强心方治疗心肾阳虚型慢性心力衰竭的临床观察
Clinical observation of Qiangxin Recipe in the treatment of chronic heart failure with syndrome of heart and kidney yang deficiency
- 上海中医药大学学报 2021年35卷第4期 页码：12-17
- 作者机构：
1.上海中医药大学附属市中医医院（上海 200071）
- 作者简介：
袁晨越，男，在读本科生，主要从事中医内科临床研究
刘晨萍，主治医师；E-mail：penny＿738@163.com
- 基金信息：上海市卫健委卫生行业临床研究专项面上项目(201940236)
DOI：10.16306/j.1008-861x.2021.04.002
中图分类号：
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袁晨越, 董耀荣, 刘晨萍. 强心方治疗心肾阳虚型慢性心力衰竭的临床观察[J]. 上海中医药大学学报, 2021,35(4):12-17.
YUAN Chenyue, DONG Yaorong, LIU Chenping. Clinical observation of Qiangxin Recipe in the treatment of chronic heart failure with syndrome of heart and kidney yang deficiency[J]. Academic Journal of Shanghai University of Traditional Chinese Medicine, 2021,35(4):12-17.
袁晨越, 董耀荣, 刘晨萍. 强心方治疗心肾阳虚型慢性心力衰竭的临床观察[J]. 上海中医药大学学报, 2021,35(4):12-17. DOI： 10.16306/j.1008-861x.2021.04.002.
YUAN Chenyue, DONG Yaorong, LIU Chenping. Clinical observation of Qiangxin Recipe in the treatment of chronic heart failure with syndrome of heart and kidney yang deficiency[J]. Academic Journal of Shanghai University of Traditional Chinese Medicine, 2021,35(4):12-17. DOI： 10.16306/j.1008-861x.2021.04.002.
摘要
目的：,2,观察强心方结合西医常规疗法治疗心肾阳虚型慢性心力衰竭（CHF）的临床疗效。,方法：,2,将符合纳入标准的82例心肾阳虚型CHF患者随机分为治疗组42例和对照组40例，两组患者均给予西医常规治疗，治疗组患者在西医常规治疗基础上给予强心方加减口服，两组治疗周期均为3个月。比较两组患者的心功能分级改善疗效、中医证候疗效；治疗前后，检测并计算所有患者的左室舒张末期内径（LVEDD）、左室收缩末期内径（LVESD）、左室射血分数（LVEF）、左室短轴缩短率（FS）、心室舒张末期容量（EDV）、每搏输出量（SV）、心输出量（CO），检测患者的血浆脑钠肽（BNP）、心肌肌钙蛋白1（cTn1）、血清同型半胱氨酸（Hcy）水平，比较两组患者的6 min步行距离（6MWD）。,结果：,2,①治疗后，治疗组患者的心功能分级改善总有效率为73.81%，对照组为52.50%，治疗组的疗效优于对照组（,P,<,0.05）。②治疗后，治疗组患者的中医证候疗效总有效率为78.57%，对照组为50.00%，治疗组的疗效优于对照组（,P,<,0.05）。③治疗后，治疗组患者的LVEDD、LVESD较治疗前减小（,P,<,0.05），LVEF、SV较治疗前增加（,P,<,0.05，,P,<,0.01）；对照组患者的LVEF较治疗前亦增加（,P,<,0.05）；且治疗组患者的LVEDD、LVESD低于对照组（,P,<,0.05，,P,<,0.01），LVEF高于对照组（,P,<,0.01）。④治疗后，两组患者的血浆BNP、cTn1及血清Hcy水平较治疗前均显著降低（,P,<,0.01），且治疗组患者的BNP、Hcy水平明显低于对照组（,P,<,0.01）。⑤治疗后，两组患者的6MWD较治疗前均明显延长（,P,<,0.01），且治疗组患者的6MWD较对照组亦明显延长（,P,<,0.05）。,结论：,2,与西医常规疗法相比，强心方联合西医常规疗法能够更好地改善心肾阳虚型CHF患者的临床症状和心功能，延缓患者心室重构的进展，调节相关神经内分泌指标水平。
Abstract
Objective:,2,To observe the clinical efficacy of Qiangxin Recipe combined with conventional western medicine in the treatment of chronic heart failure(CHF) with syndrome of heart and kidney yang deficiency.,Methods:,2,A total of 82 CHF patients with syndrome of heart and kidney yang deficiency who met the inclusion criteria were randomly divided into the treatment group(42 cases) and control group(40 cases) .The patients in both groups were treated with conventional western medicine, and the patients in the treatment group were orally treated with modified Qiangxin Recipe based on conventional western medicine.The treatment course of the two groups was 3 months.The efficacy of cardiac function classification improvement and Chinese medical syndrome were compared between the two groups.Before and after treatment, the left ventricular end diastolic diameter(LVEDD), left ventricular end systolic diameter(LVESD), left ventricular ejection fraction(LVEF), fractional shortening(FS), end diastolic volume(EDV), stroke volume(SV) and cardiac output(CO) were measured and calculated, the levels of plasma brain natriuretic peptide(BNP), cardiac troponin 1(cTn1) and serum homocysteine(Hcy) were detected, and the 6-minute walking distance(6MWD) of the two groups was compared.,Results:,2,①After treatment, the total effective rate on cardiac function classification improvement was 73.81% in the treatment group and 52.50% in the control group.The efficacy of the treatment group was better than that of the control group(,P,<,0.05) .②After treatment, the total effective rate on Chinese medical syndrome was 78.57% in the treatment group and 50.00% in the control group.The efficacy of the treatment group was better than that of the control group(,P,<,0.05) .③After treatment, the LVEDD and LVESD in the treatment group were reduced compared with those before treatment(,P,<,0.05), and the LVEF and SV were increased compared with those before treatment(,P,<,0.05,P,<,0.01) ; the LVEF in the control group was also increased compared with that before treatment(,P,<,0.05) .After treatment, the LVEDD and LVESD in the treatment group were lower than those in the control group(,P,<,0.05,P,<,0.01), and the LVEF was higher than that in the control group(,P,<,0.01) .④After treatment, the levels of plasma BNP, cTn1 and serum Hcy were significantly decreased in both groups compared with those before treatment(,P,<,0.01), and the levels of BNP and Hcy in the treatment group were significantly lower than those in the control group(,P,<,0.01) .⑤After treatment, the 6MWD of the two groups was significantly prolonged compared with that before treatment(,P,<,0.01), and the 6MWD of the treatment group was significantly longer than that of the control group(,P,<,0.05) .,Conclusion:,2,Compared with the conventional western medicine, Qiangxin Recipe combined with conventional western medicine can better improve the clinical symptoms and cardiac function of CHF patients with syndrome of heart and kidney yang deficiency, delay the progress of ventricular remodeling, and regulate the levels of relevant neuroendocrine indexes.
关键词
慢性心力衰竭心肾阳虚型强心方中西医结合
Keywords
chronic heart failuresyndrome of heart and kidney yang deficiencyQiangxin Recipeintegrated traditional Chinese and western medicine
references
中华医学会心血管病学分会心力衰竭学组，中国医师协会心力衰竭专业委员会，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2018[J].中华心血管病杂志，2018，46(10)：760-789.
邱伯雍，王永霞.慢性心力衰竭流行病学及防治研究进展[J].中华实用诊断与治疗杂志，2017，31(6)：619-621.
ZIAEIAN B，FONAROW G C. Epidemiology and aetiology of heart failure[J]. Nat Rev Cardiol，2016，13(6)：368-378.
PONIKOWSKI P，VOORS A A，ANKER S D，et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure[J]. Rev Esp Cardiol（Engl Ed），2016，69(12)：1167.
CARABALLO C，DESAI N R，MULDER H，et al. Clinical Implications of the New York Heart Association Classification[J]. J Am Heart Assoc，2019，8(23)：e014240.
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.
国家卫生计生委合理用药专家委员会，中国药师协会.心力衰竭合理用药指南（第2版）[J].中国医学前沿杂志（电子版），2019，11(7)：1-78.
沈绍功，王承德，闫希军.中医心病诊断疗效标准与用药规范[M].北京：北京出版社，2001.
SHAH N，MADANIEH R，ALKAN M，et al. A perspective on diuretic resistance in chronic congestive heart failure[J]. Ther Adv Cardiovasc Dis，2017，11(10)：271-278.
贾宏.托伐普坦治疗利尿剂抵抗心力衰竭的疗效分析[J].吉林医学，2020，41(10)：2446-2447.
DICK S A，EPELMAN S. Chronic Heart Failure and Inflammation：What Do We Really Know？[J]. Circ Res，2016，119(1)：159-176.
祝珍珍，袁灿宇，袁智宇，等.心力衰竭的古病名探究[J].中国中医基础医学杂志，2017，23(11)：1509-1511.
SCHIRONE L，FORTE M，PALMERIO S，et al. A Review of the Molecular Mechanisms Underlying the Development and Progression of Cardiac Remodeling[J]. Oxid Med Cell Longev，2017，2017：3920195.
ZHANG Y，BAUERSACHS J，LANGER H F. Immune mechanisms in heart failure[J]. Eur J Heart Fail，2017，19(11)：1379-1389.
罗芳，周宪梁，惠汝太.神经内分泌细胞因子在心力衰竭中的作用机制及临床意义[J].中国分子心脏病学杂志，2007，7(2)：108-111.
王正中，王丽，蒲毅.心力衰竭患者血浆BNP、NT-BNP及cTnⅠ水平的变化及其诊断价值研究[J].国际检验医学杂志，2017，38(9)：1283-1286.
SHARMA R，ANKER S D. Immune and neurohormonal pathways in chronic heart failure[J]. Congest Heart Fail，2002，8(1)：23-28,48.
HERRMANN M，TABAN-SHOMAL O，HÜBNER U，et al. A review of homocysteine and heart failure[J]. Eur J Heart Fail，2006，8(6)：571-576.
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