方显明教授治疗慢性心力衰竭的经验总结及临床研究
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摘要
方显明教授是著名中医药学家,全国第四批老中医药专家学术经验继承人指导老师,临床涉猎内、外、妇、儿多科,尤其在中医内科疾病方面多有心得,长期的临床医疗实践中,形成了自己独特的学术思想,强调“辨病”是疗效的基础,“辨证”是疗效的关键,临证重视阴阳,认为平调阴阳是治病之关键；强调脾胃为百病之本,治病尤重脾胃；用药轻灵,注重配伍,强调动静结合。
慢性心力衰竭是一种复杂的临床综合征,是各种心脏病的严重阶段,其发病率高、死亡率高,一旦诊断为有症状性心衰,其5年生存率仅35%。目前在治疗慢性心力衰竭方面有了较大的进步,但具有长期生存可能性的心力衰竭治疗方法仍在探索中。中医在治疗慢性心力衰竭积累了丰富的经验,实验及临床的研究充分说明,中医对慢性心力衰竭病证能显著地增加心输出量、增加心肌收缩力、改善心脏血流动力学,能明显提高患者的生存质量。因此,开展中医药对慢性心力衰竭防治的研究具有十分重要的意义。
方显明教授在精研经典著作及历代医家著述基础上,经过多年临证探索,认为慢性心力衰竭属中医学“喘证”、“痰饮”、“心悸”、“水肿”范畴。“喘”、“咳”、“悸”、“肿”是慢性心力衰竭的四大证候,也是心衰不同阶段的临床表现,当四证均出现时,则又水肿论治。本病多由脏气亏损,气血、津液运行不畅,痰浊、瘀血、水湿停聚,阻滞心脉,抑遏心阳而成。其病性总属本虚标实、阴盛阳衰,标实以痰、瘀、水互结为患,本虚以心脏阳气虚衰为本,五脏虚损为要。痰浊、瘀血、水湿均为阴邪,阴凝之邪,权当温化,故治疗宜标本兼顾、以温通为要,佐以逐瘀通脉、化痰利水。安心颗粒是方显明教授治疗慢性心力衰竭的经验方,具有补气通阳、逐瘀通脉、化痰利水之功效,为进一步验证该方的临床疗效,从而设计了该临床研究。
目的：
通过观察安心颗粒治疗慢性心力衰竭的作用,综合评价其临床疗效。
方法：
将60例慢性心力衰竭患者随机分为2组,治疗组30例,给予基础治疗加安心颗粒口服；对照组30例给予基础治疗,两组疗程均为4周,观察两组患者治疗前后的中医证候积分、心功能、心功能参数、B型脑钠肽、6分钟步行距离试验、生活质量积分及安全性等指标。
结果：
1、治疗组中医临床疗效总有效率为86.67%,对照组中医临床疗效总有效率为80.0%,两组治疗后的中医证候积分均有不同程度降低(P<0.05),治疗组中医证候积分降低较对照组明显(P<0.05)。2、治疗后Lee氏心衰计分两组间比较有差异性(P<0.05),但NYHA分级两组间比较无差异性(P>0.05)。3、两组治疗后LVSD明显降低,LVEF明显升高,与治疗前比较有差异性(P<0.05),但治疗组LVSD降低与LVEF升高较对照组明显(P<0.05)。4、两组治疗后的BNP水平均较治疗前降低(P<0.05),两组间比较有差异性(P<0.05)。5、两组治疗后的6分钟步行距离较治疗前延长(P<0.05),治疗组6分钟步行距离更长(P<0.05)。6、两组治疗后明尼苏达心衰生活质量积分均较治疗前降低(P<0.05),治疗组降低更明显(P<0.05)。7、治疗组和对照组均未发生明显的肝肾损害等不良反应。
结论：
安心颗粒临床疗效确切,结合常规西药治疗慢性心力衰竭,不但更好地改善患者的临床症状,能增强心脏收缩功能,改善心脏舒张功能,而且更好地提高患者的运动耐量和生活质量。
Professor Fang-Xian Ming was one of famous TCM doctors, He was also the national experts in the fourth installment of the old academic experience in the pharmaceutical heir instructor. He dabbled in internal medicine surgical, gynecology and pediatrics, especially accumulated abundant clinical experience in miscellaneous disease. after a long-term clinical practice, he formed its own unique academic thought. He stressed that identifying disease is the basis for effective, and differentiation is the key to effective in the clinic, he emphasis on yin and yang. He stressed that the level of yin and yang is the key to treatment, and in coordination between spleen and stomach is the source of sickness. so, It is important to recuperate the spleen and stomach. it requires drug light spirits compatibility and combination of static and dynamic.
Chronic heart failure CHF)was a compound clinical syndrome and the severest stage of all kinds of heart disease, characterized by high incidence and high mortality, once the diagnosis of symptomatic heart failure, the5-year survival rate of only35%. Currently in the treatment of chronic heart failure has made great progress. but with the possibility of long-term survival of heart treatment still exploring, Chinese medicine in the treatment of chronic heart failure has accumulated a wealth of experience, experimental and clinical research to fully explain that Chinese medicine can improve chronic heart failure syndromes, and it also can significantly increase cardiac output、increase cardiac contractility、improve cardiac hemodynamics, and significantly improve the patients quality of life. Therefore, to carry out research on the prevention and treatment of chronic heart failure in Traditional Chinese Medical research is of great significance.
After many years of clinical evidence to explore, professor Fang-Xian Ming believes that chronic heart failure is attributable to "asthma"、"phlegm"、"palpitations"、"edema" in the category of Chinese medicine."Asthma"、"cough"、palpitate"、"swollen" are the four chronic heart failure syndrome, also are the different stages of clinical manifestations of heart failure. when four cards have appeared, according to edema of governance. This disease from the Decadency of visceral qi、and poor qi、blood or body fluid running. It also relates to the accumulation of phlegm、blood stasis、moisture stop poly, which blocked heart vessel, and inhibited the heart-yang. The total is a disease of the vacuity、weak、and phlegm, blood stasis, formed a risk of water each, which are yin pathogen. When we treat this disease, we should note that it is manifested in the deficiency in five origin、excess in superficiality and based on yang qi failure in heart. Therefore, we need to think over all of these, to warm heart yang and promoting blood circulation for removing blood stasis and resolving phlegm and water.
Anxin Granule(AXG), which contains the above effect, has been used in clinic by professor Fang-Xian Ming and be testified effectively to treat heart failure.To further validate the clinical efficacy of AXG, we designed the clinical study.
Objective
The Study is associated with the treatment with AXG for chronic heart failure, and comprehensive evaluation of its clinical efficacy.
Methods
60Patients with CHF were studied, and randomly divided into the treatment group (n=30) and control group (n=30). The control group was treated with conventional western medicine, while the treatment group was treated with Anxin Granule as well as western medicine. The treatment time was four weeks. The two groups were observed before and after treatment of TCM syndrome score、heart function、heart function parameters、BNP in the blood、six—minute walking test、quality of life indicators and safety points.
Results
1. The total effective rate in treatment group was86.67%, while in control group was80.0%, TCM syndrome score was decreased significantly in both groups after treatment (P<0.05), and with even better decrease in treatment group than that in control group (P<0.05), there was significant difference between the two groups (P>0.05).2. After treatment, there were difference between the two groups Lee's marks of CHF (P<0.05), but there were no difference between the two groups NYHA classification (P<0.05).3. The LVEF was improved significantly in both groups after treatment and LVSD was decreased significantly (P<0.05),but the improvement in treatment group was more significant than that in control group (P<0.05).4. After treatment, the concentration of BNP was decreased significantly in both groups (P<0.05), there were difference between the two groups.(P<0.05).5. After treatment, the distance of6MWT was increased significantly in both groups (P<0.05), and with even better increase in treatment group than that in control group (P<0.05).6. After treatment, the marks of MLHFQ was decreased significantly in both groups (P<0.05),and with even better decrease in treatment_group than that in control group (P<0.05).7. No side-effects such as the liver and kidney function damage were recorded in both groups.
Conclusion
Anxin Granule has a constant effect on the CHF patients in the clinical practice it has cooperative function with conventional western medicine on CHF treatment. It is not only to relieve the symptoms、enhance systolic function and improve diastolic function, but also enhance exercise performance and life quality.
慢性心力衰竭是一种复杂的临床综合征,是各种心脏病的严重阶段,其发病率高、死亡率高,一旦诊断为有症状性心衰,其5年生存率仅35%。目前在治疗慢性心力衰竭方面有了较大的进步,但具有长期生存可能性的心力衰竭治疗方法仍在探索中。中医在治疗慢性心力衰竭积累了丰富的经验,实验及临床的研究充分说明,中医对慢性心力衰竭病证能显著地增加心输出量、增加心肌收缩力、改善心脏血流动力学,能明显提高患者的生存质量。因此,开展中医药对慢性心力衰竭防治的研究具有十分重要的意义。
方显明教授在精研经典著作及历代医家著述基础上,经过多年临证探索,认为慢性心力衰竭属中医学“喘证”、“痰饮”、“心悸”、“水肿”范畴。“喘”、“咳”、“悸”、“肿”是慢性心力衰竭的四大证候,也是心衰不同阶段的临床表现,当四证均出现时,则又水肿论治。本病多由脏气亏损,气血、津液运行不畅,痰浊、瘀血、水湿停聚,阻滞心脉,抑遏心阳而成。其病性总属本虚标实、阴盛阳衰,标实以痰、瘀、水互结为患,本虚以心脏阳气虚衰为本,五脏虚损为要。痰浊、瘀血、水湿均为阴邪,阴凝之邪,权当温化,故治疗宜标本兼顾、以温通为要,佐以逐瘀通脉、化痰利水。安心颗粒是方显明教授治疗慢性心力衰竭的经验方,具有补气通阳、逐瘀通脉、化痰利水之功效,为进一步验证该方的临床疗效,从而设计了该临床研究。
目的：
通过观察安心颗粒治疗慢性心力衰竭的作用,综合评价其临床疗效。
方法：
将60例慢性心力衰竭患者随机分为2组,治疗组30例,给予基础治疗加安心颗粒口服；对照组30例给予基础治疗,两组疗程均为4周,观察两组患者治疗前后的中医证候积分、心功能、心功能参数、B型脑钠肽、6分钟步行距离试验、生活质量积分及安全性等指标。
结果：
1、治疗组中医临床疗效总有效率为86.67%,对照组中医临床疗效总有效率为80.0%,两组治疗后的中医证候积分均有不同程度降低(P<0.05),治疗组中医证候积分降低较对照组明显(P<0.05)。2、治疗后Lee氏心衰计分两组间比较有差异性(P<0.05),但NYHA分级两组间比较无差异性(P>0.05)。3、两组治疗后LVSD明显降低,LVEF明显升高,与治疗前比较有差异性(P<0.05),但治疗组LVSD降低与LVEF升高较对照组明显(P<0.05)。4、两组治疗后的BNP水平均较治疗前降低(P<0.05),两组间比较有差异性(P<0.05)。5、两组治疗后的6分钟步行距离较治疗前延长(P<0.05),治疗组6分钟步行距离更长(P<0.05)。6、两组治疗后明尼苏达心衰生活质量积分均较治疗前降低(P<0.05),治疗组降低更明显(P<0.05)。7、治疗组和对照组均未发生明显的肝肾损害等不良反应。
结论：
安心颗粒临床疗效确切,结合常规西药治疗慢性心力衰竭,不但更好地改善患者的临床症状,能增强心脏收缩功能,改善心脏舒张功能,而且更好地提高患者的运动耐量和生活质量。
Professor Fang-Xian Ming was one of famous TCM doctors, He was also the national experts in the fourth installment of the old academic experience in the pharmaceutical heir instructor. He dabbled in internal medicine surgical, gynecology and pediatrics, especially accumulated abundant clinical experience in miscellaneous disease. after a long-term clinical practice, he formed its own unique academic thought. He stressed that identifying disease is the basis for effective, and differentiation is the key to effective in the clinic, he emphasis on yin and yang. He stressed that the level of yin and yang is the key to treatment, and in coordination between spleen and stomach is the source of sickness. so, It is important to recuperate the spleen and stomach. it requires drug light spirits compatibility and combination of static and dynamic.
Chronic heart failure CHF)was a compound clinical syndrome and the severest stage of all kinds of heart disease, characterized by high incidence and high mortality, once the diagnosis of symptomatic heart failure, the5-year survival rate of only35%. Currently in the treatment of chronic heart failure has made great progress. but with the possibility of long-term survival of heart treatment still exploring, Chinese medicine in the treatment of chronic heart failure has accumulated a wealth of experience, experimental and clinical research to fully explain that Chinese medicine can improve chronic heart failure syndromes, and it also can significantly increase cardiac output、increase cardiac contractility、improve cardiac hemodynamics, and significantly improve the patients quality of life. Therefore, to carry out research on the prevention and treatment of chronic heart failure in Traditional Chinese Medical research is of great significance.
After many years of clinical evidence to explore, professor Fang-Xian Ming believes that chronic heart failure is attributable to "asthma"、"phlegm"、"palpitations"、"edema" in the category of Chinese medicine."Asthma"、"cough"、palpitate"、"swollen" are the four chronic heart failure syndrome, also are the different stages of clinical manifestations of heart failure. when four cards have appeared, according to edema of governance. This disease from the Decadency of visceral qi、and poor qi、blood or body fluid running. It also relates to the accumulation of phlegm、blood stasis、moisture stop poly, which blocked heart vessel, and inhibited the heart-yang. The total is a disease of the vacuity、weak、and phlegm, blood stasis, formed a risk of water each, which are yin pathogen. When we treat this disease, we should note that it is manifested in the deficiency in five origin、excess in superficiality and based on yang qi failure in heart. Therefore, we need to think over all of these, to warm heart yang and promoting blood circulation for removing blood stasis and resolving phlegm and water.
Anxin Granule(AXG), which contains the above effect, has been used in clinic by professor Fang-Xian Ming and be testified effectively to treat heart failure.To further validate the clinical efficacy of AXG, we designed the clinical study.
Objective
The Study is associated with the treatment with AXG for chronic heart failure, and comprehensive evaluation of its clinical efficacy.
Methods
60Patients with CHF were studied, and randomly divided into the treatment group (n=30) and control group (n=30). The control group was treated with conventional western medicine, while the treatment group was treated with Anxin Granule as well as western medicine. The treatment time was four weeks. The two groups were observed before and after treatment of TCM syndrome score、heart function、heart function parameters、BNP in the blood、six—minute walking test、quality of life indicators and safety points.
Results
1. The total effective rate in treatment group was86.67%, while in control group was80.0%, TCM syndrome score was decreased significantly in both groups after treatment (P<0.05), and with even better decrease in treatment group than that in control group (P<0.05), there was significant difference between the two groups (P>0.05).2. After treatment, there were difference between the two groups Lee's marks of CHF (P<0.05), but there were no difference between the two groups NYHA classification (P<0.05).3. The LVEF was improved significantly in both groups after treatment and LVSD was decreased significantly (P<0.05),but the improvement in treatment group was more significant than that in control group (P<0.05).4. After treatment, the concentration of BNP was decreased significantly in both groups (P<0.05), there were difference between the two groups.(P<0.05).5. After treatment, the distance of6MWT was increased significantly in both groups (P<0.05), and with even better increase in treatment group than that in control group (P<0.05).6. After treatment, the marks of MLHFQ was decreased significantly in both groups (P<0.05),and with even better decrease in treatment_group than that in control group (P<0.05).7. No side-effects such as the liver and kidney function damage were recorded in both groups.
Conclusion
Anxin Granule has a constant effect on the CHF patients in the clinical practice it has cooperative function with conventional western medicine on CHF treatment. It is not only to relieve the symptoms、enhance systolic function and improve diastolic function, but also enhance exercise performance and life quality.
引文
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[51]Singla DK, Lyons GE,Kamp TJ Transplanted embryonic stem cells following mouse myocardial infarction inhibit apoptosis and cardiac remodeling. Am j Physiol Heart Circ Physiol,2007,293(2):H1308-1314.
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[53]奚悦文,范维琥.明尼苏达心力衰竭生活质量调查适用性的评价.上海医学,2004,27(4)：222-223.
[54]黄绍湘,杨小英.益心脉颗粒治疗慢性心力衰竭的疗效观察.中西医结合心脑血管病杂志.2007.5(5)：381.
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