中西医结合治疗妊娠期病毒性心肌炎临床研究
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摘要
目的:观察中西医结合治疗妊娠期病毒性心肌炎的的疗效。方法:纳入192例妊娠期病毒性心肌炎患者,随机分为观察组和对照组各96例。对照组予常规干预措施和抗病毒治疗,观察组在对照组治疗基础上予五味消毒饮合水牛角地黄汤加减方治疗,2组疗程均为4周。治疗前后检测2组患者的白细胞介素-4 (IL-4)和巨噬细胞移动抑制因子(MIF)、心型游离脂肪酸结合蛋白(H-FABP)、肌钙蛋白I (c TnI)水平,评定临床症状评分与中医证候评分,分析2组的临床疗效及用药安全性。结果:治疗后,观察组总有效率87.50%,高于对照组(75.00%),差异有统计学意义(P <0.05)。2组中医证候评分均较治疗前下降,差异均有统计学意义(P <0.05),观察组中医证候评分低于对照组(P <0.05)。2组发热、咽痛、心悸、心烦胸闷评分均较治疗前降低,差异均有统计学意义(P <0.05);观察组各症状评分均低于对照组(P <0.05)。2组血清cTnI、H-FABP、MIF、IL-4水平均较治疗前下降,差异均有统计学意义(P <0.05);观察组4项指标值均低于对照组(P <0.05)。结论:中西医结合治疗妊娠期病毒性心肌炎可有效改善患者的临床症状及心肌功能,减轻炎症反应,提高临床疗效,在妊娠期使用具有较高的安全性,下调患者血清中的MIF和IL-4水平可能与其疗效有关。
Objective: To observe the therapeutic effect of integrated Chinese and western medicine therapy in treating viral myocarditis during pregnancy. Methods: A total of 192 cases of patients with viral myocarditis during pregnancy were included, and were randomly divided into the observation group and the control group, 96 cases in each group. The control group received conventional intervention and antiviral therapy,and the observation group was additionally given modified Wuwei Xiaodu yin combined with Shuiniujiao Dihuang tang based on the treatment of the control group. Two groups were treated for four weeks. Levels of interleukin-4(IL-4), macrophage migration inhibitory factor(MIF), heart-type fatty acid binding protein(H-FABP) and cardiac troponin I(cTnI) were measured and scores of clinical symptome and Chinese medicine syndrome were evaluated before and after treatment in the two groups, and clinical effect and drug safety of the two groups were assessed. Results: After treatment, the total effective rate in the observation group was 87.50%,higher than that of75.00% in the control group,the difference being significant(P < 0.05). Chinese medicine syndrome scores in both groups were lower than those before treatment(P < 0.05), the score in the observation group was lower than that in the control group(P< 0.05). The scores of fever, sore throat, palpitations,vexation and chest distress in the two groups were lower than those before treatment, differences being significant(P < 0.05); the above symptom scores in the observation group were lower than those in the control group(P < 0.05). Levels of cTnI, H-FABP, MIF and IL-4 in the two groups were decreased when compared with those before treatment, differences being significant(P < 0.05); the above levels in the observation group were lower than those in the control group(P< 0.05). Conclusion: Integrated Chinese and western medicine therapy for viral myocarditis during pregnancy can effectively improve the clinical symptoms and myocardial function of the patients,reduce the inflammatory responses, improve the clinical effect, and have higher safety during pregnancy. The decrease of the levels of MIF and IL-4 in serum may be related to the curative effect.
Objective: To observe the therapeutic effect of integrated Chinese and western medicine therapy in treating viral myocarditis during pregnancy. Methods: A total of 192 cases of patients with viral myocarditis during pregnancy were included, and were randomly divided into the observation group and the control group, 96 cases in each group. The control group received conventional intervention and antiviral therapy,and the observation group was additionally given modified Wuwei Xiaodu yin combined with Shuiniujiao Dihuang tang based on the treatment of the control group. Two groups were treated for four weeks. Levels of interleukin-4(IL-4), macrophage migration inhibitory factor(MIF), heart-type fatty acid binding protein(H-FABP) and cardiac troponin I(cTnI) were measured and scores of clinical symptome and Chinese medicine syndrome were evaluated before and after treatment in the two groups, and clinical effect and drug safety of the two groups were assessed. Results: After treatment, the total effective rate in the observation group was 87.50%,higher than that of75.00% in the control group,the difference being significant(P < 0.05). Chinese medicine syndrome scores in both groups were lower than those before treatment(P < 0.05), the score in the observation group was lower than that in the control group(P< 0.05). The scores of fever, sore throat, palpitations,vexation and chest distress in the two groups were lower than those before treatment, differences being significant(P < 0.05); the above symptom scores in the observation group were lower than those in the control group(P < 0.05). Levels of cTnI, H-FABP, MIF and IL-4 in the two groups were decreased when compared with those before treatment, differences being significant(P < 0.05); the above levels in the observation group were lower than those in the control group(P< 0.05). Conclusion: Integrated Chinese and western medicine therapy for viral myocarditis during pregnancy can effectively improve the clinical symptoms and myocardial function of the patients,reduce the inflammatory responses, improve the clinical effect, and have higher safety during pregnancy. The decrease of the levels of MIF and IL-4 in serum may be related to the curative effect.
引文
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[14]罗进光,张嘉宁,王智彬,等.参麦注射液与曲美他嗪和左卡尼汀联合治疗妊娠期病毒性心肌炎的临床疗效及对血清TNF-α和IL-4水平的影响[J].中华医院感染学杂志,2017,27(3):576-579.
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[16]Sutidze M,Kajrishvili M,Tsimakuridze M,et al.Factors associated with increased serum levels of specific markers of myocardial injury-cardiac troponins T and I in chronic haemodialysis patients[J].Georgian Med News,2009(169):39-43.
[2]傅宏.围生期病毒性心肌炎对新生儿出生时一般情况的影响[J].现代中西医结合杂志,2013,22(35):3912-3914.
[3]王龙飞,蒲志强,苏强.不同中成药辅助治疗急性病毒性心肌炎的成本-效果分析[J].时珍国医国药,2015,26(3):647-649.
[4]吕仕超,张军平.中医药防治病毒性心肌炎的优势与思考[J].广州中医药大学学报,2013,30(4):571-573.
[5]胡明,胡相冰.不同中成药辅助治疗急性病毒性心肌炎的成本-效果分析[J].中国中医急症,2015,24(6):1094-1096.
[6]刘晓梅.周颖玲:妊娠合并心肌炎的诊断与治疗[J].医师在线,2016,6(35):12-13.
[7]陈灏珠,林果为.实用内科学[M].北京:人民卫生出版社,2014:1586-1588.
[8]中华人民共和国卫生部.中药新药临床研究指导原则:第1辑[S].1993:47-51.
[9]中华医学会心血管病学分会,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.
[10]葛均波,徐永健.内科学[M].北京:人民卫生出版社,2013:282-284.
[11]张悦桃.妊娠合并病毒性心肌炎对母婴预后及围产期处理的影响与护理对策初探[J].实用妇科内分泌杂志,2017,4(1):84-85.
[12]凌智君.抗毒补心胶囊治疗病毒性心肌炎临床疗效观察[J].中国实用医药,2014,9(11):173.
[13]张翠荣,杨玉恒,张敬伟,等.黄芪注射液治疗围产期心肌病的疗效观察[J].河北医药,2014,36(22):3475-3476.
[14]罗进光,张嘉宁,王智彬,等.参麦注射液与曲美他嗪和左卡尼汀联合治疗妊娠期病毒性心肌炎的临床疗效及对血清TNF-α和IL-4水平的影响[J].中华医院感染学杂志,2017,27(3):576-579.
[15]Rex S,Kraemer S,Grieb G,et al.The role of macrophage migration inhibitory factor in critical illness[J].Mini Rev Med Chem,2014,14(14):1116-1124.
[16]Sutidze M,Kajrishvili M,Tsimakuridze M,et al.Factors associated with increased serum levels of specific markers of myocardial injury-cardiac troponins T and I in chronic haemodialysis patients[J].Georgian Med News,2009(169):39-43.