针灸联合益气活血方对早期糖尿病心肌病气阴两虚兼血瘀型病人心功能、心肌酶谱及血流动力学的影响

The Influence of Acupuncture and Yiqi Huoxue Decoction on Heart Function,Myocardial Enzyme and Hemodynamics in Patients with Early Diabetic Cardiomyopathy and Qi-yin deficiency and Blood-stasis Syndrome

目的观察针灸联合益气活血方对气阴两虚兼血瘀型早期糖尿病心肌病病人心功能、心肌酶谱及血流动力学的影响。方法将88例纳入病例随机分为观察组(46例)和对照组(42例),对照组在常规干预同时给予益气活血方治疗,观察组在对照组基础上给予针灸治疗。治疗4周,观察两组左室舒张期内径(LVEDD)、左室射血分数(LVEF)、左室收缩末期内径(LVESD)及二尖瓣E峰和A峰比值(E/A),乳酸脱氢酶(LDH)、谷草转氨酶(AST)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)及两室或两大血管间压力阶差(ΔP)、肺循环血流量/体循环血流量(QP/QS)、每博指数(SI)、心脏指数(CI)的变化。结果 1治疗后,两组LVEF、E/A明显上升而LVEDD、LVESD明显下降(P<0.05),观察组变化幅度大于对照组,两组各指标同时间点比较差异有统计学意义(P<0.05);2治疗后,两组LDH、AST、CK、CK-MB均明显下降(P>0.05),观察组降幅大于对照组,两组各指标同时间点比较差异均有统计学意义(P<0.05);3治疗后,两组ΔP、SI、CI明显上升而QP/QS明显下降(P<0.05),观察组变化幅度大于对照组,两组各指标同时间点比较差异有统计学意义(P<0.05)。结论针灸联合益气活血方治疗气阴两虚兼血瘀型早期糖尿病心肌病,能有效保护心肌组织及改善心功能、血流动力学。

Objective To observe the effects of acupuncture and Yiqi Huoxue decoction（ YHD） on heart function,myocardial enzyme and hemodynamics in patients with early diabetic cardiomyopathy and qi-yin deficiency and blood-stasis syndrome. Methods Eighty-eight patients with early diabetic cardiomyopathy and qi-yin deficiency and blood-stasis syndrome were randomly divided into two groups： control group（ n= 42） treated with routine treatment plus YHD,and treatment group（ n = 46） treated with routine treatment plus YHD and acupuncture for4 weeks. The left ventricular ejection fraction（ LVEF）,left ventricular end diastolic diameter（ LVEDD）,left ventricular end-systolic diameter（ LVESD）,E / A ratio were observed. The lactate dehydrogenase（ LDH）,aspartate aminotransferase（ AST）,creatine kinase（ CK）,creatine kinase-MB（ CK-MB） were tested. The hemodynamics including ΔP,Qp / Qs ratio,stroke index（ SI）,cardiac index（ CI） were observed. Results After treatment,LVEF,E / A increased while LVEDD,LVESD decreased in two groups（ P〈 0. 05）,which was improved more significantly in treatment group than that of control group（ P〈 0.05）. LDH,AST,CK,CK-MB levels decreased in two groups（ P〈 0.05）,which was lower in treatment group than that in control group（ P〈 0.05）. ΔP,SI,CI increased while QP / QS decreased in two groups（ P〈 0.05）,which was improved more significantly in treatment group than that of control group（ P〈 0.05）. Conclusion Acupuncture and YHD has the cardioprotection,improve cardiac function and hemodynamics in patients with early diabetic cardiomyopathy and qi-yin deficiency and blood-stasis syndrome.