丹红注射液联合比索洛尔治疗冠心病心力衰竭的临床研究

Clinical study on Danhong Injection combined with bisoprolol in treatment of coronary heart failure

目的观察丹红注射液联合富马酸比索洛尔片治疗冠心病心力衰竭的临床疗效。方法选取2016年1月—2017年9月广西中医药大学附属瑞康医院收治的89例冠心病心力衰竭患者为研究对象,随机将所有患者分为对照组(44例)和治疗组(45例)。对照组口服富马酸比索洛尔片,初始剂量为2.5 mg/次,1次/d,1周后增至5~10 mg/次,1次/d;治疗组在对照组治疗的基础上静脉滴注丹红注射液,40m L/次,1次/d。2周为1个疗程,两组连续治疗2个疗程。观察两组患者临床疗效,比较治疗前后两组的血清因子水平、外周血免疫因子水平、心功能指标和明尼苏达生活质量问卷(MLHFQ)评分。结果治疗后,对照组和治疗组的总有效率分别为84.1%、91.1%,两组比较差异具有统计学意义(P<0.05)。治疗后,两组患者血浆中的N端脑钠肽前体(NT-pro BNP)、高敏C反应蛋白(hs-CRP)水平均显著降低,血管内皮生长因子(VEGF)水平显著升高,同组治疗前后比较差异具有统计学意义(P<0.05)。治疗后,治疗组血清因子水平明显优于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组患者的CD3+、CD4+和CD4+/CD8+水平均明显升高,同组治疗前后比较差异具有统计学意义(P<0.05)。治疗后,治疗组外周血免疫因子水平显著高于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组左室舒张期末内径(LVEDD)、左室收缩期末内径(LVESD)和心率(HR)均显著降低,左室射血分数(LVEF)、6 min步行距离(6 MWT)均显著升高,同组治疗前后比较差异具有统计学意义(P<0.05)。治疗后,治疗组心功能指标显著优于对照组,两组比较差异具有统计学意义(P<0.05)。两组患者治疗2、4周后,MLHFQ评分均显著降低,同组治疗前后比较差异有统计学意义(P<0.05)。且治疗4周后,治疗组的MLHFQ评分明显低于对照组,两组比较差异具有统计学意义(P<0.05)。结论丹红注射液联合富马酸比索洛尔片治疗冠心病心力衰竭具有较好的临床疗效,可显著降低炎性反应,增强免疫功能,提高心功能,改善患者的生活质量,具有一定的临床推广应用价值。

Objective To investigate the clinical effects of Danhong Injection combined with Bisoprolol Fumarate Tablets in treatment of coronary heart failure. Methods Patients（89 cases） with coronary heart failure in Ruikang Hospital Affiliated to Guangxi University of Traditional Chinese Medicine from January 2016 to September 2017 were randomly divided into control（44 cases） and treatment（45 cases） group. Patients in the control group were po administered with Bisoprolol Fumarate Tablets, starting dosage was 2.5 mg/time, once daily, but after 1 week, dosage increased to 5 — 10 mg/time, once daily. Patients in the treatment group were iv administered with Danhong Injection on the basis of the control group, 40 mL/time, once daily. A course had 2 weeks, and patients in two groups were treated for 2 courses. After treatment, the clinical efficacy was evaluated, and the serum factor levels, peripheral blood levels of immune factors, cardiac function indexes, and MLHFQ scores in two groups before and after treatment were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 84.1% and 91.1%, respectively, and there was difference between two groups（P 〈 0.05）. After treatment, NT-proBNP and hs-CRP levels in two groups were significantly decreased, but VEGF levels were significantly increased, and the difference was statistically significant in the same group（P 〈 0.05）. After treatment, the serum factor levels in the treatment group were better than those in the control group, and there were differences between two groups（P 〈 0.05）. After treatment, the levels of CD3＋, CD4＋, and CD4＋/CD8＋ in two groups were significantly increased, and the difference was statistically significant in the same group（P 〈 0.05）. After treatment, peripheral blood levels of immune factors in the treatment group were significantly higher than those in the control group, with significant difference between two groups（P 〈 0.05）. After treatment, LVEDD, LVESD, and HR in two groups were significantly decreased, but LVEF and 6 MWT were significantly increased, and the difference was statistically significant in the same group（P 〈 0.05）. After treatment, 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 for 2 and 4 weeks, the MLHFQ scores in two groups were significantly decreased, and the difference was statistically significant in the same group（P 〈 0.05）. After treatment for 4 weeks, the MLHFQ scores in the treatment group were significantly lower than those in the control group, with significant difference between two groups（P 〈 0.05）. Conclusion Danhong Injection combined with Bisoprolol Fumarate Tablets has clinical curative effect in treatment of coronary heart failure, can significantly reduce inflammatory response, enhance immune function, improve cardiac function and the quality of life, which has a certain clinical application value.