真武汤加减联合缬沙坦治疗慢性心力衰竭合并肾功能不全的临床研究

Clinical Observation of Zhenwu Decoction Combined with Valsartan in Treatment of Chronic Heart Failure Complicated with Renal Insufficiency

目的探讨真武汤加减联合缬沙坦治疗慢性心力衰竭合并肾功能不全的临床观察。方法将2016年4月-2018年4月本院78例慢性心力衰竭合并肾功能不全患者,随机分为两组,各39例,对照组采用缬沙坦80 mg,1次/d口服;观察组采用真武汤加减联合缬沙坦80 mg 1次/d口服,持续治疗4周后进行评价。比较两组患者临床疗效、左室射血分数(left ventricular ejection fraction,LVEF)、舒张末期内径(left ventricular end diastolic diameter,LVEDd)、血尿素氮(blood urea nitrogen,BUN)、肌酐(creatinine,Scr)、胱抑素-C(Cystatin-C,Cys-C)、脑钠肽(brain natriuretic peptide,BNP)等,记录不良反应。结果对照组有效率79.49%低于观察组94.87%,差异具有统计学意义(P<0.05)。治疗前两组患者LVEF、LVEDd及血BUN、Scr、Cys-C、BNP比较,差异无统计学意义(P>0.05)。治疗后对照组和观察组LVEF分别为(44.16±6.02)%、(50.27±5.89)%,LVEDd分别为(60.12±4.61)mm、(56.89±4.35)mm,血BUN分别为(7.12±3.06)mmol/L、(5.34±2.45)mmol/L,血Scr分别为(103.45±21.08)μmol/L、(73.49±20.51)μmol/L,血Cys-C分别为(1.65±0.48)mg/L、(1.10±0.42)mg/L,血BNP分别为(194.52±64.32)pg/mL、(121.05±57.20)pg/mL,对照组和观察组上述指标比较,差异具有统计学意义(P<0.05)。治疗期间无任何不良反应出现。结论真武汤加减联合缬沙坦治疗慢性心力衰竭合并肾功能不全的疗效显著,有助于改善心、肾功能,降低Cys-C、BNP水平,且患者可以耐受,值得推广。

Objective To investigate the clinical effect of Zhenwu Decoction combined with valsartan in the treatment of chronic heart failure complicated with renal insufficiency.Methods Seventy-eight patients with chronic heart failure complicated with renal insufficiency from April 2016 to April 2018 were randomly divided into two groups,39 cases in each group.The control group received valsartan 80 mg a day orally and the observation group additionally received Zhenwu Decoction and two groups were treated for 4 weeks.The clinical efficacy,left ventricular ejection fraction(LVEF),end-diastolic diameter(LVEDd),blood urea nitrogen(BUN),creatinine(Scr),cystatin-C(Cys-C),brain natriuretic peptide(BNP)and the adverse reactions was recorded.Results The effective rate of the control group(79.49%)was lower than the observation group(94.87%)and the difference was statistically significant(P<0.05).There was no significant difference in LVEF,LVEDd,BUN,Scr,Cys-C or BNP between the two groups before treatment(P>0.05).After treatment,the LVEF levels of the control group and the observation group were(44.16±6.02)%and(50.27±5.89)%,the LVEDd levels were(60.12±4.61)mm and(56.89±4.35)mm,the blood BUN levels were(7.12±3.06)mmol/L and(5.34±2.45)mmol/L,the blood Scr levels were(103.45±21.08)μmol/L and(73.49±20.51)μmol/L,and the blood Cys-C levels were(1.65±0.48)mg/L and(1.10±0.42)mg/L,BNP levels were(194.52±64.32)pg/mL and(121.05±57.20)pg/mL,respectively,and the differences between the control group and the observation group were statistically significant(P<0.05).No adverse reactions occurred during the treatment.Conclusion Zhenwu Decoction combined with valsartan in the treatment of chronic heart failure with renal insufficiency has a significant effect.It is helpful to improve the heart and kidney function,reduce the levels of Cys-C and BNP,and patients can tolerate it.It is worthy of promoting.