益气温阳活血利水法治疗充血性心力衰竭的疗效及对胰岛素抵抗的影响研究

Effect and Influence on Insulin Resistance of Invigorating Qi and Warming Yang and Promoting Blood and Diuresis in the treatment of Congestive Heart Failure

目的:观察益气温阳、活血利水法治疗充血性心力衰竭的疗效及对胰岛素抵抗的影响。方法:选取2012年4月—2014年4月在我院接受治疗的80例充血性心力衰竭患者,按照就诊顺序将其随机分为两组,每组各40例。对照组给予强心、利尿等西医标准抗心力衰竭治疗,而观察组则在标准抗心力衰竭治疗的基础上给予中药益气温阳、活血利水法治疗,两组疗程均为4周。观察两组患者临床疗效,比较两组患者治疗前后空腹血糖(FBG)、空腹胰岛素(FINS)、左心室射血分数(LVEF)的检测结果,计算胰岛素抵抗评估指数(HOMA-IR)和胰岛素敏感指数(ISI)。结果:观察组总有效率92.50%,显著高于对照组的77.50%(P<0.05);两组患者治疗后FINS、HOMA-IR均较治疗前明显降低,而ISI较治疗前明显升高,差异均具有统计学意义(P<0.05)。而观察组患者治疗后FINS、HOMA-IR下降幅度及ISI的上升幅度显著高于对照组,且两组间比较差异具有统计学意义(P<0.05)。观察组和对照组治疗后LVEF分别为(54.69±7.28)%和(46.32±7.42)%,与治疗前的(41.73±6.87)%和(42.67±8.58)比较均明显升高,且观察组上升幅度显著高于对照组,差异具有统计学意义(P<0.05)。结论:益气温阳活血利水法治疗充血性心力衰竭疗效确切,可以有效缓解患者心衰症状,提高胰岛素敏感性,改善患者的胰岛素抵抗,具有较高的临床应用价值,值得大力推广和应用。

Objective ： To observe the effect and Influence on Insulin Resistance of Invigorating Qi and Warming Yang and Promoting Blood and Diuresis in the treatment of Congestive Heart Failure. Methods ： 80 cases of congestive heart fail- ure were randomly divided into study group with 40 cases and the control group with 40 cases. The control group were trea- ted by anti -heart failure and the study group were treated by Invigorating Qi and Warming Yang and Promoting Blood and Diuresis besides western medicine. The courses was 4 weeks. After the clinical treatment for 4 weeks, observed the clinical efficacy,fasting blood glucose （FBG）, fasting insulin （FINS）, left ventricular ejection fraction （LVEF） test re- suits, and evaluated index calculated insulin resistance （HOMA IR） and insulin sensitive index （ISI）. Results： The to- tal effectiveness of study group was 92.50%, was significantly higher than 77.50% in the control group （P 〈 0.05 ）. The FINS and HOMA - IR of two groups after treatment were significantly reduced, and the ISI of two groups were signifi- cantly improved, the differences were statistically significant （P 〈 0.05 ）. The reduction of FIN/HOMA - IR and increase of ISI of the study group were significantly higher than the control group （ P 〈 O. 05 ）. After treatment, LVEF of study group and control group respectively （54.69 ＋ 7.28 ） % and （46.32 _＋ 7.42） %, and were significantly increased before the treatment （41.73 -＋ 6.87） % and （42.67 ＋ 8.58 ） , and the increase of study group was significantly higher than control group, difference was statistical significance （ P 〈 O. 05 ）. Conclusion ： The therapeutic effect of Invigorating Qi and Warming Yang and Promoting Blood and Diuresis treatment of congestive heart failure is accurate, can effective im-prove ISI/IR, and is worth promoting and application.