炙甘草汤加减治疗气阴两虚型急性病毒性心肌炎的临床研究

Modified Zhigancao decoction for the treatment of Qi/Yin-deficiency acute viral myocarditis

目的:探讨炙甘草汤加减治疗气阴两虚型急性病毒性心肌炎的疗效以及对血清高迁移率蛋白1(HMGB1)水平的影响。方法:选择2017年7月至2018年12月淳安县中医院收治的气阴两虚型急性病毒性心肌炎患者88例,依据随机数字表法分为对照组43例和观察组45例。对照组根据予标准常规干预治疗,观察组在对照组基础上口服炙甘草汤加减治疗。两组均予4周疗效观察。比较两组肌钙蛋白I(cTnI)、HMGB1、中医症状评分及临床疗效。结果:治疗后2周和4周,观察组患者的cTnI水平[(590.22±78.42)ng/L,(461.36±52.44)ng/L]均低于对照组同期水平[(621.41±86.12)ng/L,(587.62±67.94)ng/L](t2周=1.574,t4周=9.785,均P<0.05)。治疗后,观察组治疗后中医各症状评分均显著低于对照组(t发热=27.650,t咽痛=27.210,t心悸=14.560,t心烦胸闷=15.370,均P<0.01)。观察组总有效率为93.33%(42/45),明显高于对照组的72.09%(32/43),差异有统计学意义(χ^(2)=8.41,P<0.05)。治疗后2周和4周,观察组患者血清HMGB1水平均低于对照组同期水平(2周t=9.144,4周t=11.534,均P<0.01)。结论:在常规西医干预基础上,炙甘草汤加减治疗气阴两虚型急性病毒性心肌炎疗效显著,下调患者血清HMGB1水平可能与上述疗效有关。

Objective To investigate the efficacy of modified Zhigancao decoction on Qi/Yin-deficiency acute viral myocarditis and its effect on serum level of high mobility group box chromosomal protein 1(HMGB-1).Methods Eighty-eight patients with Qi/Yin-deficiency acute viral myocarditis who received treatment in Chun'an Hospital of Traditional Chinese Medicine from July 2017 to December 2018 were included in this study.They were randomly assigned to undergo either standard conventional intervention(control group,n=43)or treatment with modified Zhigancao decoction based on standard conventional intervention(observation group,n=45)for 4 weeks.After treatment,serum levels of cardiac troponin I(cTnI)and HMGB1,traditional Chinese medicine symptom score,and clinical efficacy were compared between the two groups.Results After 2 and 4 weeks of treatment,serum level of cTnI in the observation group was(590.22±78.42)ng/L and(461.36±52.44)ng/L,respectively,which was concurrently significantly lower than that in the control group,respectively[(621.41±86.12)ng/L,(587.62±67.94)ng/L,(t2 weeks=1.574,t4 weeks=9.785,both P<0.05).After treatment,traditional Chinese medicine symptom score in the observation group was significantly lower than that in the control group(tfever=27.650,tsore throat=27.210,tpalpitation=14.560,tvexation and chest tightness=15.370,all P<0.01).Total effective rate in the observation group was significantly higher than that in the control group[93.33%(42/45)vs.72.09%(32/43),χ^(2)=8.41,P<0.05).After 2 and 4 weeks of treatment,serum level of HMGB1 in the observation group was concurrently significantly lower than that in the control group(t2 weeks=9.144,t4 weeks=11.534,both P<0.01).Conclusion Modified Zhigancao decoction combined with conventional western medicine intervention for the treatment of Qi/Yin-deficiency acute viral myocarditis exhibits great therapeutic effects possibly through downregulating serum level of HMGB1.