参附注射液对缺血性心肌病合并心功能不全患者的临床疗效及其对炎性因子的影响

Effect of Shenfu injection on clinical efficacy and inflammatory factors in patients with ischemic cardiomyopathy complicated ventricular dysfunction

目的探讨参附注射液在缺血性心肌病合并心7功能不全治疗中的应用价值。方法选取北京安贞医院2009年10月至2012年12月诊断为缺血性心肌病合并左心功能不全的患者180例，按随机数字表法随机分为对照组和观察组，各90例。对照组常规予以阿司匹林、硝酸酯类、他汀类、利尿剂及血管紧张素转换酶抑制剂治疗；观察组在此基础上予以参附注射液50ml静脉滴注，每日1次；疗程均为15d。疗程结束后观察2组患者疗效分别于治疗前和治疗后取空腹静脉血，检测血浆脑钠肽（BNP）水平血清白细胞介素6（IL-6）和肿瘤坏死因子仪（TNF－α）水平。结果治疗后，2组患者症状均较治疗前改善，但观察组总有效率[91．1％（82／90）]明显高于对照组[80．0％（72／90）]（P〈0．05）。治疗后，2组患者BNP、IL-6和TNF-d水平均较治疗前明显降低[观察组：（332±78）ng／L比（985±123）ng／L、（73±11）ng／L比（102±10）ng／L、（2．8±0．3）μg／L比（5．1±0．7）μg／L，对照组：（554±89）．g／L比（978±83）ng／L、（83±8）ng／L比（100±10）ng／L、（4．0±0．5）μg/L比（5．2±0．9）μg／L]（均P〈0．01）；与观察组治疗后BNP、IL-6和TNF-α均明显降于对照组（均P〈0．05）。结论参附注射液联合给药能有效提高缺血性心肌病患者临床疗效，降低患者炎性因子水平。

Objective To observe the effect of Shenfu injection on clinical manifestations, left ventricular ejection fraction（LVEF） and inflammatory factors in patients with ischemic cardiomyopathy complicated ventricular dysfunction, and explore its possible clinical therapeutic value. Methods Totally 180 ischemic cardiomyopathy pa- tients complicated with ventricular dysfunction at Anzhen Hospital were enrolled. All the patients were randomly di- vided into two groups： control group（ n =90） and observation group（ n = 90）. Control group was treated with aspirin, nitrates, statin, diuretics and angiotensin converting enzyme inhibitor. Observation group was intravenously administered with Shenfu injection 50 ml once a day for 15 days. Before treatment and 15 days later, the changes of clinical manifestations and LVEF were investigated. The levesl of blood brain natriuretic peptide （BNP）, interleu- kin-6 （IL-6） and tumor necrosis factor-or （TNF-a） were examined. Results Fifteen days later, the clinical symp- toms of two groups were improved markedly. The total effective rates of observation group were higher than those of control group[ 91.1% （82/90） vs 80. 0% （72/90） ] （P 〈 0.05 ）. 15 days later, the levels of blood BNP, IL-6 and TNF-α of two groups were deceased [ observation group ： （332 ± 78 ） ng/L vs （985 ± 123 ） ng/L, （ 73 ± 11 ） ng/L vs （102 ± 10）ng/L, （2.8 ±0.3） μg/L vs （5.1 ±0.7）μg/L, control group： （554 ± 89）ng/L vs （978 ±83）ng/L, （83 ±8）ng/L vs （100~10）ng/L, （4.0±0.5）μg/L vs 5.2 ±0.9）μg/L] （all P〈0.01）. Compared with con- trol group, the blood level of BNP, IL-6 and TNF-ct were lower （ P 〈 0.05 ）. Conclusion Shenfu injection com- bined with aspirin, nitrates, statin, diuretics and ACEI can improve clinical manifestation and ventrieular function in ischemic cardiomyopathy patients complicated ventricular dysfunction and decrease inflammatory response.