芪苈强心胶囊联合西药治疗老年2型心肾综合征临床疗效及对肾小管损伤和肾脏弹性的影响

Clinical observation of Qili Qiangxin capsule combined with western medicine in the treatment of elderly type 2 cardiorenal syndrome and its influence on renal tubular injury and renal elasticity

目的观察芪苈强心胶囊联合西药治疗老年2型心肾综合征(CRS)的临床疗效及对肾小管损伤和肾脏弹性的影响。方法将78例老年2型CRS患者按照随机数字表法分为2组。对照组39例采用常规西药治疗,治疗组39例在对照组治疗基础上予芪苈强心胶囊治疗。2组疗程为12周。比较2组治疗前后心、肾功能指标[血清N末端B型利钠肽原(NT-proBNP)、血清胱抑素C(CysC)、估算肾小球滤过率(eGFR)、左室射血分数(LVEF)]、尿β2微球蛋白(β2-MG)、尿肾损伤分子-1(KIM-1)及肾脏杨氏模量值(YM)的变化,并统计疗效。另选健康体检者20例作为健康对照组。结果治疗组总有效率92.31%(36/39),对照组总有效率82.05%(32/39),治疗组疗效优于对照组。与健康对照组比较,治疗组、对照组治疗前CysC、NT-proBNP均升高(P<0.05),eGFR、LVEF均降低(P<0.05)。治疗后治疗组、对照组CysC、NT-proBNP均较本组治疗前降低(P<0.05),eGFR、LVEF均较本组治疗前升高(P<0.05),且治疗后治疗组CysC、NT-proBNP均低于对照组(P<0.05),eGFR、LVEF均高于对照组(P<0.05)。与健康对照组比较,治疗组、对照组治疗前尿β2-MG、KIM-1、YM均升高(P<0.05)。治疗后治疗组、对照组尿β2-MG、KIM-1、YM均较本组治疗前降低(P<0.05),且治疗后治疗组尿β2-MG、KIM-1、YM均低于对照组(P<0.05)。结论老年2型CRS患者存在肾小管损伤,肾脏弹性下降。常规抗心力衰竭、保肾治疗基础上加芪苈强心胶囊,可在一定程度上减轻老年2型CRS患者肾小管损伤,改善肾脏弹性及心肾功能,临床疗效确切,安全性好。

Objective To observe the effect of Qili Qiangxin capsules combined with western medicine in the treatment of elderly type 2 cardiorenal syndrome(CRS)and its influence on renal tubular injury and renal elasticity.Methods 78 elderly patients with CRS were randomly divided into two groups according to the random number table method.39 cases in the control group were treated by conventional western medicine.39 cases in the treatment group were treated by Qili Qiangxin capsules on the basis of the control group.Both groups were treated for 12 weeks.The changes of cardiac and renal function indexes[serum N-terminal pro-B-type natriuretic peptide(N-proBNP),serum cystatin C(CysC),glomerular filtration rate(eGFR),left ventricular ejection fraction(LVEF)],urinaryβ2-microglobulin(β2-MG),urinary kidney injury molecule-1(KIM-1)and kidney Young's modulus(YM)were compared between the two groups before and after treatment,and the curative effect was counted.Another 20 healthy people were selected as healthy control group.Results The total effective rate of the treatment group was 92.31%(36/39),and that of the control group was 82.05%(32/39).The clinical curative effect of the treatment group was better than that of the control group.Compared with healthy control group,CysC and NT-proBNP in treatment group and control group were increased(P<0.05),eGFR and LVEF were decreased(P<0.05).After treatment,CysC and NT-proBNP in treatment group and control group were lower than those in the group before treatment(P<0.05),eGFR and LVEF were higher than those in the group before treatment(P<0.05),while CysC and NT-proBNP in treatment group were lower than those in the control group(P<0.05),eGFR and LVEF were higher than those in the control group(P<0.05).Compared with the healthy control group,the levels of urinaryβ2-MG,KIM-1 and YM in the treatment group and the control group were all increased(P<0.05).After treatment,urineβ2-MG,KIM-1 and YM in treatment group and control group were lower than those in the group before treatment(P<0.05),and urinaryβ2-MG,KIM-1 and YM in treatment group were lower than those in the control group(P<0.05).Conclusion Elderly patients with type 2 CRS have renal tubular injury and decreased renal elasticity.The addition of Qili Qiangxin capsules on the basis of conventional anti-heart failure and kidney protection therapy can reduce renal tubular damage in CRS patients to a certain extent,improve kidney elasticity,and significantly improve heart and kidney function in elderly patients with type 2 CRS.The clinical effect is accurate and safe.