补阳还五汤加减治疗糖尿病合并心力衰竭患者的疗效及预后

Modified Buyang Huanwu Tang for reducing brain natriuretic peptide(BNP) level in patients with diabetes complicated by heart failure

目的探讨补阳还五汤加减治疗糖尿病合并心力衰竭患者的疗效及预后。方法选择2015年1月～2017年12月于北京王府中西医结合医院门诊及住院治疗的2型糖尿病合并心力衰竭的患者252例,基础治疗均采取降糖、降压、降脂、扩血管、醛固酮拮抗剂治疗,并利用随机数字表将其分为基本综合治疗组(对照组)132例和基本综合治疗加用补阳还五汤加减治疗组(观察组)120例;记录所有患者服药前后的一般资料和服药后第1～4周每周NT-proBNP水平。结果入组前观察组和对照组患者的年龄、性别、病程、心功能分级、基础用药、血钾、谷丙转氨酶、谷草转氨酶、肌酐等指标水平比较,均无统计学差异(P>0.05)。观察组和对照组组内治疗前后比较NT-proBNP水平均呈逐渐下降的趋势(P<0.05);观察组和对照组组间比较治疗前后NT-proBNP水平观察组低于对照组(P<0.05);治疗后观察组患者肌酐水平低于对照组(P<0.05);血糖、血钾、肝功能指标比较治疗前后均无显著性差异(P>0.05)。观察组临床疗效和总有效率均优于对照组(P<0.05)。结论补阳还五汤治疗糖尿病合并心力衰竭,对于降低脑钠肽(NT-proBNP)水平、改善预后有较好的临床效果,值得临床应用和推广。

Objective To investigate the modified Buyang Huanwu Tang on level of N-terminal probrain natriuretic peptide(NT-proBNP)and prognosis in patients with diabetes complicated by heart failure(HF).Methods The patients with type 2 diabetes mellitus(T2DM)complicated by HF(n=252)were chosen from Beijing Royal Integrative Medicine Hospital from Jan.2015 to Dec.2017.All patients were given basic therapies including reducing blood sugar,blood pressure and blood fat,vascular dilation and aldosterone(ALD)antagonist,and the patients were divided,according to random digital table,into control group(n=132,treated with basic comprehensive therapy)and observation group(n=120,treated with basic comprehensive therapy and modified Buyang Huanwu Tang).The general data before and after treatment,and NT-proBNP level in each week after treatment for 1 to 4 weeks were recorded in 2 groups.Results There was no statistical difference in age,sex,disease course,cardiac functional grading,basic drugs,and levels of serum potassium,alanine aminotransferase,aspertate aminotransferase and creatinine between observation group and control group before treatment(P>0.05).NT-proBNP level showed a gradual descending trend in 2 groups after treatment(P<0.05).NT-proBNP level was lower in observation group than that in control group before and after treatment(P<0.05).The level of creatinine was lower in observation group than that in control group after treatment(P<0.05).The levels of blood sugar and serum potassium,and indexes of liver function had no significant difference between 2 groups before and after treatment(P>0.05).The clinical efficacy and the total effective rate were higher in observation group than those in control group(P<0.05).Conclusion Buyang Huanwu Tang has better clinical efficacy for reducing NT-proBNP level and improve prognosis in patients with T2DM complicated by HF,and it is worthy of clinic application.