复心汤对老年心力衰竭患者心肌缺血及心功能的影响

Effects of the Fuxin decoction on myocardial ischemia and cardiac function in elderly patients with heart failure

目的:观察复心汤对老年心力衰竭(CHF)患者心肌缺血及心功能的影响。方法:将82例CHF患者随机分为对照组和观察组,每组41例。对照组给予常规西医治疗,观察组在对照组基础上加用复心汤治疗。分别于治疗前后检测患者血清一氧化氮(NO)、内皮素-1(ET-1)、降钙素基因相关肽(CGRP)、抵抗素、N末端利钠肽(NT-pro BNP)、半乳糖凝集素-3(Galectin-3)、肌酸激酶(CK)、肌钙蛋白I(c Tn I)等水平,比较两组中医症候积分、心肌缺血、心功能指标及生活质量变化,并观察临床疗效及不良反应发生情况。结果:观察组治疗总有效率(90.24%)明显高于对照组的治疗总有效率(68.29%),差异有统计学意义(P<0.05);治疗后,观察组心悸、疲乏、胸闷、气急、腹胀、食欲不振等症状评分较对照组显著降低(P<0.05)。治疗后,观察组血清NO、CGRP较对照组明显升高(P<0.05),ET-1、抵抗素、NT-pro BNP、Galectin-3、CK、c Tn I水平明显降低(P<0.05)。治疗后,观察组心电图ST段压低>0.5mm的导联数(NST)及常规12导联中ST段压低总和(∑ST)水平分别为(3.26±1.87)、(3.67±2.43)mm,均明显低于对照组的(4.83±2.04)、(4.91±2.28)mm(P<0.05)。治疗后,观察组每博输出量(SV)、左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)、心脏指数(CI)分别为(72.53±10.67)ml、(63.25±3.36)%、(44.18±1.26)mm、(3.51±0.33),均优于对照组的(66.24±15.28)ml、(53.39±3.57)%、(48.32±1.24)mm、(3.02±0.38)(P<0.05);且治疗后观察组生活质量改善情况明显优于对照组(P<0.05);两组治疗期间均未见严重不良反应。结论:复心汤辅治CHF(气虚血瘀水停证)疗效确切,明显降低了中医症候积分,改善了心肌缺血指标及心功能指标,其机制可能与调节血清NO、CGRP、ET-1、抵抗素平衡,增强血管内皮功能有关。

Objective:To observe the effects of the Fuxin decoction on myocardial ischemia and cardiac function in elderly patients with heart failure.Methods:82cases were randomly divided into the control group and the observation group,41cases in each.The control group was treated with conventional western medicine and the observation group was given the Fuxin decoction more.The levels of NO,ET-1,CGRP,NT-proBNP,galactin-3,CK and cTnI were measured;and the TCM syndrome scores,myocardial ischemia,cardiac function index and quality of life were compared;the clinical efficacy and adverse reactions were observed.Results:The total efficiency was90.24%in the observation group,and significantly higher than68.29%in the control group,with a statistically significant difference(P<0.05).In the observation group,the symptoms scores of the palpitations,fatigue,chest tightness,shortness of breath,bloating and loss of appetite were significantly increased(P<0.05);the serum NO,CGRP were significantly higher(P<0.05);the levels of ET-1,resistin,NTproBNP,Galectin-3,CK and cTnI were significantly lower than those in the control group(P<0.05).The NST andΣST were(3.26±1.87)and(3.67±2.43)mm respectively in the observation group,significantly lower than(4.83±2.04)and(4.91±2.28)mm in the control group(P<0.05).The SV,LVEF,LVESD,CI were(72.53±10.67)ml,(63.25±3.36)%,(44.18±1.26)mm and(3.51±0.33)respectively in the observation group,better than(66.24±15.28)ml,(53.39±3.57)%and(48.32±1.24)mm,(3.02±0.38)in the control group(P<0.05).The improvement of quality of life in the observation group was significantly better than that in the control group(P<0.05).There was no serious adverse reaction in groups during the treatment period.Conclusion:The Fuxin decoctionon on CHF(the Qixu Xueyu Shuiting syndrome)shows a significant effect,can significantly decrease TCM symptom scores,improve the index of myocardial ischemia and heart function indexes.The mechanism may be related to the regulation of serum NO,CGRP,ET-1,resistin,enhancement of endothelial function.