生脉饮联合依那普利治疗慢性心力衰竭的临床研究
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摘要
目的探讨生脉饮联合马来酸依那普利片治疗慢性心力衰竭的临床疗效。方法选取2017年5月—2018年6月在辽宁中医药大学附属医院收治的慢性心力衰竭患者98例为实验对象,根据用药的差别分为对照组和治疗组,每组各49例。对照组口服马来酸依那普利片,10 mg/次,1次/d。治疗组在对照组治疗的基础上口服生脉饮,10 mL/次,3次/d。两组患者均治疗4周。观察两组的临床疗效,比较两组的心功能指标、血清学指标、心肌纤维化标志物。结果治疗后,对照组和治疗组的总有效率分别为81.63%、97.96%,两组比较差异有统计学意义(P<0.05)。治疗后,两组左心室射血分数(LVEF)、左心室收缩末期容积(LVESV)均明显增高,左室舒张末期内经(LVEDD)、左心室收缩末期内径(LVESD)均明显降低,同组治疗前后比较差异有统计学意义(P<0.05);且治疗后治疗组LVEF、LVESV、LVEDD、LVESD明显优于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组血清N末端B型钠尿肽原(NT-proBNP)、细胞间黏附分子-1(sICAM-1)、胱抑素C(Cys-C)、可溶性晚期糖基化终产物受体(sRAGE)、心型脂肪酸结合蛋白(H-FABP)水平均显著降低,同组治疗前后比较差异有统计学意义(P<0.05);且治疗后治疗组血清NT-proBNP、sICAM-1、Cys-C、sRAGE、H-FABP水平明显低于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组血清Ⅰ型胶原羧基端肽(ICTP)、Ⅲ型前胶原氨基端肽(PⅢNP)、结缔组织生长因子(CTGF)、透明质酸(AH)、层黏连蛋白(LN)水平均显著降低,同组治疗前后比较差异有统计学意义(P<0.05);且治疗后治疗组血清ICTP、PⅢNP、CTGF、HA、LN水平明显低于对照组,两组比较差异具有统计学意义(P<0.05)。结论生脉饮联合马来酸依那普利片治疗慢性心力衰竭具有较好的临床疗效,可改善患者心功能,降低心肌损伤血清学指标,抑制心肌纤维化进程,具有一定的临床推广应用价值。
Objective To explore the clinical efficacy of Shengmai Drink combined with Enalapril Maleate Tablets in treatment of chronic heart failure. Methods Patients(98 cases) with chronic heart failure in the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine from May 2017 to June 2018 were enrolled in this study. According to the difference treatment plan, patients were randomly divided into control and treatment groups, and each group had 49 cases. Patients in the control group were poadministered with Enalapril Maleate Tablets, 10 mg/time, once daily. Patients in the treatment group were po administered with Shengmai Drink on the basis of the control group, 10 mL/time, three times daily. Patients in two groups were treated for 4 weeks. After treatment, the clinical efficacies were evaluated, and cardiac function indexes, serological indexes, and myocardial fibrosis markers in two groups were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 81.63% and 97.96%, respectively, and there was difference between two groups(P < 0.05). After treatment, LVEF and the LVESV in two groups were significantly increased, but LVEDD and the LVESD in two groups were significantly decreased, and the difference was statistically significant in the same group(P < 0.05). And the cardiac function indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups(P < 0.05). After treatment, the levels of NT-proBNP, sICAM-1, Cys-C, sRAGE, and H-FABP in two groups were significantly decreased, and the difference was statistically significant in the same group(P < 0.05). And the serological indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups(P < 0.05). After treatment, the levels of ICTP, PⅢNP, CTGF, HA, and LN in two groups were significantly decreased, and the difference was statistically significant in the same group(P < 0.05). And the myocardial fibrosis markers indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups(P < 0.05). Conclusion Shengmai Drink combined with Enalapril Maleate Tablets has clinical curative effect in treatment of chronic heart failure, can improve cardiac function, reduce serological indexes of myocardial injury, and inhibit the process of myocardial fibrosis, which has a certain clinical application value.
Objective To explore the clinical efficacy of Shengmai Drink combined with Enalapril Maleate Tablets in treatment of chronic heart failure. Methods Patients(98 cases) with chronic heart failure in the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine from May 2017 to June 2018 were enrolled in this study. According to the difference treatment plan, patients were randomly divided into control and treatment groups, and each group had 49 cases. Patients in the control group were poadministered with Enalapril Maleate Tablets, 10 mg/time, once daily. Patients in the treatment group were po administered with Shengmai Drink on the basis of the control group, 10 mL/time, three times daily. Patients in two groups were treated for 4 weeks. After treatment, the clinical efficacies were evaluated, and cardiac function indexes, serological indexes, and myocardial fibrosis markers in two groups were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 81.63% and 97.96%, respectively, and there was difference between two groups(P < 0.05). After treatment, LVEF and the LVESV in two groups were significantly increased, but LVEDD and the LVESD in two groups were significantly decreased, and the difference was statistically significant in the same group(P < 0.05). And the cardiac function indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups(P < 0.05). After treatment, the levels of NT-proBNP, sICAM-1, Cys-C, sRAGE, and H-FABP in two groups were significantly decreased, and the difference was statistically significant in the same group(P < 0.05). And the serological indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups(P < 0.05). After treatment, the levels of ICTP, PⅢNP, CTGF, HA, and LN in two groups were significantly decreased, and the difference was statistically significant in the same group(P < 0.05). And the myocardial fibrosis markers indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups(P < 0.05). Conclusion Shengmai Drink combined with Enalapril Maleate Tablets has clinical curative effect in treatment of chronic heart failure, can improve cardiac function, reduce serological indexes of myocardial injury, and inhibit the process of myocardial fibrosis, which has a certain clinical application value.
引文
[1]陈灏珠,林果为,王吉耀.实用内科学(下册)[M].第14版.北京:人民卫生出版社, 2013:1496-1497.
[2]刘健,肖霞,郑月元,等.依那普利联合环磷腺苷葡胺对心力衰竭患者心功能、血浆脑利钠肽浓度的影响[J].河北医药, 2016, 38(2):255-257.
[3]杜荣生,游大勇,唐刚.生脉饮对心力衰竭患者培哚普利耐受性的影响[J].临床合理用药杂志, 2018,11(20):7-8.
[4]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.
[5]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, 2002:77-82.
[6]陈可冀,吴宗贵,朱明军,等.慢性心力衰竭中西医结合诊疗专家共识[J].中国中西医结合杂志, 2016,36(2):133-141.
[7]杨明月,杜晔,王丹丹,等.中医药治疗冠心病心力衰竭的研究进展[J].中国中医急症, 2018, 27(9):1664-1666, 1683.
[8]伍树芝,邓胜,秦伟国,等.联合检测NT-proBNP、H-FABP和cTnI对老年重症心力衰竭患者的临床价值[J].检验医学, 2014, 29(4):312-318.
[9]熊彬,魏任雄,陈国方.慢性心力衰竭患者IL-6、sICAM-1的血浆表达及与BNP和心功能关系的相关性研究[J].中国卫生检验杂志, 2013, 23(14):2951-2952,2960.
[10]张云芳,王玉明,段勇.急性心肌梗死及梗死后心衰患者胱抑素C测定的临床意义[J].现代检验医学杂志, 2014, 29(3):95-98.
[11]郭新颖,郭彩霞,杜凤和,等.心力衰竭患者血浆可溶性晚期糖基化终末产物受体(sRAGE)变化与心功能的关系[J].首都医科大学学报, 2014, 35(6):805-808.
[12] Tegn N, Abdelnoor M, Aaberge L, et al. Invasive versus conservative strategy in patients aged 80 years or older with non-ST-elevation myocardial infarction or unstable angina pectoris(After Eighty study):an open-label randomised controlled trial[J]. Lancet, 2016, 387(10023):1057-1065
[13]许兆延,王雪珍,杨希立.血清间质胶原动态变化预测急性心肌梗死心室重构的意义[J].临床心血管病杂志, 2015, 31(11):1178-1181.
[14]张平,张再伟,邵靓. TGF-β1、CTGF对慢性心衰心肌纤维化进展的临床意义[J].昆明医科大学学报,2014, 35(11):45-47, 55.
[15]陈晓锋,唐礼江,朱敏,等.急性心肌梗死患者血清Ⅳ-C、PC-Ⅲ、LN、HA水平测定的临床意义[J].苏州大学学报:医学版, 2003, 23(6):710-711, 713.
[2]刘健,肖霞,郑月元,等.依那普利联合环磷腺苷葡胺对心力衰竭患者心功能、血浆脑利钠肽浓度的影响[J].河北医药, 2016, 38(2):255-257.
[3]杜荣生,游大勇,唐刚.生脉饮对心力衰竭患者培哚普利耐受性的影响[J].临床合理用药杂志, 2018,11(20):7-8.
[4]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.
[5]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, 2002:77-82.
[6]陈可冀,吴宗贵,朱明军,等.慢性心力衰竭中西医结合诊疗专家共识[J].中国中西医结合杂志, 2016,36(2):133-141.
[7]杨明月,杜晔,王丹丹,等.中医药治疗冠心病心力衰竭的研究进展[J].中国中医急症, 2018, 27(9):1664-1666, 1683.
[8]伍树芝,邓胜,秦伟国,等.联合检测NT-proBNP、H-FABP和cTnI对老年重症心力衰竭患者的临床价值[J].检验医学, 2014, 29(4):312-318.
[9]熊彬,魏任雄,陈国方.慢性心力衰竭患者IL-6、sICAM-1的血浆表达及与BNP和心功能关系的相关性研究[J].中国卫生检验杂志, 2013, 23(14):2951-2952,2960.
[10]张云芳,王玉明,段勇.急性心肌梗死及梗死后心衰患者胱抑素C测定的临床意义[J].现代检验医学杂志, 2014, 29(3):95-98.
[11]郭新颖,郭彩霞,杜凤和,等.心力衰竭患者血浆可溶性晚期糖基化终末产物受体(sRAGE)变化与心功能的关系[J].首都医科大学学报, 2014, 35(6):805-808.
[12] Tegn N, Abdelnoor M, Aaberge L, et al. Invasive versus conservative strategy in patients aged 80 years or older with non-ST-elevation myocardial infarction or unstable angina pectoris(After Eighty study):an open-label randomised controlled trial[J]. Lancet, 2016, 387(10023):1057-1065
[13]许兆延,王雪珍,杨希立.血清间质胶原动态变化预测急性心肌梗死心室重构的意义[J].临床心血管病杂志, 2015, 31(11):1178-1181.
[14]张平,张再伟,邵靓. TGF-β1、CTGF对慢性心衰心肌纤维化进展的临床意义[J].昆明医科大学学报,2014, 35(11):45-47, 55.
[15]陈晓锋,唐礼江,朱敏,等.急性心肌梗死患者血清Ⅳ-C、PC-Ⅲ、LN、HA水平测定的临床意义[J].苏州大学学报:医学版, 2003, 23(6):710-711, 713.