复心合剂治疗阳虚水泛型心肌梗死后心力衰竭的前瞻性临床研究

Prospective Clinical Study of Fuxin Mixture in the Treatment of Heart Failure of Yang Deficiency and Water Inundation Type after Myocardial Infarction

目的探讨复心合剂治疗阳虚水泛型心肌梗死后心衰患者临床疗效及对血清心肌损伤、心室重构相关指标的影响。方法将92例阳虚水泛型心肌梗死后心衰患者随机分为观察组与对照组各46例。对照组给予西医基础治疗,观察组在对照组治疗基础上加服复心合剂,治疗前后评估2组患者的中医证候积分,超声心动图指标[左心室射血分数(LVEF)、左心室Tei指数、每搏输出量(SV)],血清心肌损伤指标[血清N末端B型利钠肽原(NT-ProBNP)水平、血清高敏心肌肌钙蛋白I(hs-cTnI)水平、肌酸激酶同工酶(CK-MB)水平],血清心室重构指标[缺氧诱导因子1α(HIF-1α)、可溶性生长刺激表达基因2蛋白(sST2)、血管紧张素Ⅱ(AngⅡ)],明尼苏达州心功能不全生命质量量表(MLHFQ)变化情况,治疗后随访1年观察2组患者主要不良心血管事件发生情况。结果治疗后,2组中医证候积分均显著降低(P<0.01),观察组优于对照组(P<0.05,P<0.01)观察组中医临床总有效率优于对照组(P<0.05);2组患者血清超声心动图指标,心肌损伤、心室重构指标及MLHFQ评分均显著降低(P<0.01),观察组优于对照组(P<0.01)。随访期间,观察组治疗后全因死亡率、恶性心律失常率、急性心力衰竭率均显著低于对照组(P<0.05,P<0.01)。结论复心合剂治疗阳虚水泛型心肌梗死后心衰患者临床疗效显著,疗效机制可能与其减轻心肌损伤、抑制心室重构有关。

OBJECTIVE To explore the clinical efficacy of Fuxin Mixture in the treatment of patients with heart failure of yang deficiency and water inundation type after myocardial infarction and its effect on serum myocardial injury and ventricular remodeling related indicators.METHODS A total of 92 patients with heart failure of yang deficiency and water inundation type after myocardial infarction were randomly divided into an observation group and a control group(n=46).The control group was given basic western medicine treatment,and the observation group was given Fuxin Mixture on the basis of the control group's treatment.The TCM syndrome scores,ultrasound cardiogram indices[left ventricular ejection fraction(LVEF),left ventricular Tei index,and stroke volume(SV)],serum myocardial injury indices[serum N-terminal pro-B-type natriuretic peptide(NT-ProBNP)level,serum high-sensitivity cardiac troponin I(hs-cTnI)level,and creatine kinase isoenzyme(CK-MB)level],serum ventricular remodeling indices[hypoxia-inducible factor 1α(HIF-1α),soluble growth-stimulated gene expressed 2 protein(sST2),and angiotensinⅡ(AngⅡ)],and changes in the Minnesota Living with Heart Failure Questionnaire(MLHFQ)were evaluated before and after treatment.The two groups were followed up for 1 year after treatment to observe the occurrence of major adverse cardiovascular events.RESULTS After treatment,the TCM syndrome scores of both groups were significantly reduced(P<0.01),the observation group was better than the control group(P<0.05,P<0.01),and the total effective rate of TCM in the observation group was better than that of the control group(P<0.05);the serum ultrasound cardiogram indexes,myocardial injury,ventricular remodeling indexes and MLHFQ scores of the two groups were significantly reduced(P<0.01),and the observation group was better than the control group(P<0.01).During the follow-up period,the all-cause mortality,malignant arrhythmia rate and acute heart failure rate of the observation group after treatment were significantly lower than those of the control group(P<0.05,P<0.01).CONCLUSION Fuxin Mixture has significant clinical efficacy in the treatment of patients with heart failure of yang deficiency and water inundation type after myocardial infarction,and the efficacy mechanism may be related to its reduction of myocardial injury and inhibition of ventricular remodeling.