通心络胶囊对慢性心力衰竭患者神经内分泌系统及血管内皮功能的影响研究

Study on the effect of Tongxinluo capsule on neuroendocrine system and vascular endothelial function in patients with chronic heart failure

目的观察基于营卫"由络以通,交会生化"为指导的通心络胶囊对慢性心力衰竭患者神经内分泌系统及血管内皮功能的影响。方法将99例慢性心力衰竭患者随机分为2组,对照组44例给予常规治疗,治疗组55例在常规治疗基础上加服通心络胶囊,连续治疗12周。治疗前及治疗12周后心脏超声检测左心室舒张末内径(LVEDd)、左心室收缩末内径(LAESd)、左心室射血分数(LVEF)、心排血量(CO),计算短轴缩短率(FS);二维超声测量肱动脉舒张末期内径(D0)、反应性充血后肱动脉内径(D1)、未充血情况下肱动脉内径(D2),计算反应性充血前后和含服硝酸甘油前后肱动脉内径变化率(FMD和NED);取血检测血管内皮功能指标血浆内皮素(ET)、降钙素基因相关肽(CGRP)、血清一氧化氮(NO)水平和神经内分泌因子指标血浆B型利钠肽(BNP)、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)、血浆肾素(PRA)水平;观察2组治疗前后心功能分级变化情况。结果治疗后,2组心脏超声检查各项指标均较治疗前明显改善(P均<0.05),且治疗组LVEDd、LAESd均小于对照组(P均<0.05),LVEF、FS、CO均高于对照组(P均<0.05);2组FMD、NED及NO、CGRP水平均明显高于治疗前(P均<0.05),ET、AngⅡ、ALD、PRA、BNP水平均明显低于治疗前(P均<0.05),且治疗组上述各指标改善情况均明显优于对照组(P均<0.05);2组心功能等级均显著改善(P均<0.05),且治疗组改善情况优于对照组(P<0.05)。结论通心络胶囊具有多靶点、多方位、多层次的作用机制,同时也验证了慢性心力衰竭患者微血管损伤与神经内分泌功能的相关性,为揭示脉络学说营卫"由络以通,交会生化"理论及从保护"孙络-微血管"完整性角度治疗慢性心力衰竭提供了支持。

Objective It is to observe the effect of Tongxinluo capsule on the neuroendocrine system and vascular endothelial function in patients with chronic heart failure（CHF） based on ＂the network-mediated and biochemical＂.Methods 99 patients with CHF were randomly divided into two groups,the control group（n = 44） was given routine therapy,the treatment group（n = 55） was treated with Tongxinluo capsule for 12 weeks on the basis of therapy in control group.Cardiac ultrasound indexes（LVEDd,LAESd,left LVEF,CO） and vasodilation function indexes（D0,D1,D2,FMD and NED）,vascular endothelial function indexes（ET,CGRP,NO,BNP,AngⅡ,ALD,PRA） were detected before treatment and in 12 weeks after treatment in both groups.The changes of heart function classification before and after treatment was observed in both groups.Results After treatment,the cardiac ultrasound indexes were significantly improved in both groups compared with that before treatment（P〈0.05）,and LVEDd,LAESd were less while LVEF,FS CO were higher in treatment group than that in control group（P〈0.05）;the levels of FMD,NED and NO,CGRP were significantly higher while the levels of ET,angⅡ,ALD,PRA,BNP were lower than that before treatment in both groups（P〈0.05）,and the improvements of these indexes in treatment group were better than that in control group（P〈0.05）;heart function classification was significantly improved in both groups,and the improvement in treatment group was better than that in control group（P〈0.05）.Conclusion Tongxinluo capsule has the multi-target,multi-azimuth and multi-level mechanism of action,it also confirms the correlation between CHF microvascular injury and neuroendocrine function,which reveals the theory of ＂ network-mediated and biochemical＂ and provides the clinical support for the treatment of CHF from the point of view of protecting the integrity of Sun-collaterals microvasculature.