真武汤合苓桂术甘汤联合西医常规疗法治疗老年心功能衰竭临床研究

Clinical study of Zhenwu decoction combined with Linggui-Zhugan decoction combined with western medicine in the treatment of senile heart failure

目的 观察真武汤合并苓桂术甘汤加减联合西医常规疗法治疗老年心功能衰竭患者的疗效.方法 将符合入选标准的123例心功能衰竭患者采用随机数字表法分为3组,每组41例.对照组采用西医常规疗法治疗,真武汤组在对照组基础上加用真武汤,合方组在对照组基础上加用真武汤合苓桂术甘汤.3组均治疗8周,随访1个月.分别于治疗前后采用放射免疫分析法检测脑钠肽（brain natriuretic peptide,BNP）、N端B型利钠肽原（nt-proBNP）,采用ELISA法检测TGF-？1,采用心脏超声检测仪检测左心室射血分数（left ventricular ejection fraction,LVEF）;比较3组治疗前后中医症状、体征积分,评价临床疗效.结果 治疗后8周,合方组心悸[（0.68±0.53）分比（0.79±0.64）分、（1.12±0.70）分,F=7.207]、胸闷[（0.66±0.52）分比（0.79±0.60）分、（1.36±0.70）分,F=6.367]、浮肿[（0.32±0.31）分比（0.43±0.41）分、（0.52±0.37）分,F=7.054]、喘息[（0.62±0.55）分比（0.82±0.69）分、（0.88±0.68）分,F=6.634]、乏力[（0.73±0.47）分比（0.94±0.62）分、（1.49±0.58）分,F=5.832]、自汗[（0.46±0.39）分比（0.89±0.62）分、（0.99±0.79）分,F=7.207]、眠差[（0.42±0.39）分比（0.74±0.50）分、（0.79±0.58）分,F=6.672]评分均低于真武汤组与对照组（P〈0.05）;血清TGF-？1[（102.75±15.79）ng/L比（121.57±19.25）ng/L、（184.35±23.74）ng/L,F=160.776]水平低于真武汤组与对照组（P〈0.01）.合方组总有效率为81.8%（27/33）、真武汤组为78.1%（25/32）、对照组为62.16%（23/37）,3组比较差异有统计学意义（χ2=7.089,P=0.037）.结论 真武汤合苓桂术甘汤联合西医常规疗法可改善老年心功能衰竭患者的症状、体征,降低血清TGF-？1水平.

Objective To observe the clinical effect of Zhenwu decoction combined with Linggui-Zhugan decoction on senile patients with heart failure. Methods A total of 123 patients with heart failure who met the inclusion criteria were randomly divided into 3 groups by random number table method, each group of 41 cases. The patients in the control group were treated with routine western medicine, Zhenwu decoction group was treated with Zhenwu decoction on the basis of the control group treatment, and the combined decoction group was treated with Zhenwu and Linggui-Zhugan decoction on the basis of the control group. The treatment last 4 weeks as 1 course, 2 courses in total. The TCM syndrome score, left ventricular ejection fraction, brain natriuretic peptide level, nt-probnp level and TGF-？1 level were observed, and the clinical effect was evaluated. Results After 8 weeks treatment, Palpitation （0.68 ± 0.53 vs. 0.79 ± 0.64, 1.12 ± 0.70, F=7.207）, chest distress （0.66 ± 0.52 vs. 0.79 ± 0.60, 1.36 ± 0.70, F=6.367）, edema （0.32 ± 0.31 vs. 0.43 ± 0.41, 0.52 ± 0.37, F=7.054）, wheezing （0.62 ± 0.55 vs. 0.82 ± 0.69, 0.88 ± 0.68, F=6.634）, fatigue （0.73 ± 0.47 vs. 0.94 ± 0.62, 1.49 ± 0.58, F=5.832）, spontaneous sweat （0.46 ± 0.39 vs. 0.89 ± 0.62, 0.99 ± 0.79, F=7.207）, insomnia （0.42 ± 0.39 vs. 0.74 ± 0.50, 0.79 ± 0.58, F=6.672） in the combination group were significantly lowere than those in the other two groups （P〈0.05）. The TGF-？1 （102.75 ± 15.79 ng/L vs. 121.57 ± 19.25 ng/L, 184.35 ± 23.74 ng/L, F=160.776） in the combination group was significantly lowere than that in the other two groups （P〈0.01）. The total effective rate was 81.8% （27/33） in the combination group, 78.1% （25/32） in the Zhenwu group, and 62.16% （23/37） in the control group. The the difference of total effective rates among three groups were statistically significant （χ2=7.089, P=0.037 ）. Conclusions The Zhenwu decoction and Linggui-Zhugan decoction combined with the routine therapy can improve the symptoms and signs of elderly patients with heart failure, and reduce the serum TGF-1 level.