化瘀复元胶囊对窦性心律慢性心力衰竭患者凝血状态及内皮功能的影响

Effect of Huayu Fuyuan Capsule on coagulation state and endothelial function in patients with sinus rhythm and chronic heart failure

目的观察化瘀复元胶囊对窦性心律慢性心力衰竭患者的凝血状态及内皮功能的影响,探讨中医药防治心力衰竭高凝状态的作用。方法将2020年1月至2020年12月在南通市中医院门诊及住院治疗的64例(治疗后共剔除5例,实际统计59例)气虚血瘀型慢性心力衰竭合并窦性心律患者随机分为两组,对照组常规西药治疗,观察组在对照组基础上加用化瘀复元胶囊。观察两组治疗前后凝血功能[D-二聚体、纤维蛋白原(FIB)、血管性假性血友病因子(vWF)、纤溶酶原激活剂抑制物-1(PAI-1)、可溶性血栓调节蛋白(sTM)]、血管内皮功能[内皮素1(ET-1)、一氧化氮(NO)]、心功能指标[血清N末端B型利钠肽原(NT-proBNP)]、心脏超声参数[左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室射血分数(EF)]水平及中医临床证候积分。结果治疗后两组患者D-二聚体、FIB、VWF、PAI-1、sTM均较治疗前降低(P<0.01),观察组FIB、VWF、PAI-1、sTM和D-二聚体降低水平优于对照组(P<0.05,P<0.01)。治疗后两组ET-1均较前下降、NO均较前上升,观察组ET-1下降水平优于对照组,NO上升水平显著优于对照组(P<0.05,P<0.01)。两组患者治疗后血清NT-proBNP及LVEDD、LVESD水平均较前下降,EF值均较前上升(P<0.01),两组治疗后相比未见明显差异(P>0.05)。观察组中医症候总有效率略高于对照组,但差异无统计学意义(P>0.05)。结论化瘀复元胶囊联合西药治疗与单纯西药治疗相比更能有效改善心力衰竭患者的高凝状态、血管内皮功能及中医临床证候,且其安全性高,服用方便。

Objective To observe the effect of Huayu Fuyuan Capsule on coagulation state and endothelial function in patients with sinus rhythm and chronic heart failure,and to explore the advantages of Chinese medicine in preventing and treating hypercoagulable state of heart failure.Methods From January 2020 to December 2020,64 patients with chronic heart failure complicated with sinus rhythm who were type of qi deficiency and blood stasis were selected and divided into control group and observation group randomly(n=32,each).The control group was treated with conventional western medicine,and the observation group was treated with Huayu Fuyuan Capsule on the basis of the control group.The levels of coagulation function[D-dimer,fibrinogen(FIB),von Willebrand factor(vWF),plasminogen activator Inhibitor-1(PAI-1),soluble thrombomodulin(sTM)],vascular endothelial function[endothelin-1(ET-1),NO],cardiac function indexes[serum N-terminal prohormone of brain natriuretic peptide(NT-proBNP),cardiac ultrasound parameters]and TCM clinical syndrome scores were observed before and after treatment.Results After treatment,the levels of D-dimer,FIB,vWF,PAI-1 and sTM were decreased in both group,and these in the observation group were significantly lower than those in the control group(P<0.05).The decreased level D-dimer in the observation group was significantly better than that in the control group(P<0.01).After treatment,ET-1 decreased and NO increased in both groups(P<0.01).The decreased level of ET-1 in the observation group was better than that in the control group(P<0.05),and the increased level of in the observation group was significantly better than that in the control group(P<0.01).After treatment,the levels of serum NT-proBNP and cardiac ultrasound parameters(LVEDD and LVESD)in the two groups were lower than those before treatment,and the EF value was higher than that before treatment.There was no significant difference between the two groups(P>0.05).The total effective rate of TCM symptoms in the observation group was slightly higher than that in the control group without significant difference(P>0.05).Conclusion Huayu Fuyuan Capsule combined with western medicine can improve the hypercoagulable state,vascular endothelial function and clinical syndromes of Chinese medicine in patients with heart failure more effectively than western medicine alone,which has the advantages of high safety and convenient use.