天王补心丹加减治疗心房颤动合并冠心病阴虚火旺证的临床观察

Clinical Efficacy of Tianwang Buxindan Treatment on Atrial Fibrillation Combined with Coronary Heart Disease with Yin Deficiency and Fire Prosperity

目的：探讨天王补心丹加减治疗心房颤动合并冠心病（阴虚火旺证）的临床疗效及抗炎作用机制。方法：将118例患者随机按数字表法以1：1比例分为对照组和观察组各59例。对照组口服华法林钠片，2．5-5mg·d-1次／d，监测国际标准化比值（INR）2．0-3．0；口服琥珀酸美托洛尔缓释片，23．75-47．5mg，1次／d；口服阿托伐他汀钙片，20mg·d-1次／晚。观察组在对照组治疗的基础加服天王补心丹加减，1剂／d。两组疗程均为连续治疗8周。进行治疗前后动态心电图和超声心动图检查[记录左室射血分数（LVEF），心输出量（CO），左室收缩末内径（LVESD）和每搏输出量（sV）]；进行心悸阴虚火旺证评分；检测治疗前后甘油三酯（TG），总胆固醇（TC），高密度脂蛋白（HDL—C）和低密度脂蛋白（LDL—C）水平；检测治疗前后N-末端B型利钠肽原（NT—proBNP），白细胞介素-6（IL-6），肿瘤坏死因子-d（TNF—a），c-反应蛋白（CRP）和单核细胞趋化蛋白-l（MCP-1）；进行治疗前后安全性评价。结果：经秩和检验，治疗后观察组动态心电图疗效优于对照组（P〈0．05）；治疗后观察组患者心室率少于对照组（P〈0．05）；观察组房颤伴发心电图异常情况少于对照组（X。=6．631，P〈0．05）；观察组心悸、失眠、烦躁、胸闷、胸痛等主要症状评分和次证评分及阴虚火旺证总分均低于对照组（P〈0．01）；观察组患者血脂异常例数少于对照组（z。=4．417，P〈0．05）；观察组患者LVEF，CO和sV均高于对照组（P〈0．05）；观察组患者NT-proBNP，IL-6，TNF-ol，CRP和MCP-l水平低于对照组（P〈0．01）。结论：在西医常规治疗的基础上，采用天王补心丹加减治疗冠心病合并房颤可控制心室率，减轻临床症状，调节脂代谢，改善心功能和抑制炎症反应，起到治疗房颤的作用。

[Abstract] Objective： To discuss the clinical efficacy of Tianwang Buxindan treatment to atrial fibrillation combined with coronary heart disease （Yin deficiency and fire prosperity） and investigate its mechanism of anti-inflammatory action. Method： One hundred and eighteen patients were randomly divided into control group and observation group by random number table at ratio of 1 ： 1,59 cases in each group. Patients in control group got warfarin sodium tablets, 2.5-5.0 mg/days, qd, with international normalized ratio （INR） monitoring for 2.0-3.0 times. Metoprolol succinate sustained-release tablets, 23.75-47.5 rag, qd, and atorvastatin calcium tablets, 20 mg/days, qd at night. Based on the treatment in control group, the patients in observation group added TianwangBuxindan treatment, 1 dose/day. The treatment course was 8 weeks for both groups. Before and after treatment, electrocardiogram and echocardiography examinations were conducted [ left ventricular ejection fraction （LVEF） , cardiac output （CO） , left ventricular end systolic diameter （LVESD） , and stroke volume （SV） were recorded]. Scores of Yin deficiency and fire prosperity were graded; levels of triglyceride （TG） , total cholesterol （TC）, high density lipoprotein （HDL-C）, low density lipoprotein （LDL-C）, NT-pro btype natriuretic peptide （NT-proBNP）, interleukin-6 （IL-6） , tumor necrosis factor-or （TNF-c~） , C reactive protein （CRP） and monocyte chemoattractant protein-1 （MCP-1） were detected; and the safety was also evaluated both before and after treatment. Result： In the rank sum test, in observation group were superior to that in control group （P 〈 0.05）. After treatment, the ventricular rate in observation group was lower than that in control group （P 〈 0.05） , and the number of atrial fibrillation combined with abnormality of electrocardiogram was lower than that in control group （X2 = 6. 631, P 〈 0.05）. The scores of palpitation, insomnia, irritability, chest tightness, chest pain, scores of the secondary symptoms and total score of Yin deficiency and fire prosperity were all lower than those in control group （P 〈 0. 01）. Number of cases of dyslipidemia was also lower than that in control group （X2 = 4. 417, P 〈 0. 05 ）. Levels of LVEF, CO and SV in observation group were higher than those in control group （ P 〈 0.05 ）, while the levels of NT-proBNP, IL-6, TNF-a, CRP and MCP-1 were lower than those in control group （P 〈 0. 01）. During the study, no serious adverse event and hemorrhage happened, and there was no statistical significance in the abnormality of liver and kidney function and clotting routine. Conclusion： Based on the treatment of routine western medicine treatment, Tianwang Buxindan treatment can control ventricular rate, relieve clinical symptoms, regulate lipid metabolism, ameliorate heart function and inhibit inflammatory reaction, which is effective for atrial fibrillation.