益气养阴通络汤联合美托洛尔治疗高血压性心脏病的疗效及作用机制研究

Efficacy and Mechanism of Yiqi Yangyin Tongluo Decoction Combined with Metoprolol in the Treatment of Hypertensive Heart Disease

目的探讨益气养阴通络汤联合美托洛尔治疗高血压性心脏病(HHD)的临床疗效及其作用机制。方法选取2018年1月—2019年1月期间接诊的96例HHD患者,按随机数字表法分为两组:对照组48例接受常规治疗和美托洛尔治疗,治疗组48例在对照组基础上加用益气养阴通络汤治疗,疗程3个月。观察比较两组临床疗效及药物不良反应,治疗前后测定血压[舒张压(DBP)、收缩压(SBP)]、心率(HR)、6 min步行距离(6MWT)、超声心动图参数[左室射血分数(LVEF)、左室舒张/收缩末期内径(LVEDD,LVESD)、左心室质量指数(LVMI)、室间隔厚度(IVST)、E/A]、血清B型脑钠肽(BNP)、超氧化物歧化酶(SOD)、丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-Px)、基质金属蛋白酶-9(MMP-9)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)水平。结果治疗后治疗组总有效率为95.83%(46/48)、对照组总有效率为83.33%(40/48),两组比较差异有统计学意义(P<0.05)。治疗后两组患者DBP、SBP、HR均降低,6MWT均升高,与治疗前比较差异有统计学意义(P<0.05);且治疗组HR、6MWT方面优于对照组,两组比较差异有统计学意义(P<0.05)。治疗后两组患者LVEF、E/A均较治疗前升高(P<0.05);治疗组LVEDD、LVESD、LVMI均降低(P<0.05)而对照组无明显变化(P>0.05)。治疗组LVEF、E/A升高指标,LVEDD、LVESD、LVMI降低指标均优于对照组,两组比较差异均有统计学意义(P<0.05)。治疗后两组患者血清SOD、GSH-Px均升高,MDA水平均降低(P<0.05);且治疗组血清SOD、GSH-Px水平升高、MDA水平降低指标均优于对照组(P<0.05)。治疗后两组患者血清炎症因子及BNP水平均较治疗前降低(P<0.05),且治疗组的变化较对照组更为明显(P<0.05)。治疗期间两组患者均未出现不良反应情况。结论益气养阴通络汤联合美托洛尔治疗HHD疗效确切,能够改善患者的心功能,阻碍甚至逆转心室重构,其机制可能与抗炎、抗氧化作用有关。

Objective To investigate the clinical efficacy and mechanism of Yiqi Yangyin Tongluo Decoction combined with metoprolol in the treatment of hypertensive heart disease(HHD).Methods A total of 96 HHD patients admitted from January 2018 to January 2019 were randomly divided into two groups according to the random number table method,48 patients in the control group received conventional treatment and metoprolol treatment,and 48 patients in the observation group received Yiqi Yangyin Tongluo Decoction on the basis of the control group for 3 months.The clinical efficacy and adverse drug reactions were compared between the two groups.Blood pressure[diastolic blood pressure(DBP),systolic blood pressure(SBP)],heart rate(HR),6-min walking distance(6MWT),echocardiographic parameters[left ventricular injection]were measured before and after treatment.Blood fraction(LVEF),left ventricular diastolic/end-systolic diameter(LVEDD,LVESD),left ventricular mass index(LVMI),ventricular septal thickness(IVST),E/A,serum B-type brain natriuretic peptide(BNP),ultra Oxide dismutase(SOD),malondialdehyde(MDA),glutathione peroxidase(GSH-Px),matrix metalloproteinase-9(MMP-9),tumor necrosis factor-α(TNF-α),Interleukin-6(IL-6)levels were measured before and after treatment.Results After treatment,the total effective rate in the treatment group was 95.83%(46/48),and the total effective rate in the control group was 83.33%(40/48).The difference between the two groups was statistically significant(P<0.05).After treatment,the DBP,SBP,and HR of the two groups of patients were reduced,and 6MWT was increased,which was significantly different from that before treatment(P<0.05);and the treatment group was better than the control group in terms of HR and 6MWT,and there were differences between the two groups.Statistically significant(P<0.05).After treatment,LVEF and E/A of the two groups were higher than before treatment(P<0.05);LVEDD,LVESD,and LVMI in the treatment group were all decreased(P<0.05),but there was no significant change in the control group(P>0.05).The treatment group's LVEF,E/A increase indexes,LVEDD,LVESD,and LVMI decrease indexes were better than those of the control group,and the difference between the two groups was statistically significant(P<0.05).After treatment,the serum SOD and GSH-Px of the two groups of patients increased,and the MDA level decreased(P<0.05);and the serum SOD,GSH-Px levels increased,and the MDA level decreased indexes of the treatment group were better than those of the control group(P<0.05).After treatment,serum inflammatory factors and BNP levels of the two groups were lower than before treatment(P<0.05),and the changes in the treatment group were more significant than those in the control group(P<0.05).During the treatment,there were no adverse reactions in both groups.Conclusion Yiqi Yangyin Tongluo Decoction combined with metoprolol is effective in the treatment of HHD.It can improve the heart function and hinder or even reverse ventricular remodeling.The mechanism may be related to anti-inflammatory and anti-oxidation effects.