芪苈强心胶囊辅治扩张型心肌病合并慢性心力衰竭的疗效及对神经内分泌因子、炎性因子及心室重构的影响

Effect of Qiliqiangxin Capsule on Dilated Cardiomyopathy with Chronic Heart Failure and Its Influence on Neuroendocrine Factors,Inflammatory Factors and Ventricular Remodeling

目的探讨芪苈强心胶囊辅治扩张型心肌病(DCM)并慢性心力衰竭(CHF)的效果及对神经内分泌因子、炎性因子及心室重构的影响。方法选择2018年11月—2019年10我院心内科收治的DCM合并CHF患者95例,据治疗方法不同分为观察组45例和对照组40例。对照组按指南给予常规治疗,观察组在对照组基础上联合芪苈强心胶囊,2组均治疗4周。比较2组临床疗效,治疗前后左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF),治疗前1 d及治疗结束后首日去甲肾上腺素(NE)、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)、肿瘤坏死因子-α(TNF-α)、N末端脑钠肽前体(NTpro-BNP)、超敏C反应蛋白(hs-CRP)、基质金属蛋白酶-9(MMP-9)、Ⅰ型前胶原氨基末端肽(PⅠNP)和Ⅲ型前胶原氨基末端肽(PⅢNP)水平。结果观察组总有效率高于对照组(P<0.05)。2组治疗后LVEDD、LVEF均较治疗前明显改善,且观察组改善程度优于对照组(P<0.01)。2组治疗后血清NE、AngⅡ、ALD、TNF-α、NTpro-BNP、hs-CRP水平显著下降,且观察组低于对照组(P<0.01)。2组治疗后血清MMP-9、PⅠNP和PⅢNP水平均低于治疗前,且观察组低于对照组(P<0.05,P<0.01)。结论芪苈强心胶囊辅助治疗可提高DCM合并CHF的疗效,使患者症状明显好转,并可改善其心功能,减少NE、AngⅡ和ALD的产生,抑制炎性因子分泌,减轻心肌损伤,延缓和改善心室重构,从而改善预后。

Objective To investigate the effect of Qiliqiangxin capsule on dilated cardiomyopathy(DCM)with chronic heart failure(CHF)and its effects on neuroendocrine factors,inflammatory factors and ventricular remodeling.Methods From November 2018 to October 2019,95 patients with DCM and CHF were selected and divided into observation group(n=45)and control group(n=40)according to different treatment methods.The control group was given conventional treatment according to the guidelines,and the observation group was supplemented with Qiliqiangxin capsule on the basis of the control group.Both groups were treated for 4 weeks.The clinical efficacy,left ventricular end diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)before and after treatment were compared between the two groups.D and on the first day after treatment,norepinephrine(NE),angiotensinⅡ(AngⅡ),aldosterone(ALD),tumor necrosis factor-α(TNF-α),N-terminal pro brain natriuretic peptide(NTpro-BNP),high sensitivity C-reactive protein(hs-CRP),matrix metalloproteinase-9(MMP-9),N-terminal pro collagen peptide(PⅠNP)and N-terminal pro collagen peptide(PⅢNP)were detected at 1 d before treatment and at 1 d after completion of treatment.Results The total effective rate of the observation group was higher than that of the control group(P<0.05).LVEDD and LVEF were significantly improved after treatment,and the indicators were improved more significantly in the observation group than in the control group after treatment(P<0.01).After treatment,the levels of serum NE,AngⅡ,ALD,TNF-α,NTpro-BNP and hs-CRP in the two groups were decreased significantly,and the indicators were lower in the observation group than in the control group(P<0.01).After treatment,the serum levels of MMP-9,PⅠNP and PⅢNP in the two groups were lower than those before treatment,and the levels were lower in the observation group than in the control group(P<0.05,P<0.01).Conclusion Qiliqiangxin capsule can improve the clinical efficacy of DCM patients with CHF,improve their condition and cardiac function,reduce the production of NE,AngⅡand ALD,inhibit the secretion of inflammatory factors,reduce myocardial injury,and delay and improve ventricular remodeling,thereby improving the prognosis of patients.