鹿角方治疗充血性心衰竭疗效观察

OBSERVATION ON THERAPEUTIC EFFECT OF LUJIAO PRESCRIPTION ON CONGESTIVE HEART FAILURE

目的 :进一步观察鹿角方治疗充血性心衰竭 (CHF)的临床疗效及其作用机制。方法 :将充血性心衰竭患者 6 0例随机分为鹿角方组 4 0例、地高辛组 2 0例 ,观察临床疗效、肾虚症状积分、NYHA心功能分级、Lee心衰评分、心率 (HR)、心肌耗氧量 (MOC)、心胸比例、超声心动图 (射血分数 (EF)、心输出量 (CO)、舒张期室间隔厚度 (IVST) ,舒张期左室后壁厚度 (PWT)、左室质量指数(LVMI) )、放射免疫法测定血浆心钠素 (ANF)、血管紧张素Ⅱ (AngⅡ )等指标。结果 :鹿角方组临床总有效率为 90 .0 % ,与地高辛组 (90 .0 % )无显著性差异 (P >0 .0 5 )。鹿角方组肾虚症状总积分显著下降 (P <0 .0 1) ,而地高辛组疗后未见显著改变 (P >0 .0 5 )。鹿角方组、地高辛组NYHA心功能分级均显著改善 (P <0 .0 1)。鹿角方组、地高辛组Lee心衰评分均显著改善 (P <0 .0 1)。鹿角方组、地高辛组HR、MOC均显著下降 (P <0 .0 1)。鹿角方组、地高辛组心胸比例均显著改善 (P <0 .0 1)。鹿角方组EF、CO、IVST、LVMI均显著改善 (P <0 .0 1) ;地高辛组EF、CO显著改善 (P <0 .0 1) ,而IVST、PWT、LVMI未见显著下降 (P >0 .0 5 )。鹿角方组血浆ANF和AngⅡ水平均显著下降 (P <0 .0 1) ;地高辛组仅血浆ANF水平显著下降 (P <0 .0 1) 。

Objective:To confirm the clinical effect of Lujiao prescription on congestive heart failure(CHF) and to elucidate its possible mechanism. Method: 60 cases of CHF were at random divided into Lujiao prescription group (40 cases) and digoxin group (20 cases). The total clinical effective rate, integrals of the symptoms of renal asthenia, classification of functional capacity of the New York Heart Association(NYHA), Lee score, heart rate(HR), myocardium oxygen consumption(MOC), the proportion of heart to chest, and echocardiogram (ejection fraction (EF), cardiac output (CO), interventricular septal thickness(IVST), posterior wall thickness(PWT), left ventricular mass index (LVMI))as well as the measurement of plasma angiotensin Ⅱ(AngⅡ) and plasma atrial natriuretic factor(ANF) in the patients were observed.Result:The total clinical effective rate of the Lujiao prescription group was 90.0%, which showed no significant difference from the digoxin group (90.0%,P>0.05). Improvement was significantly obsereved in the integrals of the symptoms of renal asthenia. It was found that classification of functional capacity of NYHA between Lujiao prescription group and digoxin group after treatment was obviously decreased (P<0.01). Lee score between Lujiao prescription group and digoxin group after treatment was decreased (P<0.01). Myocardium oxygen consumption between Lujiao prescription group and digoxin group after treatment was decreased (P<0.01).The proportion of heart to chest between Lujiao prescription group and digoxin group after treatment was decreased (P<0.01 ) . EFand CO was increased by Lujiao prescription and by digoxin (P<0.01, vs before treatment,respectively). IVST, PWT, LVMI of Lujiao prescription group after treatment were obviously decreased (P<0.01), while those of the digoxin group were not obviously decreased (P>0.05). The level of plasma AngⅡ in the Lujiao prescription group was obviously decreased (P<0.01), while that of the digoxin group was not obviously increased(P>0.05).The level of plasma ANF was decreased by Lujiao prescription and by digoxin (P<0.01,vs before treatment,respectively).Conclusion: There is increasing cardiac constriction power and regressing left ventricular hypertrophy of patients with CHF by Lujiao prescription. There is effect on CHF.The effect may be related to the regulation of circular or local endocrine (plasma AngⅡ and ANF)disorder.