不同治法对阳虚型慢性心力衰竭患者心功能及红细胞体积分布宽度的影响

Effects of different traditional Chinese medicine therapeutic methods on heart function and red cell volume distribution width in patients with chronic heart failure accompanied by yang deficiency syndrome

目的：观察不同中医治疗方法对慢性心力衰竭（CHF）患者心功能、红细胞体积分布宽度（RDW）的影响。方法采用前瞻性、随机、盲法、对照研究方法，选择成都市第一人民医院心血管内科收治的阳虚型CHF患者190例，按随机信封方法分为对照组、温阳组、滋阴组、活血组、复合组（温阳益气兼滋阴组），每组38例，排除不符合入组条件者及失访者，最终入选：对照组37例，温阳组36例，滋阴组36例，活血组37例，复合组37例。各组均按CHF治疗指南给予基础治疗，在此基础上对照组给予安慰剂口服液，温阳组加用温阳健心灵口服液（主要成分：制附片、黄芪、川芎、淫羊藿、香加皮、葶苈子、红参），滋阴组加用麦冬知母口服液（主要成分：麦冬、知母），活血组加用丹参川芎口服液（主要成分：丹参、川芎），复合组加用阴阳双补健心灵口服液（主要成分：制附片、黄芪、川芎、淫羊藿、香加皮、葶苈子、红参、麦冬、知母），各10 mL，每日3次，疗程1年。再将患者按照预后分为存活组168例、死亡组15例。观察各组患者因心衰加重、急性心肌梗死（AMI）、心绞痛、中风等再次住院情况、心功能相关指标、血红蛋白（Hb）、RDW的变化，并比较不同预后患者Hb、RDW水平。结果活血组再入院率明显低于对照组〔27.03%（10/37）比54.05%（20/37），P＜0.05〕，其余各组比较差异均无统计学意义（均P＞0.05）。各组治疗前左室射血分数（LVEF）、左室短轴缩短率（FS）、舒张早期前向血流峰值速度/舒张晚期前向血流速度（E/A）、E峰减速时间（DT）比较差异均无统计学意义（均P＞0.05）；治疗后活血组、复合组上述各指标均较治疗前明显增加，且均较同期对照组明显增加〔LVEF：0.453±0.131、0.448±0.104比0.394±0.112，FS：（27.9±9.8）%、（27.0±11.5）%比（22.2±13.3）%，E/A：0.88±0.16、0.92±0.20比0.75±0.27， DT（ms）：265.4±30.3、251.4±37.5比225.7±35.4，均P＜0.05〕，温阳组FS、DT较治疗前明显增加〔FS：（26.4±10.3）%比（19.7±7.4）%，DT：242.0±38.7比216.3±50.9，均P＜0.05〕；活血组治疗后RDW较治疗前升高，但均明显低于对照组和滋阴组〔（12.98±2.97）%比（14.37±2.52）%、（13.05±2.36）%，均P＜0.05〕，其余各组Hb、RDW比较差异均无统计学意义（均P＞0.05）；死亡组和存活组Hb水平比较差异无统计学意义（P＞0.05），死亡组RDW明显高于存活组〔（14.39±2.17）%比（13.02±2.08）%，P＜0.05〕。结论 RDW与CHF患者预后有关，死亡组RDW高于存活组，活血化瘀法能降低CHF患者RDW，改善CHF心功能，减少再住院。

Objective To observe the effects of different traditional Chinese medicine therapeutic methods on heart function and red cell volume distribution width （RDW） in patients with chronic heart failure （CHF）. Methods A randomized, blinded and controlled study was conducted. One hundred and ninety patients with CHF accompanied by yang deficiency syndrome in Department of Cardiology of Chengdu Municipal First People＆#39;s Hospital were divided into five contrast groups according to randomized envelope method：namely control group, warming yang group, nourishing yin group, activating blood group and combined warming yang and nourishing yin therapeutic group （combined group）, each group being 38 cases. The patients not consistent with the criteria to enroll into the study and those lost contact were excluded from the study, thus the final total patients were 183 in number, including control 37, warming yang 36, nourishing yin 36, activating blood 37 and combined group 37 cases. All the cases were treated with routine medical therapy in accord to the guideline for CHF. In addition, placebo oral liquor was given to the control group, Wenyangjianxinling oral liquor （main ingredients：Aconiti Lateralis Radix Preparata, Astragali Radix, Chuanxiong Rhizoma, Epimedii Folium, Periplocae Cortex, Descurainiae Semen, Ginseng Radix et Rhizoma Rubra） was given to the warming yang group, Ophiopogonis Radix and Anemarrhenae Rhizoma oral liquor （main ingredients：Ophiopogonis Radix,Anemarrhenae Rhizoma） was taken by the nourishing yin group, Salviae Miltiorrhizae Radix and Chuanxiong Rhizoma oral liquor （main ingredients： Salviae Miltiorrhizae Radix, Chuanxiong Rhizoma） was administered by the activating blood group, and the main ingredients of oral liquors given to the warming yang and nourishing yin groups were assigned to the combined group, each group 10 mL, three times a day for one year. According to the prognosis, the patients were divided into survival group （168 cases） and death group （15 cases）. The re-hospitalization situations such as aggravation of heart failure, acute myocardial infarction, angina, stroke, etc. were observed. The changes of hemoglobin （Hb） and RDW in the survival and death groups were investigated and compared between them. Results Compared with the control group, the rate of re-hospitalization was significantly decreased in the activating blood group [27.03% （10/37） vs. 54.05%（20/37）, P〈0.05];there were no statistical significant differences among all the other groups （all P〉0.05）. Before treatment, the levels of left ventricular ejection fraction （LVEF）, fractional shortening （FS）, the ratio of early to late ventricular filling velocities （E/A ratio） and E deceleration time （DT） showed no significant differences among five groups （all P〉0.05）. Compared with the control group at the same period, the LVEF, FS, E/A and DT were significantly increased in activating blood group and combined group after the treatment [LVEF： 0.453±0.131, 0.448±0.104 vs. 0.394±0.112, FS：（27.9±9.8）%, （27.0±11.5）%vs. （22.2±13.3）%, E/A：0.88±0.16, 0.92±0.20 vs. 0.75±0.27, DT （ms）： 265.4±30.3, 251.4±37.5 vs. 225.7±35.4, all P 〈 0.05]. FS and DT were significantly increased in warming yang group after treatment [FS： （26.4±10.3）% vs. （19.7±7.4）%, DT： 242.0±38.7 vs. 216.3±50.9, both P 〈 0.05]. In the activating blood group, the level of RDW was elevated after treatment compared with that before treatment, but in the comparison with that in the control and nourishing yin groups, it was still obviously lower [（12.98±2.97）%vs. （14.37±2.52）%, （13.05±2.36）%, both P 〈 0.05]. The comparisons of Hb and RDW among other groups had no statistical significant differences （all P 〉 0.05）. The level of Hb in death and survival groups also had no statistical significant difference （P 〉 0.05）. The RDW of dead group was markedly higher than that of the survival group [（14.39±2.17）%vs. （13.02±2.08）%, P〈0.05]. Conclusion The level of RDW is related to the prognosis of CHF patients, the level of RDW in death group is higher than that in survival group, and the activating blood circulation and removing blood stasis therapy can decrease the level of RDW, reduce the rate of re-hospitalization and improve the heart function in CHF patients.