中医交通心肾法延缓心肾综合征急性恶化的机制探讨

Acute Exacerbation of Cardiorenal Syndrome Postponed by Restoring Normal Coordination between Heart and Kidney

目的探讨交通心肾法代表方复方交泰汤延缓心肾综合征(cardiorenal syndrome,CRS)急性恶化的机制。方法将60例CRS患者随机分为治疗组和对照组,给予规范的西药治疗,治疗组加用复方交泰汤煎剂,疗程14d±3d。观察两组患者心肾功能、肾素-血管紧张素-醛固酮系统(RAAS)指标、超敏C反应蛋白(hs-CRP)的变化。结果两组治疗后纽约心脏病协会(NYHA)心功能分级较治疗前明显改善(P<0.01);治疗组治疗后B型脑钠肽(NT-proBNP)明显下降(P<0.01);对照组治疗后血肌酐(Cr)、尿素氮(BUN)较治疗前明显升高(P<0.05),治疗组治疗后BUN有所下降(P<0.05);治疗组治疗后血红蛋白(Hb)较治疗前下降(P<0.01);两组治疗后血胱氨酸蛋白酶抑制物C(Cys-C)较治疗前均有下降(P<0.05或P<0.01);治疗组尿微量白蛋白(mALB)、尿肾损伤分子-1(Kim-1)呈现下降趋势(P<0.01);治疗组中医证候疗效优于对照组,差异有统计学意义(P<0.05);治疗组治疗后醛固酮(ALD)、hs-CRP明显下降,与治疗前比较差异有统计学意义(P<0.05)。结论交通心肾法代表方复方交泰汤能延缓心、肾功能恶化,其可能机制是对抗RAAS过度激活和机体炎症反应。

Objective To study the mechanism for postponing the acute exacerbation of cardiorenal syndrome by Fufang Jiaotai decoction based on restoring normal coordination between heart and kidney. Methods Sixty patients were randomly divided into control group treated with specification western medicine and treatment group treated with traditional Chinese medicine, Fufang Jiaotai decoc- iton. Heart and kidney function,RAAS and hs - CRP were observed after treatment for 14_＋ 3 days. Results NYHA were improved after treatment in two group patients. It was significantly different compared with that before treatment （P^0.01）. The level of NT- proBNP in treatment group was obviously decreased after treatment （P〈0.01）. There were no significant difference for EF in two group before and after treated （P〉0.05）. The levels of Cr and BUN in control group were increased after treatment and had significant difference with those before treatment （P〈0. 05）. The level of BUN in treatment group was lower than that in control group （P〈 0.05）. HB in treatment group was decreased after treatment （P〈0.05 or P〈0.01）. The level of Cys -C in two group were de- creased after treatment,and that in treatment group had obviously significant difference compared with that before treatment （P〈0. 01）. The level of Cys - C in treatment group was lower than that in control group （P%0.05）. The level of mALB and Kim - 1 displayed a decreasing trend compared with that in control group （P=0.06,P=0.07 respectively）. Chinese medicine syndrome therapy effect in treatment group was better than that in control group （P%0.05）. The level of ALD and bs - CRP in treatment group after treatment were lower than those before treatment （P^0.05）. Conclusion Fufang Jiaotai decoction could postpone the exacerbation of heart and kidney function,which might play role by antagonising the overactivation of RAAS and inflammation response of body.