人参保肺丸、复方地龙胶囊联合卡维地洛对老年肺心病合并右心衰竭患者血清NT-proBNP、cTnI、hs-CRP和凝血-纤溶功能的影响
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摘要
目的 观察人参保肺丸、复方地龙胶囊联合卡维地洛对老年肺心病合并右心衰竭患者血清N末端B型利钠肽原(NT-proBNP)、肌钙蛋白I(cTnI)、超敏C反应蛋白(hs-CRP)和凝血-纤溶功能的影响。方法 将120例老年肺心病合并右心衰竭患者随机分为观察组和对照组,每组60例。对照组给予基础治疗及卡维地洛口服,观察组在对照组治疗基础上给予人参保肺丸、复方地龙胶囊口服,疗程均为3个月。观察2组治疗前后中医证候积分、血气分析、肺功能及血清NT-proBNP、cTnI、hs-CRP和凝血-纤溶功能指标的变化,并统计2组临床疗效。结果 2组治疗后咳嗽咳痰、胸闷憋气、喘息乏力、自汗畏风、面色晦暗、纳少腹胀、唇舌暗紫积分和总积分,动脉血二氧化碳分压[p(CO_2)]、平均肺动脉压(mPAP)及血清NT-proBNP、cTnI、hs-CRP、纤维蛋白原(FIB)、D-二聚体(D-D)水平均显著降低(P均<0.05),且观察组治疗后各指标均显著低于对照组(P均<0.05);2组治疗后动脉血氧分压[p(O_2)]、动脉血氧饱和度[Sa(O_2)]、第1秒用力呼气容积(FEV_1)、FEV_1/FVC、峰值呼吸流速(PEF)均显著升高(P均<0.05),且观察组治疗后以上指标均显著高于对照组(P均<0.05)。观察组疾病治疗有效率显著高于对照组(P<0.05)。结论 人参保肺丸、复方地龙胶囊联合卡维地洛可显著缓解老年肺心病合并右心衰竭患者临床症状,提高心肺功能,其机制可能与减轻炎性反应、改善凝血-纤溶功能有关。
Objective It is to observe the effects of Renshen Baofei Pill, Fufang Dilong Capsule and carvedilol on serum N-terminal B-type natriuretic peptide(NT-proBNP), troponin I(cTnI), hypersensitive C-reactive protein(hs-CRP) and coagulation-fibrinolysis in elderly patients with pulmonary heart disease and right heart failure. Methods 120 elderly patients with pulmonary heart disease and right heart failure were randomly divided into observation group and control group, 60 cases in each group. The control group was given basic treatment and carvedilol orally. The observation group was given Renshen Baofei Pill, Fufang Dilong Capsule orally on the basis of the control group. The courses of treatment were 3 months. The changes of TCM syndrome scores, blood gas analysis, lung function and serum levels of NT-proBNP, cTnI, hs-CRP and coagulation-fibrinolysis function were observed before and after treatment, the clinical effects of the two groups were also statistically analyzed. Results After treatment, the scores of cough, chest tightness, wheezing, sweating, dark complexion, abdominal distension and anorexia and total score, arterial blood carbon dioxide partial pressure P(CO_2), mean pulmonary artery pressure(mPAP), and serum levels of NT-proBNP, cTnI, hs-CRP, fibrinogen(FIB), D-dimer(DD) were significantly reduced(P all <0.05), and the indicators in the observation group were significantly lower than the control group(P<0.05); the arterial oxygen partial pressure p(O_2), arterial oxygen saturation Sa(O_2), and the first second force expiratory volume(FEV_1), FEV_1/FVC, and peak respiratory flow rate(PEF) after treatment were significantly increased, and the above indicators were significantly higher in the observation group than those in the control group(P<0.05). The effective rate of disease treatment in the observation group was significantly higher than that in the control group(P<0.05). Conclusion Renshen Baofei Pill, Compound Dilong Capsule and carvedilol can significantly alleviate the clinical symptoms and improve cardiopulmonary function of elderly patients with pulmonary heart disease complicated with right heart failure. The mechanism may be related to reduce inflammatory reaction and improve coagulation-fibrinolysis.
Objective It is to observe the effects of Renshen Baofei Pill, Fufang Dilong Capsule and carvedilol on serum N-terminal B-type natriuretic peptide(NT-proBNP), troponin I(cTnI), hypersensitive C-reactive protein(hs-CRP) and coagulation-fibrinolysis in elderly patients with pulmonary heart disease and right heart failure. Methods 120 elderly patients with pulmonary heart disease and right heart failure were randomly divided into observation group and control group, 60 cases in each group. The control group was given basic treatment and carvedilol orally. The observation group was given Renshen Baofei Pill, Fufang Dilong Capsule orally on the basis of the control group. The courses of treatment were 3 months. The changes of TCM syndrome scores, blood gas analysis, lung function and serum levels of NT-proBNP, cTnI, hs-CRP and coagulation-fibrinolysis function were observed before and after treatment, the clinical effects of the two groups were also statistically analyzed. Results After treatment, the scores of cough, chest tightness, wheezing, sweating, dark complexion, abdominal distension and anorexia and total score, arterial blood carbon dioxide partial pressure P(CO_2), mean pulmonary artery pressure(mPAP), and serum levels of NT-proBNP, cTnI, hs-CRP, fibrinogen(FIB), D-dimer(DD) were significantly reduced(P all <0.05), and the indicators in the observation group were significantly lower than the control group(P<0.05); the arterial oxygen partial pressure p(O_2), arterial oxygen saturation Sa(O_2), and the first second force expiratory volume(FEV_1), FEV_1/FVC, and peak respiratory flow rate(PEF) after treatment were significantly increased, and the above indicators were significantly higher in the observation group than those in the control group(P<0.05). The effective rate of disease treatment in the observation group was significantly higher than that in the control group(P<0.05). Conclusion Renshen Baofei Pill, Compound Dilong Capsule and carvedilol can significantly alleviate the clinical symptoms and improve cardiopulmonary function of elderly patients with pulmonary heart disease complicated with right heart failure. The mechanism may be related to reduce inflammatory reaction and improve coagulation-fibrinolysis.
引文
[1] 阮景昊,周甲东,万崇华,等.慢性肺源性心脏病患者生命质量与临床客观指标的相关性研究[J].中国全科医学,2017,20(1):45-50
[2] 卢敬芝.探讨卡托普利、安体舒通、生脉在慢性肺心病合并右心衰治疗中的临床治疗效果[J].中国实用医药,2017,12(8):119-121
[3] 高喜君.血清甲状腺激素水平对肺心病合并右心衰竭患者的临床意义[J].国际呼吸杂志,2016,36(6):436-439
[4] 钟南山,刘又宁.呼吸病学[M].北京:人民卫生出版社,2012:202-203
[5] 中华中医药学会肺系病专业委员会.慢性肺原性心脏病中医诊疗指南(2014版)[J].中医杂志,2014,55(6):526-531
[6] 中华医学会心血管病学分会.右心衰竭诊断和治疗中国专家共识[J].中华心血管病杂志,2012,40(6):449-461
[7] 国家中医药管理局.中药新药临床研究指导原则(试行)[S].北京:中国医药科技出版社,2002:198-199
[8] 陈昱文,曹泽标,周小青,等.中医症状量化方法及其临床应用述评[J].湖南中医药大学学报,2016,36(3):82-86
[9] 国家中医药管理局.中医病证诊断疗效标准[S].南京:南京大学出版社,1994:234
[10] 李瑞霞.N-端脑钠肽前体在肺心病合并右心衰竭患者诊断及疗效中的价值[J].疾病监测与控制,2014,8(3):145-146
[11] 丁静.cTnI、hs-CRP和BNP在心力衰竭患者治疗前后的变化及其对诊断和预后判断的价值[J/CD].中西医结合心血管病电子杂志,2016,4(25):1-2
[12] 卓越,邢崇浩,陈亮,等.血清Copeptin、hs-CRP及IL-6水平在老年慢性肺源性心脏病患者中的表达及其临床意义[J].海南医学,2017,28(14):2297-2301
[13] 朱宝山,王永,范远威,等.低分子肝素对慢性肺源性心脏病失代偿期血清D-二聚体、凝血因子Ⅷ的影响[J].国际老年医学杂志,2016,37(3):120-123
[14] 马丽娜·艾山拜,努尔兰·阿合西塔依.COPD合并心衰患者应用比索洛尔和卡维地洛的比较[J].临床肺科杂志,2015,20(1):164-166
[15] 赵世明.依那普利联合卡维地洛对慢性心力衰竭患者心功能、神经内分泌功能及血管内皮功能的影响研究[J].实用心脑肺血管病杂志,2016,24(3):19-22
[16] 习明明,刘晶,邹莺,等.卡维地洛通过PI3K/AKT/GSK3β信号通路对H9c2缺氧/复氧损伤的保护[J].心肺血管病杂志,2016,35(4):317-321
[17] 王巍,苏光悦,胡婉琦,等.近10年人参皂苷对心血管疾病的药理作用研究进展[J].中草药,2016,47(20):3736-3741
[18] 李海刚,胡晒平,周意,等.川芎主要药理活性成分药理研究进展[J].中国临床药理学与治疗学,2018,23(11):108-114
[19] 郦岳,王益斐,张赟华,等.黄芪建中汤合经皮穴位电刺激治疗脾肺虚寒证慢性阻塞性肺病行机械通气87例[J].浙江中医杂志,2017,52(4):255
[20] 张宁,汤碧娥,张志琴,等.黄芪配伍川芎嗪对2型糖尿病大鼠大血管的保护作用[J].中国老年学杂志,2016,36(13):3138-3139
[2] 卢敬芝.探讨卡托普利、安体舒通、生脉在慢性肺心病合并右心衰治疗中的临床治疗效果[J].中国实用医药,2017,12(8):119-121
[3] 高喜君.血清甲状腺激素水平对肺心病合并右心衰竭患者的临床意义[J].国际呼吸杂志,2016,36(6):436-439
[4] 钟南山,刘又宁.呼吸病学[M].北京:人民卫生出版社,2012:202-203
[5] 中华中医药学会肺系病专业委员会.慢性肺原性心脏病中医诊疗指南(2014版)[J].中医杂志,2014,55(6):526-531
[6] 中华医学会心血管病学分会.右心衰竭诊断和治疗中国专家共识[J].中华心血管病杂志,2012,40(6):449-461
[7] 国家中医药管理局.中药新药临床研究指导原则(试行)[S].北京:中国医药科技出版社,2002:198-199
[8] 陈昱文,曹泽标,周小青,等.中医症状量化方法及其临床应用述评[J].湖南中医药大学学报,2016,36(3):82-86
[9] 国家中医药管理局.中医病证诊断疗效标准[S].南京:南京大学出版社,1994:234
[10] 李瑞霞.N-端脑钠肽前体在肺心病合并右心衰竭患者诊断及疗效中的价值[J].疾病监测与控制,2014,8(3):145-146
[11] 丁静.cTnI、hs-CRP和BNP在心力衰竭患者治疗前后的变化及其对诊断和预后判断的价值[J/CD].中西医结合心血管病电子杂志,2016,4(25):1-2
[12] 卓越,邢崇浩,陈亮,等.血清Copeptin、hs-CRP及IL-6水平在老年慢性肺源性心脏病患者中的表达及其临床意义[J].海南医学,2017,28(14):2297-2301
[13] 朱宝山,王永,范远威,等.低分子肝素对慢性肺源性心脏病失代偿期血清D-二聚体、凝血因子Ⅷ的影响[J].国际老年医学杂志,2016,37(3):120-123
[14] 马丽娜·艾山拜,努尔兰·阿合西塔依.COPD合并心衰患者应用比索洛尔和卡维地洛的比较[J].临床肺科杂志,2015,20(1):164-166
[15] 赵世明.依那普利联合卡维地洛对慢性心力衰竭患者心功能、神经内分泌功能及血管内皮功能的影响研究[J].实用心脑肺血管病杂志,2016,24(3):19-22
[16] 习明明,刘晶,邹莺,等.卡维地洛通过PI3K/AKT/GSK3β信号通路对H9c2缺氧/复氧损伤的保护[J].心肺血管病杂志,2016,35(4):317-321
[17] 王巍,苏光悦,胡婉琦,等.近10年人参皂苷对心血管疾病的药理作用研究进展[J].中草药,2016,47(20):3736-3741
[18] 李海刚,胡晒平,周意,等.川芎主要药理活性成分药理研究进展[J].中国临床药理学与治疗学,2018,23(11):108-114
[19] 郦岳,王益斐,张赟华,等.黄芪建中汤合经皮穴位电刺激治疗脾肺虚寒证慢性阻塞性肺病行机械通气87例[J].浙江中医杂志,2017,52(4):255
[20] 张宁,汤碧娥,张志琴,等.黄芪配伍川芎嗪对2型糖尿病大鼠大血管的保护作用[J].中国老年学杂志,2016,36(13):3138-3139