芪苈强心胶囊联合西药常规对慢性心力衰竭患者心室重构及相关免疫指标的影响

Effects of Qiliqiangxin capsule combined with conventional western medicines on ventricular remodeling and related immune indexes of patients with chronic congestive heart failure

目的观察芪苈强心胶囊联合西药常规对慢性心力衰竭患者心室重构及相关免疫指标的影响。方法60例慢性心力衰竭患者随机分为对照组和治疗组,每组30例。对照组给予强心、利尿、扩血管等常规的西药对症治疗,治疗组在常规西药治疗的基础上加用芪苈强心胶囊治疗。2组均治疗4周后观察临床疗效,采用三维心脏多普勒检测2组治疗前后左心室射血分数(LVEF)、左心室收缩末内径(LVESD)、左心室舒张末内径(LVEDD)、左心室舒张末容积(LVDD)及舒张功能指数(E/F)的变化,观察2组治疗前后血浆N-端脑钠肽前体(NT-pro BNP)水平、6 min步行试验(6 MWT)及总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)变化。采用流式细胞仪检测淋巴细胞亚群CD_3^+、CD_4^+、CD_8^+、CD_4^+/CD_8^+、NK细胞,同时使用酶联免疫吸附法(ELISA)检测治疗前后免疫球蛋白G(Ig G)。结果治疗组总有效率86.7%,对照组总有效率56.7%,差异有统计学意义(P<0.05)。2组治疗后LVEF、LVESD及E/F与治疗前比较差异均有统计学意义(P<0.05),治疗组改善优于对照组(P<0.05)。2组治疗前后LVEDD组内及组间比较差异均无统计学意义(P>0.05)。2组治疗后NT-pro BNP水平均降低,6 MWT均升高,与治疗前比较差异均有统计学意义(P<0.05),且治疗组降低NT-pro BNP水平、升高6 MWT均优于对照组(P<0.05)。2组治疗前后TC、TG、LDL-C及HDL-C水平与治疗前比较差异均无统计学意义(P>0.05),且2组治疗后组间比较差异均无统计学意义(P>0.05)。2组治疗前后CD_3^+水平组间、组内比较差异均无统计学意义(P>0.05),2组治疗后CD_4^+、CD_8^+、CD_4^+/CD_8^+、NK细胞及Ig G水平与治疗前比较差异均有统计学意义(P<0.05),且治疗组治疗后CD_4^+细胞亚群NK细胞及Ig G水平显著高于对照组(P<0.05)。结论芪苈强心胶囊治疗慢性心力衰竭疗效确切,可能与其改善患者心室重构及相关免疫指标有关。

Objective To observe the effects of Qiliqiangxin capsule combined with conventional western medicines on ventricular remodeling and related immune indexes of patients with chronic congestive heart failure（ CHF）. Methods Sixty patients with CHF were randomly divided into control group and observation group,with 30 patients in each group. The patients in control group were treated by routine western medicines,however,the patients in observation group,on the basis of control group,were treated by Qiliqiangxin capsule,with a treatment course of 4 weeks for both groups. Then the changes of left ventricular ejection fraction（ LVEF）,left ventricular end systolic diameter（ LVESD）,left ventricular end diastolic diameter（ LVEDD）,left ventricular end diastolic volume（ LVDD） and diastolic function index（ E/F） were detected by threedimensional Doppler before and after treatment in both groups,moreover,the changes of levels of nitrogen plasma pro brain natriuretic peptide（ NT-pro BNP）,6-min walk test（ 6 MWT） and total cholesterol（ TC）,triglyceride（ TG）,high density lipoprotein cholesterol（ HDL-C）,low density lipoprotein cholesterol（ LDL-C） and the changes of immune function were observed and compared between two groups,and the immune indexes including CD3,CD4,CD8,CD4/CD8 and NK cells were detected by flow cytometry,besides the changes of immunoglobulin G（ Ig G） levels were measured by enzyme-linked immunosorbent assay（ ELISA） before and after treatment for both groups. Results The total effective rate in observation group was 86. 7%,which was significantly higher than that（ 5 6. 7 %） in control group（ P〈0. 0 5）.After treatment the levels of LVEF,LVESD,E/F were obviously improved in both groups,moreover,the improvement degree in observation group was superior to that in control group（ P〈0. 05）. However there was no significant difference in LVEDD between two groups before and after treatment（ P〈0. 0 5）.After treatment the levels of NT-pro BNP were decreased in both groups,and 6 MWT was increased,as compared with those before treatment（ P〈0. 05）. However there were no significant differences in the levels of TC,TG,LDL-C,HDL-C in both groups before and after treatment（ P〈0. 05）. There were no significant differences in the levels of CD3^＋ in both groups before and after treatment（ P〈0. 05）,however,there were significant differences in the levels of CD4^＋,CD8^＋,CD4^＋/CD8^＋,NK cells and Ig G in observation group or in control group after treatment,as compared with those before treatment（ P〈0. 05）,moreover,after treatment the levels of CD4^＋,NK cells and Ig G in observation group were significantly higher than those in control group（ P〈0. 05）. Conclusion Qiliqiangxin capsule has definite therapeutic effects on chronic heart failure,which may be related with the improvement of ventricular remodeling and related immune indexes of patients.