稳心颗粒联合倍他乐克对冠状动脉粥样硬化性心脏病心力衰竭合并室性早搏患者血浆N-末端B型利钠肽原水平的影响

Effect of Wenxin Granule Combined with Betaloc on Plasma NT-proBNP Level in Patients with Coronary Heart Failure and Ventricular Failure

目的:观察稳心颗粒联合倍他乐克对冠状动脉粥样硬化性心脏病心力衰竭合并室性早搏患者的临床疗效及对血浆N-末端B型利钠肽原(N-terminal pro-B-type natriuretic peptide,NT-proBNP)水平的影响。方法:选取80例冠状动脉粥样硬化性心脏病心力衰竭合并室性早搏患者,随机分为观察组与对照组,各40例。两组患者均行常规西医治疗,对照组患者加用倍他乐克,观察组在对照组基础上服用稳心颗粒治疗,两组均连续治疗3个月,比较治疗前后两组患者心脏功能指标及NYHA心功能分级、血浆NT-proBNP及血管紧张素Ⅱ(angiotensinⅡ,AngⅡ)水平、中医证候积分、心电图QT间期离散度(QT dispersion,QTd)和JT间期离散度(JT dispersion,JTd)。结果:两组患者治疗前后左室射血分数、左室收缩末期内径、左室舒张末期内径、E峰与A峰比值E/A、6分钟步行试验差异显著,且治疗后观察组优于对照组,差异具有统计学意义(P<0.05);两组患者治疗前后NYHA心功能分级为Ⅱ级、Ⅲ级、Ⅳ级人数比较,差异有统计学意义(P<0.05),治疗后观察组Ⅱ级、Ⅲ级、Ⅳ级人数分别为31例、7例、2例,对照组Ⅱ级、Ⅲ级、Ⅳ级人数分别为26例、10例、4例,两组比较,差异有统计学意义(P<0.05);两组患者治疗前后血浆NT-proBNP、AngⅡ水平差异显著,且治疗后观察组分别为(312.65±67.75)ng·L^(-1)、(248.67±53.66)ng·L^(-1),低于对照组的(369.77±78.54)ng·L^(-1)、(297.73±60.32)ng·L^(-1),两组比较,差异有统计学意义(P<0.05);两组患者治疗前后舌质、舌苔、脉象中医证候积分比较,差异无统计学意义(P>0.05),心悸、气喘、气短、下肢水肿、畏寒肢冷、口唇紫绀等中医证候积分比较,差异显著,且治疗后观察组显著低于对照组,差异有统计学意义(P<0.05);两组患者治疗前后QTd、JTd差异显著,且治疗后观察组显著低于对照组,差异有统计学意义(P<0.05)。结论:稳心颗粒联合倍他乐克能显著降低冠状动脉粥样硬化性心脏病心力衰竭合并室性早搏患者NT-proBNP、AngⅡ水平,改善心脏功能,在缓解临床症状的同时缩短QTd、JTd,改善室性早搏。

Objective： To investigate the effect of Wenxin Granule combined with Betaloc on coronary heart disease,heart failure complicated with ventricular premature beat,and the influence of the level of plasma N-terminal type B natriuretic peptide(NTproBNP）,and to provide theoretical basis for the treatment of coronary heart disease and heart failure with integrated traditional Chinese and Western medicine. Methods： 80 patients treated in our hospital with coronary heart disease and ventricular premature beats from May 2015 to May 2017 were randomly divided into two groups： the observation group and the control group. The two groups were treated with conventional basic treatment. The control group was also given betaloc,and the observation group was also given Wenxin Granule and Betaloc. The levels of plasma NT-proBNP,angiotensinⅡ(AngⅡ）,TCM syndrome score,QT dispersion(QTd） and JT dispersion(JTd） between the two groups before and after treatment for 3 months were compared. Results： Left ventricular ejection fraction(LVEF）,left ventricular end-diastolic diameter(LVESD）,left ventricular end diastolic diameter(LVEDD）,E/A,and 6-minute walking test(6 MWT） were significantly different between the two groups before and after treatment,and the difference between the control group was statistically significant(P 〈 0. 05）. There was significant difference in the proportion of NYHA grade,Ⅲ and Ⅳ between the two groups before and after treatment,and there was significant difference between the observation group and the control group(P 〈 0. 05）. The levels of plasma NT-proBNP and AngⅡwere significantly different between the two groups before and after treatment,and the difference was statistically significant(P 〈 0. 05）. There was no significant difference in tongue texture,tongue coating and pulse condition between the two groups(P 〉 0. 05）. The difference of palpitations,asthma,shortness of breath,lower extremity edema,aversion to cold,lips cyanosis in observation group was significantly lower than the control group. The difference was statistically significant after treatment(P 〈 0. 05）. There was significant difference between QTd and JTd before and after treatment,and those of the observation group was significantly lower than those of the control group after treatment(P 〈 0. 05）. Conclusion： Wenxin granules combined with metoprolol can significantly reduce the levels of NT-proBNP and Ang Ⅱ in patients with coronary heart disease and heart failure,improve heart function,relieve clinical symptoms while shortening JTd and improve ventricular premature beats.