消心痹方联合卡维地洛治疗肥厚型心肌病的临床研究

Clinical Observation of Xiaoxinbi Fang Combined with Carvedilol in the Treatment of Hypertrophic Cardiomyopathy

目的观察消心痹方联合卡维地洛治疗肥厚型心肌病(HCM)的疗效及对病人心功能、胰岛素样生长因子-1(IGF-1)、B型脑钠肽(BNP)水平的影响。方法选取我院收治的124例HCM病人,随机分为观察组和对照组,各62例。两组均给予营养心肌、利尿等常规治疗,对照组在常规基础上给予卡维地洛治疗,观察组在对照组治疗基础上联合消心痹方治疗。观察并比较两组中医证候积分、临床疗效、血液流变学,使用彩色多普勒超声诊断仪检测室间隔厚度(IVST)、左心室后壁厚度(LVPWT)及左心室舒张末期内径(LVEDD)和左心室收缩末期内径(LVESD),并检测IGF-1、BNP水平。结果治疗后,两组中医证候积分较治疗前均显著降低,且观察组低于对照组(P<0.05);观察组总有效率显著高于对照组,差异有统计学意义(90.32%与75.81%,P<0.05);治疗后,两组全血黏度高切值、血浆黏度、全血黏度低切值、血红细胞比容显著低于治疗前,且观察组低于对照组(P<0.05);治疗后,两组IVST、LVPWT显著低于治疗前(P<0.05),LVEDD、LVESD显著高于治疗前(P<0.05),且观察组改善优于对照组,差异有统计学意义(P<0.05);治疗后,两组IGF-1、BNP水平显著低于治疗前(P<0.05),且观察组低于对照组,差异有统计学意义(P<0.05)。结论消心痹方联合卡维地洛能有效改善HCM病人心功能和IGF-1、BNP水平,提高临床疗效。

Objective To observe curative effect of Xiaoxinbi Fang combined with carvedilol in the treatment of hypertrophic cardiomyopathy(HCM)and its influence on cardiac function,insulin-like growth factor-1 (IGF-1),and type-B brain natriuretic peptide (BNP) levels of the patients. Methods One hundred and twenty four patients with HCM were randomly divided into the observation group and the control group,62 cases in each group.All patients were given routine treatment.On the basis of that,the control group were given carvedilol treatment,the observation group were combined with Xiaoxinbi Fang and carvedilol.Traditional Chinese medicine (TCM) symptom score,clinical efficacy,and hemorheology were observed and compared between groups.Ventricular septal thickness (IVST),left ventricular posterior wall thickness (LVPWT),left ventricular end diastolic diameter (LVEDD),and left ventricular end systolic diameter (LVESD) were detected by color Doppler ultrasound diagnostic apparatus,and IGF-1 and BNP levels were tested and compared between groups. Results The scores of TCM syndromes in the observation group and the control group were significantly lower than those before treatment ( P <0.05),and the scores of the observation group were lower than those of the control group ( P <0.05).The total effective rate of the observation group was significantly higher than that of the control group( P <0.05).There were statistical differences between the two groups ( P <0.05).The high blood viscosity,plasma viscosity,whole blood viscosity,low hematocrit,and hematocrit were significantly lower in the observation group and the control group than before treatment ( P <0.05),the observation group were lower than those of the control group ( P <0.05).IVST and LVPWT of the observation group and the control group were significantly lower than those before the treatment ( P <0.05),and the LVEDD and LVESD were significantly higher than those before the treatment ( P <0.05),there were statistical differences between the observation group and the control group ( P <0.05).The levels of IGF-1 and BNP in the observation group and the control group were significantly lower than those before the treatment ( P <0.05),and the observation group were lower than those of the control group ( P <0.05). Conclusion Xiaoxinbi Fang combined with carvedilol can effectively improve cardiac function and IGF-1 and BNP levels of patients with HCM,and improve clinical efficacy.