通脉活血汤联合缬沙坦对冠心病高血压合并慢性肾功能不全血浆BNP的影响及安全性

Study on Effect and Safety of Tongmai Huoxue Decoction Combined with Valsartan on Plasma BNPin Patients with Coronary Heart Disease,Hypertension and Chronic Renal Insufficiency

目的探讨通脉活血汤联合缬沙坦对冠心病高血压合并慢性肾功能不全患者血浆BNP的影响及安全性。方法2016年3月-2018年3月选择医院冠心病高血压合并慢性肾功能不全患者72例,随机分为两组,各36例,对照组采用缬沙坦80 mg口服;观察组采用通脉活血汤联合缬沙坦80 mg口服,4周为1个疗程,2个疗程后评价疗效。比较两组患者临床疗效、收缩压(systolic pressure,SBP)、舒张压(diastolic pressure,DBP)、六分钟步行试验(Six minute walk test,6MWT)、左室射血分数(Left ventricular ejection fraction,LVEF)及血尿素氮(Urea nitrogen,BUN)、肌酐(creatinine,Scr)、脑钠肽(brain natriuretic peptide,BNP)、护骨素(Osteoprotegerin,OPG)等,记录不良反应。结果对照组有效率72.22%(26/36)低于观察组91.67%(33/36),差异具有统计学意义(P<0.05)。治疗前两组患者SBP、DBP、6MWT、LVEF及血BUN、Scr、BNP、OPG比较,差异无统计学意义(P>0.05)。治疗后对照组和观察组SBP分别为(137.56±7.24)mmHg、(130.18±7.10)mmHg,DBP分别为(82.32±6.98)mmHg、(77.26±6.05)mmHg,6MWT分别为(451.27±87.15)m、(560.37±88.63)m,LVEF分别为(46.21±5.10)%、(51.02±5.08)%,血BUN分别为(7.10±3.21)mmol/L、(5.02±2.87)mmol/L,血Scr分别为(103.69±24.10)umol/L、(78.48±22.57)μmol/L,血BNP分别为(179.82±74.21)pg/mL、(124.02±65.19)pg/mL,血OPG分别为(254.94±50.12)ng/L、(210.06±48.55)ng/L,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)。观察组无任何不良反应出现。结论通脉活血汤联合缬沙坦对冠心病高血压合并慢性肾功能不全患者的疗效显著,有助于改善血压和心肾功能,降低BNP水平,且安全性高。

Objective To explore the effect and safety of Tongmai Huoxue Decoction combined with valsartan on plasma BNP in patients with coronary heart disease,hypertension and chronic renal insufficiency.Methods Seventy-two patients with coronary heart disease,hypertension and chronic renal insufficiency from March 2016 to March 2018 were randomly divided into two groups,36 in each group.The control group received valsartan 80 mg and the observation group additionally received Tongmai Huoxue Decoction combined with valsartan 80 mg orally,4 weeks as a course of treatment,and the curative effect was evaluated after 2 courses of treatment.The clinical efficacy,systolic pressure(SBP),diastolic pressure(DBP),six minute walk test(6 MWT),left ventricular ejection fraction(LVEF),urea nitrogen(BUN),creatinine(Scr),brain natriuretic peptide(B),osteoprotegerin(OPG),NP and so on were compared between the two groups.We recorded adverse reactions.Results The effective rate of the control group(72.22%,26/36)was lower than that of the observation group(91.67%,33/36)(P<0.05).There was no significant difference in SBP,DBP,6 MWT,LVEF,BUN,Scr,BNP or OPG between the two groups before treatment(P>0.05).After treatment,the levels of SBP of control group and observation group after treatment were(137.56±7.24)mmHg and(130.18±7.10)mmHg,respectively.The levels of DBP were(82.32±6.98)mmHg and(77.26±6.05)mmHg,respectively.The scores of 6 MWT were(451.27±87.15)m and(560.37±88.63)m,respectively.The levels of LVEF were(46.21±5.10)%and(51.02±5.08)%,respectively.The levels of blood BUN were(7.10±3.21)mmol/L and(5.02±2.87)mmol/L,respectively.The levels of blood Scr were(103.69±24.10)μmol/L and(78.48±22.57)μmol/L,respectively.The levels of blood BNP were(179.82±74.21)pg/mL and(124.02±65.19)pg/mL,respectively.The levels of blood OPG were(254.94±50.12)ng/L and(210.06±48.55)ng/L,respectively.And all indexes in two groups had statistical significance(P<0.05).There were no adverse reactions in the observation group.Conclusion Tongmai Huoxue Decoction combined with valsartan is effective for patients with coronary heart disease,hypertension and chronic renal insufficiency.It is helpful to improve blood pressure,heart and kidney function,reduce BNP level and has high safety.