桂枝汤加减对慢性心衰患者心功能及脑钠肽前体水平的影响
摘要
目的:探讨桂枝汤加减对慢性心衰(chronic heart failure,CHF)患者心功能及脑钠肽前体水平的影响。方法:将120例CHF患者随机分为对照组(60例)和治疗组(60例),对照组患者采用西药进行基础治疗,治疗组患者在西药治疗的基础上予桂枝汤加减治疗,连续治疗8周,随访12个月,比较两组患者左心室射血分数(LVEF)、左室收缩末期内径(LVESD)和左室舒张末期容积(LVEDV)、N末端脑钠肽前体(NT-pro BNP)、运动能力(6 min步行试验)、明尼苏达心力衰竭生活质量评分(MLHFQ)和主要不良心血管事件(MACE)发生情况。结果:治疗后6个月,两组患者LVEF均较治疗前明显增加(P<0.05),LVESD和LVEDV均较治疗前显著降低(P<0.05),且治疗组患者治疗后LVEF高于对照组,LVESD和LVEDV均低于对照组(P<0.05)。治疗后两组患者NT-pro BNP水平均较治疗前明显降低(P<0.05),且治疗组患者治疗后NT-pro BNP水平显著低于对照组(P<0.05)。两组患者治疗后6 min步行试验结果均较治疗前明显增加(P<0.05),MLHFQ总分均较治疗前明显降低(P<0.05),且治疗组患者治疗后6 min步行试验结果高于对照组(P<0.05),MLHFQ总分低于对照组(P<0.05);治疗后12个月内,治疗组MACE发生率为10.00%,对照组MACE发生率为25.00%,治疗组低于对照组(P<0.05)。两组均无死亡病例,治疗组MACE发生风险显著低于对照组[HR=0.373,95%CI(0.158,0.877),P=0.032]。结论:桂枝汤加减能显著改善CHF患者的心功能,降低脑钠肽前体水平,并可以提高患者的活动水平和生活质量。
引文
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[11]陈海霞,耿志浩,吴乐怀,等.倍他乐克对慢性心衰治疗前后N-端脑钠肽前体变化的临床观察[J].临床研究,2016,24(6):54-55.
[12] Khan A,Shah M H,Khan S,et al. Serum Uric Acid level in the severity of Congestive Heart Failure(CHF)[J].Pak J Med Sci,2017,33(2):330-334.
[13] Jiang P,Ma D F,Jiang Y H,et al. Preventive Effect of Different Compatibilities of Ramulus Cinnamomi and Radix Paeomlae alba in Guizhi Decoction on Cardiac Sympathetic Denervation Induced by 6-OHDA[J].Chinese Journal of Integrated Traditional&Western Medicine,2016,36(5):608-613.
[14]王银娜,黄培培,郝秀梅,等.桂枝汤加减联合西药治疗慢性心衰临床研究[J].亚太传统医药,2017,13(3):154-155.
[2]林飞,武晓菊.桂枝汤加减联合西药治疗慢性心衰临床效果分析[J].中西医结合心血管病电子杂志,2017,15(30):188-189.
[3]中国中西医结合学会心血管疾病专业委员会,中国医师协会中西医结合医师分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].心脑血管病防治,2016,16(5):142-145.
[4]郑晓萸.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,2002:77-85.
[5] Mckie P M,Schirger J A,Benike S L,et al. Chronic Subcutaneous BNP Therapy in Asymptomatic Systolic Heart Failure[J].Eur J Heart Fail,2016,18(4):433-435.
[6] Zhang S,Zhang Y,Li H,et al. Antioxidant and antiexcitotoxicity effect of Gualou Guizhi decoction on cerebral ischemia/reperfusion injury in rats[J].Experimental&Therapeutic Medicine,2015,9(6):2121-2126.
[7] Yuan H J,Li W,Jin J M,et al. Research progress on chemical constituents, pharmacological mechanism and clinical application of Guizhi decoction[J].China Journal of Chinese Materia Medica,2017,42(23):4556-4564.
[8] Junior W N,Claggett B,Mcmurray J,et al. Impact of body mass index on the accuracy of NT-pro BNP and BNP for predicting outcomes in patients with chronic heart failure and reduced ejection fraction:insights from theparadigm-hf study[J].J Am Coll Cardiol,2016,67(13):1326.
[9]刘华丹,程晓昱,盛晟.复方真武冲剂对慢性心力衰竭患者临床疗效及其血清NT-pro BNP的影响[J].中国民族民间医药,2015,12(23):107-108.
[10] Zhang Y,Zhang S,Huang LI,et al. Ameliorative effects of Gualou Guizhi decoction on inflammation in focal cerebral ischemic-reperfusion injury[J].Mol Med Rep,2015,12(1):988-994.
[11]陈海霞,耿志浩,吴乐怀,等.倍他乐克对慢性心衰治疗前后N-端脑钠肽前体变化的临床观察[J].临床研究,2016,24(6):54-55.
[12] Khan A,Shah M H,Khan S,et al. Serum Uric Acid level in the severity of Congestive Heart Failure(CHF)[J].Pak J Med Sci,2017,33(2):330-334.
[13] Jiang P,Ma D F,Jiang Y H,et al. Preventive Effect of Different Compatibilities of Ramulus Cinnamomi and Radix Paeomlae alba in Guizhi Decoction on Cardiac Sympathetic Denervation Induced by 6-OHDA[J].Chinese Journal of Integrated Traditional&Western Medicine,2016,36(5):608-613.
[14]王银娜,黄培培,郝秀梅,等.桂枝汤加减联合西药治疗慢性心衰临床研究[J].亚太传统医药,2017,13(3):154-155.