益气活血法对舒张性心力衰竭气虚血瘀证患者的影响

Effect of benefiting qi for activating blood circulation method on diastolic heart failure patients with syndrome of qi deficiency and blood stasis

目的观察益气活血法对舒张性心力衰竭(DHF)气虚血瘀证患者的影响。方法选取2017年1月-2019年11月廊坊市中医医院心内科收治的89例气虚血瘀证DHF患者,按就诊奇偶数将其分为对照组(44例)和观察组(45例)。对照组给予西医基础对症治疗,观察组在此基础上加用益肾强心汤治疗,均治疗8周。比较两组治疗前后中医证候积分、疗效、心功能指标、心室重构指标及细胞因子水平。结果治疗8周,两组心悸气短、气喘、胸闷隐痛、神疲乏力、胸胁胀痛积分均低于治疗前,且观察组低于对照组,差异有统计学意义(P <0.05)。治疗后,观察组疗效优于对照组,差异有统计学意义(P <0.05)。治疗8周,两组心功能分级、二尖瓣舒张早期血流峰值速度(E)/舒张中晚期血流峰值速度(A)高于治疗前,E快于治疗前,6 min步行试验(6MWT)长于治疗前,且观察组心功能分级、E/A高于对照组,E快于对照组,6MWT长于对照组,差异有统计学意义(P <0.05)。治疗8周,两组左室舒张末期内径(LVEDD)、舒张末期室间隔厚度(IVST)短于治疗前,左室舒张末期容积(LVEDV)小于治疗前,左心室质量指数(LVMI)低于治疗前,且观察组LVEDD、IVST短于对照组,LVEDV小于对照组,LVMI低于对照组,差异有统计学意义(P <0.05)。治疗8周,两组肌钙蛋白Ⅰ(cTnⅠ)、高敏C反应蛋白(hs-CRP)、血管紧张素Ⅱ(AngⅡ)、血管性假血友病因子(vWF)水平均低于治疗前,且观察组低于对照组,差异有统计学意义(P <0.05)。结论益肾强心汤联合西医基础对症治疗气虚血瘀证DHF的效果优于单独西医治疗,可改善患者心功能,减轻心室重构,降低cTnI、hs-CRP、AngⅡ、vWF等炎症及促血管收缩因子水平。

Objective To observe the effect of benefiting qi for activating blood circulation method on diastolic heart failure(DHF) patients with syndrome of qi deficiency and blood stasis. Methods Eighty-nine DHF patients with syndrome of qi deficiency and blood stasis in Department of Cardiology of Langfang Hospital of Traditional Chinese Medicine from January 2017 to November 2019 were selected and divided into control group(44 cases) and observation group(45 cases) according to odd and even number. Control group was given basic symptomatic treatment of Western medicine, and observation group was additionally treated with Yishen Qiangxin Decoction for eight weeks. Traditional Chinese medicine syndrome score, curative effect, cardiac function index, ventricular remodeling index and cytokine levels before and after treatment were compared between two groups. Results After eight weeks of treatment, the scores of palpitation and shortness of breath, asthma, chest tightness and dull pain, mental fatigue and chest pain in two groups were lower than those before treatment, and observation group was lower than that of control group, the differences were statistically significant(P < 0.05). The curative effect of observation group was better than that of control group, and the difference was statistically significant(P < 0.05). After eight weeks of treatment, cardiac function grade,peak velocity of early diastolic mitral flow(E)/peak velocity of mid late diastolic blood flow(A) of two groups were higher than those before treatment, E of two groups was faster than that before treatment, six-minute walk test(6 MWT)of two groups was longer than that before treatment, and cardiac function grade, E/A of observation group were higher than those of control group, E of observation group was faster than that of control group, 6 MWT of observation group was longer than that of control group, the differences were statistically significant(P < 0.05). After eight weeks of treatment, the left ventricular end diastolic diameter(LVEDD),end diastolic ventricular septal thickness(IVST) of two groups were shorter than those before treatment, left ventricular end diastolic volume(LVEDV) of two groups was less than that before treatment, left ventricular mass index(LVMI) of two groups was lower than that before treatment, and LVEDD and IVST of observation group were shorter than those of control group, LVEDV of observation group was less than that of control group, LVMI of observation group was lower than that of control group, the differences were statistically significant(P < 0.05). After eight weeks of treatment, the levels of cardiac troponin Ⅰ(cTnⅠ), high sensitivity C-reactive protein(hs-CRP), angiotensin Ⅱ(Ang Ⅱ) and von Willebrand factor(v WF) in two groups were lower than those before treatment, and observation group was lower than that of control group, the differences were statistically significant(P < 0.05). Conclusion Yishen Qiangxin Decoction combined with Western medicine in treating DHF with syndrome of qi deficiency and blood stasis is more effective than Western medicine alone. It can improve cardiac function of patient, alleviate ventricular remodeling and reduce levels of inflammatory and vasoconstrictive factors, such as c Tn I, hs-CRP, AngⅡ and v WF.