真武汤合保元汤对2型心肾综合征阳气亏虚证兼血瘀证心肾功能的影响

Effect of Zhenwutang Combined with Baoyuantang on Heart and Renal Function of Patients with Type 2 Cardiorenal Syndrome

目的：探讨真武汤合保元汤加味治疗2型心肾综合征（CRS）的临床疗效及血清一氧化氮（NO）,内皮素-1（ET-1）,白细胞介素-1（IL-1）,IL-6和肿瘤坏死因子-α（TNF-α）的影响。方法：将134例患者采用SPSS软件生成的区组,随机按数字表法分为对照组和观察组各67例。对照组服用厄贝沙坦片,0.15 g/次,1次/d;美托洛尔片,1.25 mg/次,2次/d;螺内酯片,20 mg/次,1次/d;氢氯噻嗪片25 mg/次,1次/d,地高辛片,0.125~0.25 mg·d^（-1）,必要时服用。观察组在对照组治疗的基础上给予真武汤合保元汤加味;两组疗程均为连续治疗3个月。记录治疗前后心功能指标心室射血分数（LVEF）,每搏输出量（SV）,N末端B型利钠肽原（NT-pro BNP）,6 min步行试验（6 MWT）,和肾功能指标血肌酐（Scr）,尿素氮（BUN）,血胱抑素C（CysC）,尿微量白蛋白（m ALB）,尿肾损伤分子-1（Kim-1）,并计算肾小球滤过率（eGFR）和尿微量白蛋白/肌酐（UACR）,进行治疗前后Lee氏心衰评分和中医证候评分。检测治疗前后NO,ET-1,IL-6,IL-1和TNF-α水平。结果：经Ridit分析,观察组患者临床综合疗效优于对照组（P〈0.05）;观察组NYHA分级评分和NT-pro BNP水平均低于对照组（P〈0.01）,6 MWT远于对照组（P〈0.01）,LVEF和SV均高于对照组（P〈0.05）;观察组Scr,BUN,CysC,m ALB,Kim-1和UACR水平均低于对照组（P〈0.01）;观察组eGFR较治疗前升高,并高于对照组（P〈0.01）;观察组患者Lee氏心衰评分和中医证候评分均低于对照组（P〈0.01）;观察组患者血清ET-1,hs-CRP,IL-1,IL-6和TNF-α水平均低于对照组,NO水平高于对照组（P〈0.01）。结论：在西医常规治疗的基础上,配合服用真武汤合保元汤加味治疗2型CRS患者,能改善患者的心肾功能,减轻临床症状,改善内皮功能障碍和慢性炎症状态,提高临床综合治疗效果。

Objective：To discuss the clinical efficacy of Zhenwutang combined with Baoyuantang on type2 cardio renal syndrome（CRS） and its effect on levels of serum nitric oxide（NO）,endothelin-1（ET-1）,interleukin-1（IL-1）,IL-6 and tumor necrosis factor-α（TNF-α）.Method：Totally 134 patients were randomly divided into control group（67 cases） and observation group（67 cases） by random number table.Patients in control group got irbesartan,0.15 g/tmie,1 time/day.Metoprolol tablet,1.25 mg/time,2 times/days.Spironolactone tablets,20 mg/time,1 time/day.Hydrochlorothiazide 25 mg/time,1 time/day.digoxin tablets,0.125-0.25 mg/day,when necessary.In addition to the therapy for control group,patients in observation group were also given Zhenwutang combined with Baoyuantang.The course of treatment was 3 months.Before and after treatment,cardiac function indexes,such as ventricular ejection fraction（LVEF）,stroke volume（SV）,N-natriuretic peptide（NT-pro BNP）,6-minute walking test（6 MWT） and renal function index such as serum creatinine（Scr）,urea nitrogen（BUN）,serum cystatin C（CysC）,urinary microscale albumin（m ALB）,urinary kidney injury molecule-1（Kim-1） were recorded,glomerular filtration rate（eGFR） and UACR were calculated,and Lee＇s heart failure and traditional Chinese medicine（TCM） syndromes were scored.And levels of NO,ET-1,IL-6,IL-1 and TNF-α were detected.Result：The clinical efficacy in observation group was superior to that in control group by Ridit（P 〈 0.05）.And NYHA score and levels of NT-pro BNP,Scr,BUN,CysC,m ALB,Kim-1 and UACR were lower than those in control group（P 〈 0.01）,6 MWT in observation group was longer than that in control group（P 〈 0.01）,and LVEF,SV and NO were higher than those in control group（P 〈 0.05）.Compared with before treatment,eGFR in observation group increased and was higher than that in control group（P 〈 0.01）.Scores of Lee＇s heart failure and TCM syndromes were lower than those in control group（P 〈 0.01）.And levels of ET-1,hs-CRP,IL-1,IL-6 and TNF-α were lower than those in control group（P 〈 0.01）.Conclusion：In addition to the routine western medicine therapy,Zhenwutang combined with Baoyuantang can improve heart function and renal function,relieve endothelial dysfunction and chronic inflammation,clinical symptoms,and improve the comprehensive treatment effect.