养心活血通脉汤对舒张性心衰患者左室舒张功能及NT-proBNP的影响
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摘要
目的观察养心活血通脉汤对舒张性心衰患者(心气亏虚、痰瘀阻络证)左室舒张功能及N末端脑利钠肽原(N terminal pro B type natriuretic peptide, NT-proBNP)的影响。方法将65例患者随机分为治疗组33例与对照组32例,两组均以西医常规治疗,治疗组在此基础上加服养心活血通脉汤,治疗1个月后观察两组的临床疗效及治疗前后Lee心衰积分、中医证候积分、全血NT-proBNP、二尖瓣舒张早期血流峰值(EPFV)与二尖瓣舒张晚期血流峰值(APFV)之比值、二尖瓣环舒张早期运动峰速度(Ea)与二尖瓣环舒张晚期运动峰速度(Aa)之比值的变化。结果治疗组治疗后心衰疗效及中医证候疗效均优于对照组(P<0.05);治疗后两组Lee心衰积分和中医证候积分均较治疗前明显减少(P<0.01),且治疗组改善优于对照组(P<0.05);两组患者治疗后EPFV/APFV、Ea/Aa及NT-proBNP均较治疗前明显改善(P<0.01),且治疗组改善优于对照组(P<0.05)。结论养心活血通脉汤可提高舒张性心衰患者的临床疗效,改善左室舒张功能,其作用机制与降低NT-proBNP相关。
Objective To observe the effects of Yangxin Huoxue Tongmai Decoction(YHTD) on left ventricular diastolic function and N-terminal pro-B-type natriuretic peptide(N terminal pro B type natriuretic peptide, NT-proBNP) in patients with diastolic heart failure(syndromes of heart-Qi deficiency and phlegm-stasis blocking collaterals). Methods A total of 65 patients were randomly divided into treatment group(33 cases) and control group(32 cases). The control group was treated conventionally with Western medicine, and the treatment group was given YHTD in addition to the treatment for the control group.After 1 month of treatment, the clinical outcome and the changes in Lee's heart failure score, traditional Chinese medicine(TCM)syndrome score, the level of whole blood NT-proBNP, the ratio of peak flow velocity of early diastole(EPFV) to peak flow velocity of atrial contraction(APFV), and the ratio of peak early mitral annular diastolic velocity(Ea) to peak late mitral annular diastolic velocity(Aa) were evaluated. Results After treatment, the treatment group had significantly better outcomes of heart failure and TCM syndrome than the control group(P<0.05). The Lee's heart failure score and TCM syndrome score in the two groups were both significantly reduced after treatment(P<0.01), and the improvements were significantly better in the treatment group than in the control group(P<0.05). Both groups showed significant improvements in EPFV/APFV, Ea/Aa, and NT-proBNP after treatment(P<0.01), and the treatment group had significantly better improvements than the control group(P <0.05). Conclusion YHTD can improve the clinical outcome of patients with diastolic heart failure conventionally treated with Western medicine and improve their left ventricular diastolic function. The mechanism of its action is associated with the down-regulation of NT-proBNP.
Objective To observe the effects of Yangxin Huoxue Tongmai Decoction(YHTD) on left ventricular diastolic function and N-terminal pro-B-type natriuretic peptide(N terminal pro B type natriuretic peptide, NT-proBNP) in patients with diastolic heart failure(syndromes of heart-Qi deficiency and phlegm-stasis blocking collaterals). Methods A total of 65 patients were randomly divided into treatment group(33 cases) and control group(32 cases). The control group was treated conventionally with Western medicine, and the treatment group was given YHTD in addition to the treatment for the control group.After 1 month of treatment, the clinical outcome and the changes in Lee's heart failure score, traditional Chinese medicine(TCM)syndrome score, the level of whole blood NT-proBNP, the ratio of peak flow velocity of early diastole(EPFV) to peak flow velocity of atrial contraction(APFV), and the ratio of peak early mitral annular diastolic velocity(Ea) to peak late mitral annular diastolic velocity(Aa) were evaluated. Results After treatment, the treatment group had significantly better outcomes of heart failure and TCM syndrome than the control group(P<0.05). The Lee's heart failure score and TCM syndrome score in the two groups were both significantly reduced after treatment(P<0.01), and the improvements were significantly better in the treatment group than in the control group(P<0.05). Both groups showed significant improvements in EPFV/APFV, Ea/Aa, and NT-proBNP after treatment(P<0.01), and the treatment group had significantly better improvements than the control group(P <0.05). Conclusion YHTD can improve the clinical outcome of patients with diastolic heart failure conventionally treated with Western medicine and improve their left ventricular diastolic function. The mechanism of its action is associated with the down-regulation of NT-proBNP.
引文
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[3]叶任高,陆再英,谢毅,等.内科学[M].北京:人民卫生出版社,2004:272.
[4]国家药品监督管理局.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:78-84.
[5] SHAHBAZ A U, SUN Y, BHATTACHARYA S K, et al. Fibrosis in hypertensive heart disease:molecular pathways and cardio protective strategies[J]. JHypertens, 2010,28(S1):S25-32.
[6]刘蓉芳,张辉,谭雄,等.心康冲剂调控慢性心衰大鼠miR NA-21/PTEN抗心肌纤维化研究[J].湖南中医药大学学报,2018,38(3):272-274.
[7]李醇文,周亚光,陈娣,等.丹参酮ⅡA对自发性高血压大鼠心肌纤维化的影响[J].中华中医药杂志(原中国医药学报),2010,25(12):2113-2116.
[8]喻正科,曹丕钢,陈志红,等.参竹心康汤对慢性心衰大鼠心肌纤维化及TGF-B1、CTGF表达的影响[J].中华中医药学刊,2015,36(9):2169-2171.