基于“心脾相关理论”的调脾护心方对慢性心力衰竭心室重构和预后的影响

Influence of Tiaopi Huxin Decoction on Ventricular Remodeling and Prognosis of Chronic Heart Failure Based on Theory of Heart Spleen Correlation

目的:观察基于"心脾相关理论"的调脾护心方治疗慢性心力衰竭(CHF)的临床疗效及抗炎和抗心室重构作用的机制研究。方法:将140例患者随机按数字表法分为对照组和观察组各70例。两组患者均研究期间脱落、失访4例,剔除2例,共完成64例。观察组研究期间脱落、失访6例,剔除0例,共完成64例。两组患者均口服氯沙坦钾片,50 mg/次,1次/d;和酒石酸美托洛尔片,200 mg/次,1次/d;和螺内酯片,20~40 mg/次,1次/d;对照组采用景参益气颗粒,1袋/次,3次/d。观察组内服调脾护心方,1剂/d。两组疗程均为连续治疗12周。采用超声心动图记录治疗前后左室射血分数(LVEF),左室舒张末期内径(LVEDd),左室收缩末期内径(LVEDs),每搏输出量(SV),心输出量(CO)和二尖瓣口舒张早期及舒张晚期流速峰值(E/A);进行治疗前后Lee氏心衰、气虚血瘀兼痰饮证和明尼苏达心衰生活质量调查表(MLHFQ)评分和6 min步行试验(6 MWT)评价;检测治疗前后N末端B型利钠肽原(NT-proBNP),半乳糖凝集素-3,肿瘤坏死因子-α(TNF-α),白细胞介素-6(IL-6),IL-17,转化生长因子-β(TGF)-β和基质金属蛋白酶-9(MMP-9)水平。结果:治疗后观察组LVEDd和LVEDs均低于对照组(P<0.05);观察组LVEF,SV,CO和E/A均高于对照组(P<0.05);观察组患者Lee氏心衰和气虚血瘀兼痰饮证积分均低于对照组(P<0.01);观察组患者6 MWT多于对照组(P<0.01);观察组患者MLHFQ评分低于对照组(P<0.01);观察组患者NT-proBNP,半乳糖凝集素-3,IL-17,IL-6,TNF-α,TGF-β和MMP-9水平均低于对照组(P<0.01);治疗后观察组心功能疗效好于对照组(Z=2.191,P<0.05)。结论:基于"心脾相关理论"的调脾护心方治疗CHF(气虚血瘀兼痰饮证)患者,能进一步改善心衰临床症状、体征,提高患者的运动耐量和生活质量及临床疗效,并具有抗炎和改善心室重构作用,有利于改善心衰预后。

Objective: To observe clinical effect of Tiaopi Huxin decoction to chronic heart failure(CHF)and to study mechanism of action of anti-inflammatory and anti ventricular remodeling. Method: One hundred and forty patients were randomly divided into control group(70 cases) and observation group(70 cases)by random number table. And during the study,there were four patients for falling off and missing visit,two eliminated patients in control group,and 64 patients finished the study,and there were six patients for falling off and missing visit in observation group,so 64 patients finished the study. Two groups of patients got losartan potassium tablets, 50 mg/time, 1 time/day, metoprolol tablets, 200 mg/time, 1 time/day,spironolactone tablets,20-40 mg/time,1 time/day,control group Jingshe Yiqi granule 1 bag/time,3 times/day,flushed with boiling water,patients in observation group added Tiaopi Huxin decoction,1 dose/day. The courses of treatment were 12 weeks. Before and after treatment,left ventricular ejection fraction(LVEF),left ventricular end diastolic dimension(LVEDd),leftventricular end-stolic diameter(LVEDs),stroke volume(SV),cardiac output(CO)and ratio of peak value of early diastolic velocity of mitral valve and peak velocity of late diastolic mitral valve(E/A) were recorded by echocardiography. And scores of Lee’s heart failure,Qi deficiency and blood stasis,Minnesota Heart Failure Quality of life questionnaire(MLHFQ) and 6 minutes’ walking test(6 MWT)were graded. And levels of N-terminal B-type natriuretic peptide(NT-proBNP),galactose lectin-3,tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),IL-17,transforming growth factor(TGF)-β and matrix metalloproteinase-9(MMP-9) were detected. Result: After treatment,LVEDd and LVEDs were lower than that in control group(P<0. 05). LVEF,SV,CO and E/A were higher than those in control group(P<0. 05). And scores of Lee’s heart failure,Qi deficiency blood stasis and MLHFQ were lower than those in control group(P<0. 01). And 6 MWT was more than that in control group(P<0. 01). And levels of NT-proBNP,galactose lectin 3,IL-17,IL-6,TNF-α,TGF-β and MMP-9 were lower than those in control group(P<0. 01). Effect of cardiac function was better than that in control group(Z=2. 191, P<0. 05).Conclusion: On the basis of conventional western medicine treatment and according to theory of heart and spleen,Tiaopi Huxin decoction can improve the clinical symptoms and signs of heart failure,and it had effect of antiinflammatory,and can improve ventricular remodeling,improve the exercise tolerance and quality of life of patients,improve the prognosis of heart failure,and its clinical effect is better than that of Western medicine alone.