鹿角方改善充血性心力衰竭患者左心室肥厚程度的效应(英文)

Effect of Lujiao prescription on the degree of left ventricular hypertrophy in patients with congestive heart failure

背景:左心室肥厚是充血性心力衰竭发生发展的主要环节,作为心血管疾病的独立危险因子已形成共识,如何逆转或减轻左心室肥厚对于改善心功能防治充血性心力衰竭具有重要的临床价值。目的:观察鹿角方对充血性心力衰竭患者左心室肥厚程度的影响。设计:以充血性心力衰竭患者为观察对象的随机对照观察。单位:上海中医药大学附属曙光医院心血管内科。对象:选择1996-01/1998-12上海中医药大学附属曙光医院心血管内科病房及专科门诊的充血性心力衰竭患者20例,纳入标准:①符合Framinham心衰诊断标准。②纽约心脏病学会心功能Ⅲ级以上。③病史3个月以上。④接受适量的利尿剂或扩血管药物(血管紧张素转换酶抑制剂(ACEI)除外)作基础治疗。⑤胸部X射线片及超声心动图有左心室扩大的证据。所有患者均对治疗项目知情同意。方法:将所有患者抽签法随机分为鹿角方组和地高辛组,每组10例。①给予鹿角方组患者口服上海曙光医院按既定工艺研制的鹿角方口服液35mL,2次/d,3个月为1疗程。地高辛组患者同时口服杭州民生药厂生产的地高辛片(0.25mg/片,批号970757),0.125～0.25mg,1次/d,3个月为1疗程。①治疗后分别观察两组患者纽约心脏病学会心功能分级。②超声心动图检查分别测量患者舒张期室间隔厚度、舒张期左室后壁厚度。根据Devereux公式计算左心室心肌重量,并用体表面积矫正计算左心室重量指数。参考Devereux标准判断左心室肥厚程度。③对两组患者血浆血管紧张素Ⅱ放免测定。主要观察指标:两组患者纽约心脏病学会心功能分级、超声心动图(室间隔厚度、左心室后壁厚度、左心室重量指数、左心室肥厚程度)及血浆血管紧张素Ⅱ水平。结果:纳入患者20例,全部进入结果分析。①鹿角方组患者治疗后纽约心脏病学会心功能分级Ⅰ,Ⅱ,Ⅲ,Ⅳ级分别为2,5,3,0例,与治疗前相比差异明显(0,0,7,3例,P<0.05),地高辛组患者治疗后Ⅰ,Ⅱ,Ⅲ,Ⅳ级分别为2,4,4,0例,与治疗前相比差异明显(0,0,7,3例,P<0.05)。②鹿角方组患者治疗后室间隔厚度明显低于治疗前[(11.20±0.42),(12.10±0.32)mm,P<0.01],左心室后壁厚度明显低于治疗前[(10.60±0.84),(11.40±1.10)mm,P<0.01],左心室重量指数明显低于治疗前[(139.4±12.4),(155.3±15.4)g/m2,P<0.01],地高辛组患者以上指标与治疗前无明显差异(P>0.05)。鹿角方组患者治疗后左心室基本正常、轻、中、重度肥厚分别为2,6,2,0例,明显少于治疗前(0,3,4,3例,P<0.01),地高辛组未见明显变化(P>0.05);③鹿角方组患者治疗后血浆血管紧张素Ⅱ水平明显低于治疗前[(97.7±19.5),(144.0±18.5)ng/L,P<0.01],地高辛组与治疗前无明显差异(P>0.05)。结论:鹿角方具有逆转或减轻充血性心力衰竭患者左室肥厚程度的作用。

BACKGROUND： Left ventrieular hypertrophy （LVH） is an important ring-jolnt of congestive heart failure （CHF）. It is also considered to be independent risk factor of cardiovascular disease, so how to reverse or relieve LYH is valuable to cure CHF. OBJECTIVE： To observe the effect of Lujiao prescription on degree of LVH in patients with CHF. DESIGN： A random-control observation on CHF patients. SETTING： Department of Cardiovasology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine. PARTICIPANTS： A total of 20 patients with CHF were selected from the Special Clinic and Department of Cardiovasology in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from January 1996 to December 1998. All of them were consistent with the Framinham diagnostic criteria and following standardizations： （1）above Ⅲ degree of cardiac functional grading by New York Heart Association （NYHA）;（2） over 3 months case history;（3）accepted basic treatment of quantity sufficient diuretic and vasodilating agent excluding angiotensin converting enzyme inhibitor （ACEI）;LVH was proved by echocardiogram or chest X-ray. They were informed of treatment items and consented. METHODS： According to random lot, the patients were divided into Lujiao prescription group and Digoxin group, each containing 10 patients.（1） Oral administrations of Lujiao prescription （35 mL, two times per day, produced by Shanghai Shuguang Hospital） and Digoxin （0.125-0.25 mg per tablet, batch number： 970757, once daily） were given in the corresponding groups, and the treatment duration was 3 months. After treatment, all the patients were detected in（1）NYHA cardiac functional grading; （2）interventricular septal thickness （IVST） and posterior wall thickness （PWT） in diastolic phase through echocardiogram, myocardium weight of left ventricular by Devereux formula, left ventricular mass index （LVMI） corrected by body surface area, and degree of LVH;（3）the level of plasma angiotensin Ⅱ （Ang Ⅱ ） by radioactive immunoassay. MAIN OUTCOME MEASURES： NYHA cardiac functional grading, echocardiogram （IVST, PWT, LVMI, degree of LVH）, the level of plasma Ang Ⅱ. RESULTS： All 20 adopted patients entered the result analysis.（1）The classification of NYHA cardiac functional grading （ Ⅰ , Ⅱ ,Ⅲ,Ⅳ） were respectively 2, 5, 3, 0 case in Lujiao prescription group and 2, 4, 4, 0 case in Digoxin group after treatment, and difference was significant compared with those before treatment （0, 0, 7, 3, P 〈 0.05）.（2）IVST, PWT and LVMI of Lujiao prescription group were obviously decreased after treatment [（11.20±0.42）, （12.10±0.32）mm, P 〈 0.01; （10.60±0.84）, （11.40±1.10） mm, P 〈 0.01; （139.4±12.4）, （155.3±15.4） g/m^2, P 〈 0.01], while those of the Digoxin group were untouched （P 〉 0.05）. The degree of LVH of Lujiao prescription group after treatment was obviously decreased [normal, mild, moderate, sever： 2, 6, 2, 0; 0, 3, 4, 3, P 〈 0.01], while that of the Digoxin group was not obviously decreased （P 〉 0.05）.（3）The level of plasma Ang Ⅱ in the Lujiao prescription group was obviously decreased [（97.7 ±19.5）, （144.0±18.5） ng/L, P 〈 0.01], while that of the Digoxin group was not obviously increased （P 〉 0.05）. CONCLUSION： Lujiao prescription can reverse or relieve the degree of LVH in patients with CHF.