麝香保心丸联合美托洛尔治疗老年慢性心力衰竭的疗效及对NT-proBNP和cTnⅠ水平影响

Clinical Curative Effect of Shexiang Baoxin Pill(麝香保心丸)Combined Metoprolol in Treatment of Senile Chronic Heart Failure and Its Influence on Levels of NT-proBNP and cTnⅠ

目的探讨麝香保心丸联合美托洛尔治疗老年慢性心力衰竭的疗效及对NT-proBNP和cTnⅠ水平影响。方法选取医院接受治疗的110例老年慢性心力衰竭患者,随机分为两组各55例。对照组患者给予美托洛尔,实验组在对照组基础上口服麝香保心丸,两组患者均持续治疗4周。对比两组患者的临床疗效、中医证候积分、心功能分级、明尼苏达心力衰竭生活质量量表(MLHFQ)评分和6 min步行试验(6WMT)、左心室射血分数(LVEF)、左心室收缩期末内径(LVESD)和左心室舒张末期内径(LVEDD)值、血清NT-proBNP和cTnⅠ水平、血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和C反应蛋白(CRP)水平及不良反应发生情况。结果治疗后,实验组总有效率较高(P<0.05);两组患者治疗前中医证候积分差异无统计学意义(P>0.05);两组患者治疗后气短乏力、心悸、身寒肢冷、动则气喘等体征积分显著降低(P<0.05);并且实验组降低较明显(P<0.05);两组患者治疗前心功能分级、MLHFQ评分和6WMT差异无统计学意义(P>0.05);治疗后两组患者心功能分级和MLHFQ评分显著降低,6WMT显著升高(P<0.05);并且实验组改善较明显(P<0.05);两组患者治疗前LVEF、LVESD和LVEDD值差异无统计学意义(P>0.05);治疗后两组患者LVEF显著升高,LVESD和LVEDD值显著降低(P<0.05);并且实验组改善较明显(P<0.05);两组患者治疗前血清NT-proBNP和cTnⅠ水平差异无统计学意义(P>0.05);两组患者治疗后血清NT-proBNP和cTnⅠ水平显著降低(P<0.05);并且实验组降低较明显(P<0.05);两组患者治疗前血清IL-6、TNF-α和CRP水平差异无统计学意义(P>0.05);两组患者治疗后血清IL-6、TNF-α和CRP水平明显降低(P<0.05);且实验组降低较明显(P<0.05)。结论采用麝香保心丸联合美托洛尔治疗老年慢性心力衰竭具有较好的治疗效果,能够改善血清NT-proBNP和cTnⅠ水平,安全性较高,值得在临床上推广应用。

Objective To investigate the effect of Shexiang Baoxin Pill(麝香保心丸) combined with metoprolol on senile chronic heart failure and the influence on levels of NT-proBNP and cTnⅠ. Methods A total of 110 patients with chronic heart failure in our hospital were selected and randomly divided into two groups, 55 patients in each group. Patients in the control group were given metoprolol, and those in the experimental group were given Shexiang Baoxin Pill orally on the basis of the control group. Patients in both groups were treated continuously for 4 weeks. Two groups’ clinical curative effect, traditional Chinese medicine symptom integral, heart function grading, MLHFQ score and 6 WMT, values of LVEF, LVESD and LVEDD, serum levels of NT-proBNP and cTnⅠ, serum levels of IL-6, TNF-α and CRP and adverse reactions were compared. Results After treatment, the total effective rate of the experimental group was higher(P<0.05). There was no difference in scores of TCM syndromes between the two groups before treatment(P>0.05). After treatment, the scores of shortness of breath and fatigue, palpitation, cold body and limbs, wheezing and other signs were significantly reduced in the two groups(P<0.05). In the experimental group, the decrease was more significant(P<0.05). There was no difference in cardiac function grade, MLHFQ score or 6 WMT between the two groups before treatment(P>0.05). After treatment, cardiac function grade and MLHFQ score in the two groups were significantly decreased, and 6 WMT was significantly increased(P<0.05). The improvement of the experimental group was significant(P<0.05). There was no difference in values of LVEF, LVESD or LVEDD before treatment between the two groups(P>0.05). After treatment, LVEF was significantly increased and values of LVESD and LVEDD were significantly decreased in both groups(P<0.05). The improvement of the experimental group was significant(P<0.05). Before treatment, two groups’ serum levels of NT-proBNP and cTnⅠhad no difference(P>0.05). After treatment, the two groups’ serum levels of NT-proBNP and cTnⅠ were significantly reduced(P<0.05). In the experimental group, the decrease was more significant(P<0.05). There was no difference in serum levels of IL-6, TNF-α or CRP between the two groups before treatment(P>0.05). After treatment, the serum levels of IL-6, TNF-α and CRP in both groups were significantly decreased(P<0.05). The decrease in the experimental group was significant(P<0.05). Conclusion the heart of musk pills with metoprolol therapy of elderly chronic heart failure has good treatment effect, can improve the NT-proBNP and serum cTnⅠ level, high security, worthy for popularization and application in clinic.