益气化瘀汤辅助治疗对慢性心力衰竭患者微血管损伤和心室重构及代谢重构的影响

Effect of Yiqi Huayu decoction on microvascular injury,ventricular remodeling and metabolic remodeling in treatment of chronic heart failure patient

目的探讨自拟益气化瘀汤辅助治疗慢性心力衰竭(chronic heart failure,CHF)气虚血瘀证患者的临床疗效及可能的作用机制分析。方法选择2017年5月—2019年2月杭州市中医院收治的CHF气虚血瘀证患者120例,采用随机数字表法随机分为对照组和治疗组,各60例,均接受常规抗心衰药物治疗,对照组加服曲美他嗪,治疗组在对照组的基础上加用益气化瘀汤,连续治疗6个月。比较2组患者中医证候疗效、血管内皮功能参数、心室重构参数、能量代谢重构参数的差异。结果治疗6个月后,治疗组患者总有效率为80.00%,高于对照组的58.33%(χ^2=6.604,P=0.010)。治疗后治疗组和对照组患者内皮素-1、血管紧张素Ⅱ、醛固酮、左心室质量指数、左心室收缩末周向室壁应力、心肌能量消耗值分别为(68.42±21.95)ng/L、(77.53±35.28)pg/mL、(197.38±71.84)pg/mL、(125.69±21.84)g/m^2、(130.75±18.93)kdyne/cm^2、(92.67±9.83)kcal/min和(82.68±22.53)ng/L、(101.14±36.11)pg/mL、(262.33±95.83)pg/mL、(131.47±25.36)g/m^2、(144.58±21.63)kdyne/cm^2、(101.28±11.45)kcal/min,治疗组患者上述指标均低于对照组(均P<0.05)。结论自拟益气化瘀汤辅助曲美他嗪治疗慢性心力衰竭气虚血瘀证患者可抑制微血管损伤、心室重构和能量代谢重构进程,纠正患者的病理状态和中医症状,以达到"对症""对证"治疗的目的。

Objective To observe the clinic effect and possible mechanism of Yiqi Huayu decoction in treatment of chronic heart failure(CHF)patient with Qi deficiency and blood stasis syndrome.Methods A total of 120 CHF patients with Qi deficiency and blood stasis syndrome in Hangzhou Hospital of Traditional Chinese Medicine from May 2017 to February 2019 were enrolled and randomly divided into control group and treatment group with 60 cases in each group.Based on conventional treatment,60 patients in the treatment group received trimetazidine and Yiqi Huayu decoction,while 60 patients in control group received trimetazidine for 6 months of treatment.Traditional Chinese medicine(TCM)syndrome efficacy,vascular endothelial function indexes,ventricular remodeling indexes and energy metabolism remodeling indexes were detected and compared between the two groups.Results After 6 months of treatment,the TCM symptom efficacy rate of patients in the treatment group was 80.00%,better than that in the control group 58.33%(χ^2=6.604,P=0.010).Moreover,the endothelin 1(ET-1),AngiotensinⅡ,aldosterone,left ventricular ejection fraction(LVEF),circumferential end-systolic wall stress(cESS),and myocardial energy expenditure(MEE)in the treatment group and the control group were(68.42±21.95)ng/L,(77.53±35.28)pg/mL,(197.38±71.84)pg/mL,(125.69±21.84)g/m^2,(130.75±18.93)kdyne/cm^2,(92.67±9.83)kcal/min and(82.68±22.53)ng/L,(101.14±36.11)pg/mL,(262.33±95.83)pg/mL,(131.47±25.36)g/m^2,(144.58±21.63)kdyne/cm^2,(101.28±11.45)kcal/min,respectively.The above indexes in the treatment group were lower than those in the control group(all P<0.05).Conclusion Yiqi Huayu decoction combined with trimetazidine in the treatment of CHF patients with Qi deficiency and blood stasis syndrome can inhibit the process of microvascular injury,ventricular remodeling and metabolic remodeling,correct the pathological state and symptoms of traditional Chinese medicine,so as to achieve the purpose of"symptomatic treatment"and"syndrome differentiation treatment".