( 64 cases) by random number table. Patients in control group took enalapril tablets,metoprolol tablets,and spironolactone tablets. Based on the treatment in control group,patients in observation group added Huangqi Guizhi Wuwu decoction,1 dose/day. Courses of treatment were 3 months. And 6 months' follow up were made. Before and after treatment,cardiac function according to New York heart disease assocation( NYHA) and 6 minutes' walk test were evaluated and left ventricular ejection fraction( LVEF) and cardiac output( CO) were detected by echocardiogram. Scores of Lee congestive heart failure,TCM symptoms,quality of life and echocardiography were graded. And. progression and prognosis of disease were recorded. Result: The effect of heart function in observation group was higher than that control group. After treatment,scores of NYHA,Lee congestive heart failure,TCM symptoms and MLHFQ were all lower than those in control group. Distance of 6 minutes' walk was longer than that in control group. Levels of LVEF,SV,CO and E/A were higher than those in control group. And levels of NT-pro BNP,ST2,galectin-3 and copeptin were lower than those in control group,level of e GFR was higher than that in control group. Conclusion: Huangqi Guizhi Wuwu decoction combined with Zhenwu decotion on CHF with deficiency of Yang Qi can relieve symptoms,meliorate cardiac function and improve quality of life and activity ability,stable disease and progression of disease,and can also ameliarate heart function and prognosis of disease.
引文
[1]中华医学会心血管病分会,中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志,2014,42(2):98-122.
[2]中国中西医结合学会心血管疾病专业委员会.慢性心力衰竭中西医结合诊疗专家共识[J].中国中西医结合杂志,2016,36(2):133-141.
[3]詹丽娟,白燕.黄芪桂枝五物汤合方治疗慢性心力衰竭气虚血瘀证60例[J].宁夏医学杂志,2012,34(12):1320-1321.
[4]占新辉,王微,符思.真武汤治疗慢性心力衰竭研究概述[J].辽宁中医药大学学报,2015,17(2):204-206.
[5]冠心病中医临床研究联盟,中国中西医结合学会心血管疾病专业委员会,中华中医药学会心病分会,等.慢性心力衰竭中医诊疗专家共识[J].中医杂志,2014,55(14):1258-1260.
[6]郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:77-85.
[7]邢作英.慢性心力衰竭流行病学研究现状及其病因[J].中华实用诊断与治疗杂志,2012,26(10):937-938.
[8]秘红英,郎艳松,李晓琳,等.慢性心力衰竭病机及治疗研究进展[J].中医杂志,2014,55(16):1430-1432.
[9]耿冲,安冬青,谢冲,等.益气温阳、活血利水法联合西药与常规西药治疗慢性心力衰竭临床疗效比较的Meta分析[J].中国全科医学,2015,18(2):180-183.
[10]林家茂,李珩,郭伟星,等.益气温阳、活血利水方药治疗慢性心力衰竭大鼠实验效应的系统评价[J].中华中医药杂志,2014,29(6):1949-1953.
[11]张蔷,高文远,满淑丽.黄芪中有效成分药理活性的研究进展[J].中国中药杂志,2012,37(21):3203-3207.
[12]刘萍,张丽萍.桂枝化学成分及心血管药理作用研究[J].辽宁中医杂志,2012,39(10):1926-1927.
[13]韩兆莹,田明,刘珍,等.黄芪桂枝五物汤的药理研究现状[J].黑龙江医药,2013,26(5):777-779.
[14]徐昕,刘文军.真武汤治疗心血管疾病进展[J].河南中医,2016,36(12):2068-2070.
[15]鞠静,杜武勋.真武汤药效物质基础及温阳利水机制研究[J].吉林中医药,2016,36(7):719-723.
[16]彭余波,李艳芳,陈萌萌.心力衰竭血清标记物的研究进展[J].中华老年心脑血管病杂志,2015,17(11):1218-1220.
[17]韩雪晶,贾克刚.半乳糖凝集素3作为心力衰竭新的生物标记物的研究进展[J].中华老年心脑血管病杂志,2013,15(8):882-884.
[18]信秀明,刘鹏涛,别自东.ST2与心力衰竭的研究进展[J].实用医技杂志,2015,22(3):273-275.
[19]王建红,李保,王敬萍,等.和肽素在慢性心力衰竭急性发作期治疗中的变化与预后的关系[J].中国心血管杂志,2013,18(5):339-342.
[2]中国中西医结合学会心血管疾病专业委员会.慢性心力衰竭中西医结合诊疗专家共识[J].中国中西医结合杂志,2016,36(2):133-141.
[3]詹丽娟,白燕.黄芪桂枝五物汤合方治疗慢性心力衰竭气虚血瘀证60例[J].宁夏医学杂志,2012,34(12):1320-1321.
[4]占新辉,王微,符思.真武汤治疗慢性心力衰竭研究概述[J].辽宁中医药大学学报,2015,17(2):204-206.
[5]冠心病中医临床研究联盟,中国中西医结合学会心血管疾病专业委员会,中华中医药学会心病分会,等.慢性心力衰竭中医诊疗专家共识[J].中医杂志,2014,55(14):1258-1260.
[6]郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:77-85.
[7]邢作英.慢性心力衰竭流行病学研究现状及其病因[J].中华实用诊断与治疗杂志,2012,26(10):937-938.
[8]秘红英,郎艳松,李晓琳,等.慢性心力衰竭病机及治疗研究进展[J].中医杂志,2014,55(16):1430-1432.
[9]耿冲,安冬青,谢冲,等.益气温阳、活血利水法联合西药与常规西药治疗慢性心力衰竭临床疗效比较的Meta分析[J].中国全科医学,2015,18(2):180-183.
[10]林家茂,李珩,郭伟星,等.益气温阳、活血利水方药治疗慢性心力衰竭大鼠实验效应的系统评价[J].中华中医药杂志,2014,29(6):1949-1953.
[11]张蔷,高文远,满淑丽.黄芪中有效成分药理活性的研究进展[J].中国中药杂志,2012,37(21):3203-3207.
[12]刘萍,张丽萍.桂枝化学成分及心血管药理作用研究[J].辽宁中医杂志,2012,39(10):1926-1927.
[13]韩兆莹,田明,刘珍,等.黄芪桂枝五物汤的药理研究现状[J].黑龙江医药,2013,26(5):777-779.
[14]徐昕,刘文军.真武汤治疗心血管疾病进展[J].河南中医,2016,36(12):2068-2070.
[15]鞠静,杜武勋.真武汤药效物质基础及温阳利水机制研究[J].吉林中医药,2016,36(7):719-723.
[16]彭余波,李艳芳,陈萌萌.心力衰竭血清标记物的研究进展[J].中华老年心脑血管病杂志,2015,17(11):1218-1220.
[17]韩雪晶,贾克刚.半乳糖凝集素3作为心力衰竭新的生物标记物的研究进展[J].中华老年心脑血管病杂志,2013,15(8):882-884.
[18]信秀明,刘鹏涛,别自东.ST2与心力衰竭的研究进展[J].实用医技杂志,2015,22(3):273-275.
[19]王建红,李保,王敬萍,等.和肽素在慢性心力衰竭急性发作期治疗中的变化与预后的关系[J].中国心血管杂志,2013,18(5):339-342.