益气活血利水法对心力衰竭患者脑钠肽及超敏C-反应蛋白的影响

The effects of qi-tonifying and stasis-eliminating （益气活血利水） therapy on plasma levels of brain natriuretic peptide and hypersensitization C-reactive protein in patients with heart failure

目的观察中药养心汤加减对心力衰竭（心衰）患者急性期血中脑钠肽（BNP）、超敏C-反应蛋白（hs—CRP）含量变化的影响，证实益气活血利水法对心衰的临床疗效和作用机制。方法选择在本院住院的82例心衰患者，按随机数字表法分为中西医结合治疗组（治疗组）和西医治疗对照组（对照组）。对照组给予规范强心、利尿、抗凝等药物治疗；治疗组在对照组规范治疗基础上加以益气活血利水方剂养心汤加减治疗。观察两组治疗前后心功能、中医证候、BNP、hs—CRP的变化。结果心功能分级（NYHA）疗效：治疗组显效32例，好转9例；对照组显效15例，好转26例；治疗组疗效好于对照组（x2=14．406，P〈0.01）。中医证候疗效：治疗组显效26例，好转15例；对照组显效14例，好转27例；治疗组疗效好于对照组（X2=7．029，P〈0.01）。两组治疗后BNP、hs—CRP、左室射血分数（LVEF）、中医证候积分均较治疗前明显改善，且以治疗组BNP、中医证候积分改善明显（均P〈0．01）。结论益气活血利水方剂可以明显降低心衰患者血中BNP、hs—CRP，改善心功能，提高生活质量。

Objective To investigate the effects of modified yang xin decoction （养心汤加减）, a traditional Chinese medicine （TCM）, on plasma levels of brain natriuretic peptide （BNP） and hypersensitization C-reactive protein （hs-CRP） to demonstrate the clinical efficacy and mechanism of Qi-tonifying and stasis-eliminating （QTSE, 益气活血利水） therapy in patients with acute heart failure. Methods Eighty-two hospitalized patients with heart failure were randomly divided into combination group of traditional Chinese and western medicine and control group （each, n = 41）. In the control group, standard western medicine was used for treatment, while in the combination group, beside the treatment in the control group, additionally qi-tonifying and stasis-eliminating therapy （益气活血利水方齐） or modified yang xin decoction （养心汤加减） was applied. The changes of levels of plasma BNP and hs-CRP, heart function （NYI-IA） and TCM syndromes were observed before and after treatment in both groups. Results In the combination treatment group, 32 cases obtained significant therapeutic effect and 9 cases obtained improvement, while in the control group, 15 cases got significant therapeutic effect and 26 cases improvement in heart function （NYHA, ;（2= 14. 406, P〈0. 01）. In regard to the efficacy of TCM syndrome, there were 26 cases with excellent result and 15 cases with improvement, while in the control group, they were 14 and 27 cases respectively （x2 = 7. 029, P〈0. 01）. Therefore, the therapeutic effect of combination group was better than that of the control group. After treatment, the levees of BNP and hs-CRP, left ventricle election fraction （LVEF）and TCM syndrome integration scores were improved obviously in comparison to those before treatment. BNP and TCM syndrome integration scores in the combination treatment group were improved more significantly than those in the control group （both P〈0.01）. Conclusion QTSE therapy is effective for patients with heart failure and can significantly decrease the levels of BNP and hs-CRP,improve heart function and enhance the quality of life.