鹿角方治疗慢性心力衰竭合并肾功能不全(心肾阳虚证)的临床疗效

Clinical Observation on Lujiao Decoction for the Treatment of Chronic Heart Failure with Chronic Renal Dysfunction and Heart-kidney Yang Deficiency Syndrome

目的观察鹿角方对慢性心力衰竭合并肾功能不全(心肾阳虚证)患者的临床疗效。方法入选慢性心力衰竭合并肾功能不全(心肾阳虚型)患者45例,随机分为治疗组和对照组,随访1个月。观察鹿角方干预前后临床疗效、心功能分级、相关生化指标血浆脑利钠肽[血浆脑利纳肽(BNP)、血管紧张素Ⅱ(ATⅡ)、肾素(PRA)、醛固酮(ALD)、尿酸(UA)、血清肌酐(Scr)、肌酐清除率(Ccr)]及左心功能指标[左室射血分数(LVEF)、舒张期室间隔厚度(IVSTd)、舒张期左室厚度(PWT)、左室收缩末内径(LVESD)、左室舒张末内径(LVEDD)]的变化情况。结果治疗后,治疗组和对照组中医证候总有效率分别为81.82%和52.17%,治疗组在改善中医症候方面疗效优于对照组(P<0.05)。两组治疗前后心功能分级有效率无统计学意义(P>0.05)。治疗组治疗后血浆BNP水平明显改善(P<0.01);且治疗组治疗后血浆BNP改善水平明显优于对照组(P<0.05)。治疗组治疗后血浆Ccr水平明显下降(P<0.05);且治疗组经治疗后血浆Ccr下降水平明显优于对照组(P<0.01);两组治疗前后Scr、UA水平差异无统计学意义(P>0.05)。治疗组治疗后PRA、ATⅡ水平明显改善(P<0.05);且治疗组经治疗后PRA、ATⅡ改善水平明显优于对照组(P<0.05);两组治疗前后ALD水平差异无统计学意义(P>0.05)。治疗组治疗后LVEF水平明显改善(P<0.01);且治疗组治疗后LVEF改善水平明显优于对照组(P<0.01);两组治疗前后IVSTd、PWT、LVESD、LVEDD水平差异无统计学意义(P>0.05)。结论鹿角方能有效改善慢性心力衰竭合并肾功能不全(心肾阳虚证)患者的心肾功能。

Objective To observe the clinical efficacy of Lujiao decoction（LJD）in chronic heart failure （CHF）patients with chronic re-nal dysfunction （CRD）and heart kidney yang deficiency syndrome.Methods Forty five CHF patients with CRD and heart kid-ney yang deficiency syndrome were randomly divided into the control group and the treatment group.After one month,the clinical ef-ficiency,heart function classification,relative biochemical marks and the left ventricle function were observed.Results After treat-ment,the total effective rate of syndromes were 81.82% in treatment group and 52.17% in control group,respectively.The clinical efficiency in treatment group was better than that in control group（P〈0.05）.The heart function classification showed no difference between two groups （P〉0.05）.The level of the plasma BNP was very significantly improved after treatment（P〈0.01）.Compared with the control group,the level of the plasma BNP in treatment group was significantly improved（P〈0.05）.The level of Ccr was significantly decreased after treatment（P〈0.05）.Compared with the control group,the level of Ccr in treatment group was very significantly improved（P〈0.01）.There was no improvement in serum UA,Scr levels（P〉0.05）.The level of serum PRA and ser-um ATⅡwas obviously improved after treatment（P〈0.05）.Compared with the control group,the level of serum PRA and serum ATⅡin treatment group was significantly improved（P〈0.05）.There was no great improvement in the level of serum ALD（P〉0.05）.The level of the LVEF was obviously improved after treatment（P〈0.01）.Compared with the control group,the LVEF level was significantly elevated in the treatment group （P〈0.01）.Conclusion LJD could improve heart and kidney function in CHF pa-tients with CRD and heart kidney yang deficiency syndrome.