温阳利水汤对急性心力衰竭合并1型心肾综合征患者心肾功能保护效应

Protective effect of Wenyang Lishui decoction on cardiac and renal function in patients with acute heart failure complicated with type 1 cardio-renal syndrome

目的:观察温阳利水汤对急性心力衰竭(AHF)合并1型心肾综合征(CRS)患者心肾功能保护效应。方法:将90例AHF合并1型CRS患者随机分为观察组(n=45)和对照组(n=45),对照组给予常规西医治疗,观察组在对照组的基础上给予温阳利水汤治疗,疗程2周。统计两组临床疗效;观察两组治疗前后中医症状积分、心肾功能和相关生化检查指标的变化。结果:观察组临床疗效显著优于对照组(P<0.05);两组治疗后中医症状单项(胸闷、心悸、气喘、水肿、尿量减少、形寒肢冷、倦怠乏力)积分与总积分均显著降低,观察组治疗后以上积分均低于对照组(P<0.05);两组治疗后LVEF、FS、LVEDD、E/A、CO和CI均显著改善,观察组治疗后以上指标均优于对照组(P<0.05)。两组治疗后Cr、BUN、MAU、eGFR和尿量均显著改善,观察组治疗后以上指标均优于对照组(P<0.05)。两组治疗后血清hs-CRP、Hcy和NT-proBNP均显著降低,观察组治疗后以上指标均低于对照组(P<0.05)。结论:温阳利水汤可改善AHF合并1型CRS患者临床症状,提高临床疗效,具有显著的心肾保护效应,其机制可能与其下调血清hs-CRP、D-D和NT-proBNP表达有关。

Objective :To observe the protective effect of Wenyang Lishui decoction on cardiac and renal function in patients with acute heart failure (AHF) complicated with type 1 cardio-renal syndrome (CRS). Methods :90 cases of AHF patients with type 1 CRS were randomly divided into the observation group ( n =45) and the control group ( n =45). The control group was treated with conventional western medicine. Statistics of clinical efficacy of the two groups;Changes in TCM symptom score,cardiac and renal function and related biochemical parameters were observed before and after treatment in the two groups. Results: the clinical efficacy of the observation group was significantly better than that of the control group ( P <0.05). After treatment,the single item of TCM symptoms (chest tightness,palpitation,asthma,edema,reduced urine volume,cold body shape,fatigue and weakness) and the total score of the two groups were significantly reduced,and the above score of the observation group was lower than that of the control group ( P <0.05). After treatment,LVEF,FS,LVEDD,E/A,CO and CI were significantly improved in both groups,and the above indicators in the observation group were better than those in the control group ( P <0.05). Cr,BUN,MAU,eGFR and urine volume were significantly improved after treatment in both groups,and the indicators above in the observation group were better than those in the control group ( P <0.05). The serum hs-crp,Hcy and nt-probnp of the two groups were significantly decreased after treatment,and the above indexes of the observation group were lower than those of the control group ( P <0.05). Conclusion: Wenyang Lishui decoction can improve the clinical symptoms and clinical efficacy of AHF combined with type 1 CRS patients,and has significant cardio-renal protective effect. The mechanism may be related to the down-regulation of the expression of serum hs-crp,d-d and NT-proBNP.