五苓散加减方联合参附注射液治疗急性心力衰竭临床疗效及对血清脑啡肽酶浓度的影响

Clinical Efficacy of Modified Wulingsan and Shenfu Injection in Treating Acute Heart Failure and Its Effect on Serum Neprilysin Concentration

目的探讨五苓散加减方联合参附注射液治疗急性心力衰竭的临床疗效及其对病人血清脑啡肽酶(sNEP)浓度的影响。方法选取2013年10月—2016年10月本院心内科及重症监护室收治的82例急性心力衰竭病人,根据入院先后顺序将其分为观察组(40例)和对照组(42例)。对照组采用强心、利尿、扩血管等传统治疗心力衰竭药物治疗方案,观察组在此基础上应用五苓散加减方联合参附注射液治疗,比较两组病人临床疗效、左室射血分数(LVEF)、每搏输出量(SV)、N末端脑钠肽前体(NT-proBNP)、Lee心衰积分及不良反应等。采用ELISA法测定治疗前后两组病人sNEP水平,并分析血清sNEP水平与急性心力衰竭严重程度的相关性。结果观察组治疗总有效率高于对照组,差异有统计学意义(92.5%与76.2%,P<0.05)。两组治疗前LVEF、SV、NT-proBNP、Lee心衰积分及sNEP水平比较差异均无统计学意义(P>0.05),治疗后,两组心功能指标较治疗前均有明显改善,且观察组各项指标改善明显优于对照组;两组sNEP水平较治疗前降低,且观察组sNEP水平降低程度优于对照组,差异有统计学意义(P<0.05)。血清sNEP水平与心功能分级呈负相关(r=-0.825,P=0.000)。结论基础治疗上五苓散加减方联合参附注射液治疗急性心力衰竭临床疗效显著,可有效改善心功能指标,降低血清sNEP水平。

Objective To investigate the clinical effect of modified Wulingsan(MWLS)and Shenfu Injection(SFI)in treating acute heart failure(AHF)and its effect on serum neprilysin(sNEP)concentration.Methods Eighty-two patients with AHF were randomly divided into two groups:the control group(n=42)treated with routine treatment,and the observation group(n=40)treated with MWLS and SFI in the basis of routine treatment.The clinical efficacy,left ventricular ejection fraction(LVEF),stroke volume(SV),N-terminal pro-brain natriuretic peptide(NT-proBNP),Lee′s heart failure score,and adverse reactions were compared between the two groups.The sNEP levels were determined by enzyme-linked immunosorbnent assay(ELISA)in patients before and after treatment,and the correlation between serum sNEP levels and the severity of AHF was analyzed.Results The total effective rate of treatment in the observation group was significantly higher than that in the control group(92.5%vs 76.2%,P<0.05).There was no significant differences in LVEF,SV,NT-proBNP,Lee′s heart failure scores,and sNEP levels between two groups before treatment(P>0.05).After treatment,cardiac function indicators were significantly improved in two groups compared to that before treatment.The improvement of various indicators in the observation group was better than that in the control group.The sNEP levels in two groups were lower than that before treatment,which was lower in the observation group than that in the control group,the difference was statistically significant(P<0.05).Serum sNEP levels were negatively correlated with cardiac function classification(r=-0.825,P=0.000).Conclusion MWLS and SFI can effectively improve the cardiac function and reduce serum sNEP levels without significant adverse reactions in patients with AHF.