参芪血府逐瘀汤对糖尿病心肌病的临床作用及机制

Clinical effect and mechanism of Shenqi Xuefu Zhuyu Decoction in treatment of diabetic cardiomyopathy

目的探讨在常规治疗基础上联用参芪血府逐瘀汤对糖尿病心肌病(diabetic cardiomyopathy,DCM)的临床作用及可能的机制。方法以2017年8月~2020年7月西安交通大学医院中医科和西安交通大学医学院第一附属医院心内科门诊和住院的100例气阴两虚血瘀型DCM患者为研究对象,选取100例气阴两虚血瘀型DCM患者随机分为对照组和治疗组,每组50例。对照组采用西医规范化治疗;治疗组在对照组的基础上联用参芪血府逐瘀汤加减治疗;两组均连续治疗2个月。比较两组临床总有效率,治疗前后检测心脏功能指标[心脏彩超检测左室收缩末期内径(LVESD),左室舒张末期内径(LVEDD),左心室射血分数(LVEF),另行6 min步行试验(6MWT)]、氧化应激指标[总抗氧化能力(T-AOC)、超氧化物歧化酶(SOD)和谷胱苷肽过氧化物酶(GSH-PX)]、炎症指标[白介素6(IL-6)、肿瘤坏死因子(TNF-α)、NOD样受体蛋白3(NLRP3)和凋亡相关斑点样蛋白(ASC)]等情况。结果与本组治疗前比较,治疗后两组心功能LVESD、LVEDD、LVEF和6MWT指标明显改善(P<0.05);血清SOD、T-AOC和GSH-PX明显升高(P<0.05);血清中的炎症指标IL-6、TNF-α、NLRP3和ASC显著降低(P<0.05)。与对照组治疗后比较,治疗组临床总有效率达88%,明显高于对照组(P<0.05);治疗组心功能LVESD、LVEDD、LVEF和6MWT指标改善明显优于对照组(P<0.05);治疗组血清SOD、T-AOC和GSH-PX显著高于对照组(P<0.05);治疗组血清中的炎症指标IL-6、TNF-α、NLRP3和ASC明显低于对照组(P<0.05)。结论参芪血府逐瘀汤加减治疗DCM疗效确切,可明显改善心功能,在抗氧化应激和抗炎症方面作用显著,能有效抑制DCM的发展进程。

AIM To observe the therapeutic effect and possible mechanism of Shenqi Xuefu Zhuyu Decoction combined with conventional therapy in the treatment of diabetic cardiomyopathy.METHODS One hundred cases of diabetic cardiomyopathy with deficiency of Qi and Yin and blood stasis were divided randomly into treatment group and control group,50 cases in each group.The control group was treated with standardized treatment of Western medicine and the treatment group was combined with Shenqi Xuefu Zhuyu Decoction on the basis of the control group.Both groups were treated continuously for 2 months.Clinical total effective rate,detecting cardiac function indicators before and after the treatment[LVESD,LVEDD,LVEF,6 MWT],oxidative stress indexes[T-AOC,SOD,GSH-PX]and inflammation indicators[IL-6,TNF-α,NLRP3,ASC]were compared between the two groups.RESULTS Compared with those before treatment,the cardiac function indexes LVESD,LVEDD,LVEF and 6 MWT were significantly improved in both groups(P<0.05),serum SOD,T-AOC and GSH-PX were significantly increased(P<0.05)and inflammation indicators in serum IL-6,TNF-α,NLRP3 and ASC were significantly decreased after treatment(P<0.05).Compared with those in control group,the total effective rate of the treatment group(88.0%)was significantly higher than that in the control group(P<0.05),cardiac function indexes in the treatment were significantly better improved(P<0.05),the serum SOD,T-AOC and GSH-PX in the treatment group were significantly higher(P<0.05)and the serum inflammation indicators were significantly lower(P<0.05).CONCLUSION Shenqi Xuefu Zhuyu Decoction is effective in the treatment of diabetic cardiomyopathy and significantly improves the cardiac functions.It plays a significant role in anti-oxidative stress and anti-inflammation and effectively inhibits the development of diabetic cardiomyopathy.