益气通阳利水法对慢性心力衰竭患者B型钠尿肽水平及生存率的影响

Effect of Reinforcing Qi,Activating Yang and Inducing Diuresis Method on B-type Natriuretic Peptide and Survival Rate of Chronic Heart Failure Patients

目的研究益气通阳利水法对慢性心力衰竭患者血浆B型钠尿肽(BNP)水平及生存率的影响。方法采用随机、对照方法,将慢性心力衰竭心功能～级的151例患者分为治疗组和对照组,对照组采用标准心力衰竭治疗方案,治疗组在标准治疗基础上,加用益气通阳利水方药,每月随访1次,共21个月。观察患者生存率和血浆BNP水平。结果治疗组和对照组血浆BNP水平差异有显著性意义(P<0.01);两组起始血浆BNP水平接近(P>0.05),但对照组分别在随访的第4个月、第9个月、第13个月出现峰值大于1000ng/L的3次高峰期,而治疗组只在第4个月出现高峰,且峰值低于对照组,差异有显著性意义(P<0.01)。治疗组生存率明显高于对照组(P<0.05),且两组生存率下降期与BNP分泌高峰期一致,其中第1～4个月为心力衰竭患者死亡高发期。结论在标准治疗基础上配合益气通阳利水方药,可进一步降低心力衰竭患者的长期血浆BNP水平,并提高生存率。

Objective To observe the effect of reinforcing qi, activating yang and inducing diuresis method on B-type natriuretic peptide （BNP） and survival rate of chronic heart failure patients. Methods The 151 cases of chronic heart failure of Ⅲ-Ⅳ degree of cardiac function were randomized into treatment group and control group. The control group was treated with the standard plan for heart failure and the treatment group with standard plan plus the herbal formula based on the principle to reinforce qi, activate yang and induce diuresis. The follow-up was done once a month for totally 21 months to observe the survival rate and the level of BNP. Results The significant difference existed between the control and treatment group in BNP （P〈0.01）. At the beginning the level of BNP of two groups was almost the same. In the fourth, ninth, and thirteenth month, the level of BNP of control group reached to the peak, higher than 1000ng/L. But in the treatment group, the level of BNP reached to the peak only in the fourth month and the peak value was lower than that of control group. The difference was significant in statistics （P〈0.01）. The survival rate of treatment group was obviously higher than that of control group （P〈0.05）, and the descending of survival rate of two groups was in accordance with the peak stage of BNP secretion. The first to fourth month was the peak stage of death of heart failure patients. Conclusion The standard plan plus the herbal formula to reinforce qi, activate yang and induce diuresis can decrease further the level of BNP and raise the survival rate.