辨证使用参附、参麦注射液对扩张型心肌病心力衰竭患者6分钟步行试验、BNP、hsCRP的影响

Effects of dialectical use of Shenfu,Shenmai injection on 6-minute walk,B-type natriuretic peptide and high-sensitive C-creative protein in patients with heart failure by dilated cardiomyopathy

目的观察辨证使用参附、参麦注射液对扩张型心肌病心力衰竭患者心功能的影响。方法采用病例对照研究方法,将93例扩张型心肌病心衰患者分为3组,符合心阳亏虚型进入A组,在西医常规治疗基础上加用参附注射液。符合气阴两虚型进入B组,在西医常规治疗基础上加用参麦注射液。C组仅用西医常规抗心衰治疗。观察3组患者治疗前后血压、心率、6分钟步行试验、血B型脑钠肽(BNP)浓度、高敏C反应蛋白的变化。结果治疗2周后,A组、B组在控制血压与心率,降低B型脑钠肽与高敏C反应蛋白,改善6分钟步行试验方面明显优于C组,差异有统计学意义(P<0.05)。结论对扩张型心肌病心衰患者辨证联合使用参附、参麦注射液,可降低脑钠肽与高敏C反应蛋白,改善亚极量运动能力,有效改善心功能。可能机制为控制心率、调节心脏神经内分泌、增强心肌收缩力等。

Objective To observe the clinical efficacy on 6-minute walk, B-type natriuretic peptide, high-sensitive C-crea- tive protein of dialectical use of Shenfu Injection and Shenmai Injection in patients who have dilated cardiomyopathy （DCM） with heart failure. Methods Ninty-three cases of dilated cardiomyopathy patients with heart failure were divided into three groups. All patients received conventional western medicine treatment. Patients who had traditional Chinese medicine syndromes of deficiency of heart yang were divided into group A. Group A plus Shenfu Injection on the basis of above treatment. Patients who had traditional Chinese medicine syndromes of deficiency of qi-yin were divided into group B. Group B plus Shenmai Injection on the basis of above treatment. Group C only received conventional western medicine treatment. Before and after treatment, 6-minute walk, hem1 rate, blood pressure and B-type natriuretic peptide （ BNP）, high-sensitive C-creative protein（hsCRP） were observed. Results After 2 weeks, compared with group C, patients in treatment group A and B were benefited clinically, as shown by an improvement in blood pressure, heart rate, and 6-minute walk, B-type natriuretic peptide, high-sensitive C-creative protein （hsCRP）. Conclusion Shenfu Injection and Shenmai Injection produced clinical and hemodynamic improvement in patients who have heart failure with dilated cardiomyopathy, they improved submaximal exercise tolerance . Their possible mechanisms may be benifited by the control of heart rate, neuroendocrine regulation of the heart and enhanced myocardial contractility.