温阳振衰颗粒治疗慢性心力衰竭阳虚水泛证的临床研究
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摘要
目的:研究温阳振衰颗粒对慢性心力衰竭阳虚水泛证患者心功能、运动耐力和血清基质金属蛋白酶-2(MMP-2)、N-端脑钠肽前体(NT-proBNP)、C反应蛋白(CRP)的影响。方法:将84例慢性心力衰竭阳虚水泛证患者随机分成对照组与治疗组,每组42例。对照组患者采用左西孟旦治疗,治疗组患者在对照组基础上采用温阳振衰颗粒治疗。观察并比较两组患者的临床疗效、心功能、运动耐力、血清MMP-2、NT-proBNP、CRP表达水平及不良反应情况。结果:治疗组患者心力衰竭总有效率为92.86%,对照组患者心力衰竭总有效率为71.42%,治疗组优于对照组(χ2=6.574,P=0.010);治疗组患者心功能总有效率为85.72%,对照组患者心功能总有效率为64.28%,治疗组优于对照组(χ2=5.143,P=0.023)。两组患者治疗后左心室射血分数(LVEF)水平升高,左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、NT-proBNP水平均降低,且治疗组改变幅度大于对照组(P<0.05)。两组患者治疗后峰值氧耗量(VO2peak)、无氧代谢阈值氧耗量(VO2AT)水平均上升,6 min步行距离均增加,且治疗组改变幅度大于对照组(P<0.05)。两组患者治疗后血清MMP-2、MMP-9及CRP水平均降低,且治疗组患者治疗后血清MMP-2、MMP-9及CRP水平均低于对照组(P<0.05)。治疗组不良反应总发生率为16.68%,对照组不良反应总发生率为35.72%,治疗组低于对照组(χ2=3.941,P=0.047)。结论:温阳振衰颗粒治疗慢性心力衰竭阳虚水泛证患者可显著提高临床疗效,改善心功能,增加运动耐量,降低血清MMP-2、NT-proBNP、CRP水平,无明显不良反应。
Objective: To investigate effect of Wenyang Zhenxi granules combined with levosimendan on cardiac function, exercise endurance, serum matrix metalloproteinase-2(MMP-2), N-terminal pro brain natriuretic peptide(NT-proBNP), C-reactive protein(CRP) in chronic heart failure(CHF) patients with Yang deficiency and water flooding syndrome, and to provide an effective theoretical basis for better treatment of CHF patients.Methods: 84 cases of CHF patients with Yang deficiency and water flooding syndrome were selected and equally divided into two groups. The control group received the levosimendan, based on this, the study group received the Wenyang Zhenxi granules. Then the clinical efficacy, cardiac function, exercise tolerance, and the expression levels of MMP-2, NT-proBNP and CRP, and the adverse reactions were compared. Results: The total effective rate of heart failure after treatment in the study group was significantly higher than that of the control group(92.86% vs 71.42%, P<0.05). The total effective rate of heart function after treatment in the study group was significantly higher than that of the control group(85.72% vs 64.28%, P<0.05). After treatment, the level of left ventricular ejection fraction(LVEF) was increased, the left ventricular diastolic diameter(LVEDD), the left ventricular end systolic diameter(LVESD), and the NT-proBNP level were decreased, both changes were more significant in the study group than in the control group(P <0.05). After treatment, the peak oxygen consumption(VO2 peak), threshold of oxygen consumption of anaerobic metabolism(VO2 AT) and 6 min walking distance were increased, and were higher in the study group than in the control group(P<0.05). The level of MMP-2, serum matrix metalloproteinase-9(MMP-9) and CRP were decreased after treatment, and were lower in the study group than in the control group(P<0.05). The overall incidence of adverse reactions in the study group was significantly lower than that in the control group(16.68% vs 35.72%, P <0.05). Conclusion: The combination of the Wenyang Zhenxi granules and levosimendan can effectively and safely ameliorate the cardiac function, increase exercise tolerance, reduce serum MMP-2, NT-proBNP, CRP levels for CHF patients with Yang deficiency and water flooding syndrome with no obvious adverse reactions.
Objective: To investigate effect of Wenyang Zhenxi granules combined with levosimendan on cardiac function, exercise endurance, serum matrix metalloproteinase-2(MMP-2), N-terminal pro brain natriuretic peptide(NT-proBNP), C-reactive protein(CRP) in chronic heart failure(CHF) patients with Yang deficiency and water flooding syndrome, and to provide an effective theoretical basis for better treatment of CHF patients.Methods: 84 cases of CHF patients with Yang deficiency and water flooding syndrome were selected and equally divided into two groups. The control group received the levosimendan, based on this, the study group received the Wenyang Zhenxi granules. Then the clinical efficacy, cardiac function, exercise tolerance, and the expression levels of MMP-2, NT-proBNP and CRP, and the adverse reactions were compared. Results: The total effective rate of heart failure after treatment in the study group was significantly higher than that of the control group(92.86% vs 71.42%, P<0.05). The total effective rate of heart function after treatment in the study group was significantly higher than that of the control group(85.72% vs 64.28%, P<0.05). After treatment, the level of left ventricular ejection fraction(LVEF) was increased, the left ventricular diastolic diameter(LVEDD), the left ventricular end systolic diameter(LVESD), and the NT-proBNP level were decreased, both changes were more significant in the study group than in the control group(P <0.05). After treatment, the peak oxygen consumption(VO2 peak), threshold of oxygen consumption of anaerobic metabolism(VO2 AT) and 6 min walking distance were increased, and were higher in the study group than in the control group(P<0.05). The level of MMP-2, serum matrix metalloproteinase-9(MMP-9) and CRP were decreased after treatment, and were lower in the study group than in the control group(P<0.05). The overall incidence of adverse reactions in the study group was significantly lower than that in the control group(16.68% vs 35.72%, P <0.05). Conclusion: The combination of the Wenyang Zhenxi granules and levosimendan can effectively and safely ameliorate the cardiac function, increase exercise tolerance, reduce serum MMP-2, NT-proBNP, CRP levels for CHF patients with Yang deficiency and water flooding syndrome with no obvious adverse reactions.
引文
[1]赵汉清,贾评,蒋欢欢,等.利水活血温阳方结合穴位敷贴治疗慢性心力衰竭的疗效观察[J].中医药导报,2017,24(16):93-96.
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[4]石刚,刘婷,贺铿.补气活血化痰通脉方对慢性心力衰竭患者心率变异性和QT离散度的影响[J].湖南中医药大学学报,2016,36(2):1355.
[5]吕俊芳,张宝霞.益气活血利水方治疗冠状动脉粥样硬化性心脏病慢性心力衰竭心肾阳虚证临床研究[J].中医学报,2018,33(1):133-137.
[6]刘佑晖,李琰,蔡虎志,等.温阳振衰颗粒治疗慢性肾功能衰竭(阳虚证)的临床研究[J].中国中医急症,2018,27(2):653-657.
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[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].中国实用乡村医生杂志,2014,22(2):6-12.
[10]马利平,李翠芳.芪苈强心胶囊对心力衰竭患者NT-proBNP及hs-CRP的影响[J].中医药导报,2016,23(8):92-95.
[11] Davarzani N, Wijk S S, Karel J, et al. NT-proBNP Guided Therapy in Chronic Heart Failure Reduces Repeated Hospitalizations-Results From TIME-CHF[J].Journal of Cardiac Failure,2017,23(5):382.
[12]朱迎春.瑞舒伐他汀联合美托洛尔对心力衰竭患者血浆MMP-2、MMP-9水平和左心室功能的影响[J].贵州医药,2018,43(1):483-487.
[13]唐胜,沈建锋,谢玉华,等.自拟益气活血方治疗冠心病慢性心力衰竭临床效果及对炎症因子水平的影响[J].河北中医药学报,2018,33(1):857-859.
[14]葛岚,程晓昱.中药复方真武冲剂对慢性心力衰竭患者中医证候及MCP-1、BNP的影响[J].辽宁中医药大学学报,2017,32(8):60-63.
[15]李丽丽,刘辉,董志,等.左西孟旦治疗急性心力衰竭患者的效果及其对血清脑钠肽的影响[J].疑难病杂志,2016,15(8):787-790.
[16]李传威,孙志军,杨波,等.左西孟旦改善急性心肌梗死伴心力衰竭患者近期血流动力学的研究[J].中华老年多器官疾病杂志,2016,15(4):241-244.
[17]蔡虎志,王笑莹,陈青扬,等.温阳振衰颗粒对慢性心衰模型大鼠心肌中MEF2表达的影响[J].中国药房,2017,28(34):4780-4783.
[18]杨磊,张曼华,蔡虎志,等.HPLC测定温阳振衰颗粒中人参皂苷Rg1、人参皂苷Re、人参皂苷Rb1含量[J].中国中医药信息杂志,2017,24(4):75-78.
[19]尹玲珑,陈新宇,蔡虎志,等.温阳振衰颗粒对慢性心力衰竭阳虚水泛证患者临床疗效及血管内皮功能的影响[J].湖南中医药大学学报,2014,34(4):20-23.
[20]高耀青,杜媛.左西孟旦对慢性心力衰竭患者NT-proBNP、RDW、hs-CRP和LVEF的影响[J].西北国防医学杂志,2016,38(8):507-509.
[21]陈新宇,陆虎,蔡虎志,等.温阳振衰颗粒对慢性心力衰竭患者临床疗效及血清MMP-2、MMP-9的影响[J].湖南中医杂志,2015,31(4):1-4.
[2] Sandri M,Viehmann M,Adams V,et al. Chronic heart failure and aging-effects of exercise training on endothelial function and mechanisms of endothelial regeneration:Results from the Leipzig Exercise Intervention in Chronic heart failure and Aging(LEICA)study[J].European Journal of Preventive Cardiology,2016,23(4):349.
[3]马妮娜,柴小奇,李子杰,等.参松养心胶囊联合阿托伐他汀对慢性心力衰竭患者心电图相关指标及心率变异性的影响[J].中医学报,2017,32(6):1025-1028.
[4]石刚,刘婷,贺铿.补气活血化痰通脉方对慢性心力衰竭患者心率变异性和QT离散度的影响[J].湖南中医药大学学报,2016,36(2):1355.
[5]吕俊芳,张宝霞.益气活血利水方治疗冠状动脉粥样硬化性心脏病慢性心力衰竭心肾阳虚证临床研究[J].中医学报,2018,33(1):133-137.
[6]刘佑晖,李琰,蔡虎志,等.温阳振衰颗粒治疗慢性肾功能衰竭(阳虚证)的临床研究[J].中国中医急症,2018,27(2):653-657.
[7]中华医学会心血管病学分会.慢性心力衰竭诊断治疗指南[J].中华心血管病杂志,2007,35(12):1076-1095.
[8]郑筱萸.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,2002:72-77.
[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].中国实用乡村医生杂志,2014,22(2):6-12.
[10]马利平,李翠芳.芪苈强心胶囊对心力衰竭患者NT-proBNP及hs-CRP的影响[J].中医药导报,2016,23(8):92-95.
[11] Davarzani N, Wijk S S, Karel J, et al. NT-proBNP Guided Therapy in Chronic Heart Failure Reduces Repeated Hospitalizations-Results From TIME-CHF[J].Journal of Cardiac Failure,2017,23(5):382.
[12]朱迎春.瑞舒伐他汀联合美托洛尔对心力衰竭患者血浆MMP-2、MMP-9水平和左心室功能的影响[J].贵州医药,2018,43(1):483-487.
[13]唐胜,沈建锋,谢玉华,等.自拟益气活血方治疗冠心病慢性心力衰竭临床效果及对炎症因子水平的影响[J].河北中医药学报,2018,33(1):857-859.
[14]葛岚,程晓昱.中药复方真武冲剂对慢性心力衰竭患者中医证候及MCP-1、BNP的影响[J].辽宁中医药大学学报,2017,32(8):60-63.
[15]李丽丽,刘辉,董志,等.左西孟旦治疗急性心力衰竭患者的效果及其对血清脑钠肽的影响[J].疑难病杂志,2016,15(8):787-790.
[16]李传威,孙志军,杨波,等.左西孟旦改善急性心肌梗死伴心力衰竭患者近期血流动力学的研究[J].中华老年多器官疾病杂志,2016,15(4):241-244.
[17]蔡虎志,王笑莹,陈青扬,等.温阳振衰颗粒对慢性心衰模型大鼠心肌中MEF2表达的影响[J].中国药房,2017,28(34):4780-4783.
[18]杨磊,张曼华,蔡虎志,等.HPLC测定温阳振衰颗粒中人参皂苷Rg1、人参皂苷Re、人参皂苷Rb1含量[J].中国中医药信息杂志,2017,24(4):75-78.
[19]尹玲珑,陈新宇,蔡虎志,等.温阳振衰颗粒对慢性心力衰竭阳虚水泛证患者临床疗效及血管内皮功能的影响[J].湖南中医药大学学报,2014,34(4):20-23.
[20]高耀青,杜媛.左西孟旦对慢性心力衰竭患者NT-proBNP、RDW、hs-CRP和LVEF的影响[J].西北国防医学杂志,2016,38(8):507-509.
[21]陈新宇,陆虎,蔡虎志,等.温阳振衰颗粒对慢性心力衰竭患者临床疗效及血清MMP-2、MMP-9的影响[J].湖南中医杂志,2015,31(4):1-4.