益气活血化瘀方对慢性心力衰竭患者心肌能量穿梭、心室重塑及心功能的影响

Effect of Yiqi Huoxue Huayu Decoction on myocardial energy shuttle,ventricular remodeling and heart function in patients with chronic heart failure

目的探讨益气活血化瘀方参芪扶心口服液对慢性心力衰竭患者心肌能量穿梭、心室重塑及心功能的影响。方法选择2015年1月—2019年9月北京朝阳中西医结合急诊抢救中心、解放军总医院第六医学中心、解放军总医院第七医学中心收治的140例慢性心力衰竭患者,随机分为2组,最后治疗组65例、对照组68例入选。治疗组在原标准西药治疗基础上加服参芪扶心口服液20 mL/次,对照组在原标准治疗基础上加服辅酶Q1040 mg/次,均每天3次,随访24个月。观察2组治疗前及治疗24个月后临床症状得分、心功能分级得分、心肌能量穿梭指标[无机磷(Pi)/心肌磷酸肌酸(PCr)值、PCr/三磷酸腺苷(ATP)值、Pi/ATP值]、心室重塑指标[舒张期室间隔厚度(LVST)、左室舒张末期内径(LVEDd)、左室后壁厚度(LVPWT)、左室心肌质量(LVM)、左室心肌质量指数(LVMI)]及血浆脑钠肽(BNP)、氨基末端脑钠肽前体(NT-proBNP)水平变化。结果治疗组治疗24个月后临床症状得分及NYHA分级得分均明显低于治疗前(P均<0.05),且临床症状得分明显低于同期对照组(P<0.05);对照组治疗24个月后仅NYHA分级得分明显低于治疗前(P<0.05)。2组治疗后PCr/ATP值均明显升高(P均<0.05),Pi/PCr值、Pi/ATP值、LVEDd、LVPWT、LVM、LVMI及血浆BNP、NT-proBNP水平均明显降低(P均<0.05),但2组治疗后各指标比较差异均无统计学意义(P均>0.05)。结论参芪扶心口服液能够调控慢性心力衰竭患者的心肌能量穿梭,纠正心脏重塑,改善心功能。

Objective It is to investigate the effects of Shenqi Fuxin Oral Liquid of Yiqi Huoxue Huayu Decoction on myocardial energy shuttle,ventricular remodeling and cardiac function in patients with chronic heart failure.Methods 140 patients with chronic heart failure admitted to the Beijing Chaoyang Integrative Medicine Emergency Medical Center,the Sixth Medical Center of the PLA General Hospital,and the Seventh Medical Center of the PLA General Hospital from January 2015 to September 2019 were selected and randomly divided into 2 groups,65 cases in the treatment group and 68 cases in the control group were selected finally.The treatment group was treated with Shenqi Fuxin Oral Liquid on the basis of the original standard western medicine therapy,20 mL/time,and the control group was treated with 40 mg of coenzyme Q10 per time on the basis of the original standard treatment,both 3 times a day,followed up for 24 months.The changes of the clinical symptom scores,cardiac function classification scores,and myocardial energy shuttle index[inorganic phosphorus(Pi)/myocardial creatine phosphate(PCr)value,PCr/adenosine triphosphate(ATP)value,Pi/ATP value],ventricular remodeling index[diastolic ventricular septal thickness(LVST),left ventricular end-diastolic diameter(LVEDd),left ventricular posterior wall thickness(LVPWT),left ventricular myocardial mass(LVM),left ventricular myocardial mass index(LVMI)]and the levels of plasma brain natriuretic peptide(BNP)and N-terminal-brain natriuretic peptide(NT-proBNP)before treatment and after treatment for 24 months were observed in the two groups.Results The clinical symptom scores and NYHA classification scores of the treatment group after 24 months of treatment were significantly lower than those before treatment(P both<0.05),and the clinical symptom scores were significantly lower than the control group during the same period(P<0.05);only NYHA classification scores was significantly lower than that before treatment in the control group(P<0.05).The PCr/ATP values were significantly increased after treatment(P<0.05),while Pi/PCr,Pi/ATP,LVEDd,LVPWT,LVM,LVMI,and the levels of plasma BNP and NT-proBNP were significantly reduced in the two groups(P both<0.05),but there was no statistically significant difference in the indicators between the two groups after treatment(all P>0.05).Conclusion Shenqi Fuxin Oral Liquid can regulate myocardial energy shuttle,correct heart remodeling,and improve heart function in patients with chronic heart failure.