活血通脉汤辅助治疗阳虚寒凝证扩张型心肌病心力衰竭患者的临床观察

Clinical observation of Huoxue Tongmai Decoction in the adjuvant treatment of dilated cardiomyopathy patients with heart failure due to Yang deficiency and cold coagulation

目的研究活血通脉汤治疗阳虚寒凝证扩张型心肌病(DCM)心力衰竭(HF)的效果。方法选取2018年3月~2020年3月收治的阳虚寒凝证DCM-HF患者92例,按照随机数字表分为常规组、研究组,各46例。常规组采用常规治疗,研究组在常规组基础上采用活血通脉汤治疗。比较两组临床疗效、治疗前及治疗4周后中医证候积分、明尼苏达心衰生活质量量表(LHFQ评分)、心功能[左心室射血分数(LVEF)、左室舒张末期内径(LVEDD)]、血清炎性因子水平[C反应蛋白(CRP)、肿瘤坏死因子(TNF-α)]、内分泌激素[肾素(PRA)、醛固酮(ALD)]及不良反应。结果研究组总有效率为95.65%,高于常规组的78.26%(P<0.05)。治疗4周后研究组中医证候积分、LHFQ评分低于常规组(P<0.001);研究组LVEF大于常规组,LVEDD小于常规组(P<0.001);研究组血清炎性因子CRP、TNF-α水平,内分泌激素PRA、ALD水平低于常规组(P<0.001)。研究组不良反应发生率为15.22%,常规组不良反应发生率为8.70%,组间比较差异无统计学意义(P>0.05)。结论活血通脉汤联合西医基础治疗阳虚寒凝证DCM-HF效果明确,能改善症状及生活质量,提升心功能,减轻炎症反应,调节内分泌激素水平,安全性高。

Objective To study the effect of Huoxue Tongmai Decoction on heart failure(HF)of dilated cardiomyopathy(DCM)with Yang deficiency and cold coagulation syndrome.Methods From March 2018 to March 2020,92 cases of DCM-HF with Yang deficiency and cold coagulation syndrome in our hospital were randomly divided into routine group and study group,with 46 cases in each group.The routine group were treated with routine therapy,while the study group were treated with Huoxue Tongmai Decoction on the basis of routine therapy.And then,curative effects,TCM syndrome scores before treatment and 4 weeks after treatment,Minnesota Heart Failure Quality of Life Scale(LHFQ)scores,heart functions(left ventricular ejection fraction[LVEF]and left ventricular end diastolic diameter[LVEDD]),serum inflammatory factors(C-reactive protein[CRP]and tumor necrosis factor[TNF-α]),endocrine hormones(plasma renin activity[PRA]and aldosterone[ALD])and adverse reactions were compared between the two groups.Results The total effective rate of the study group was 95.65%,higher than that of the conventional group(78.26%)(P<0.05).After 4 weeks of treatment,the TCM syndrome score and LHFQ score in the study group were lower than those in the routine group(P<0.001);LVEF in the study group was higher than that in the routine group,but LVEDD was lower than that in the routine group(P<0.001);the levels of serum inflammatory factors(CRP and TNF-α)and endocrine hormones(PRA and ALD)in the study group were lower than those in the routine group(P<0.001).The incidence of adverse reactions was 15.22%in the study group and 8.70%in the routine group,and there was no statistically significant difference between the two groups(P>0.05).Conclusion Huoxue Tongmai Decoction combined with western medicine is effective in treating DCM-HF with Yang deficiency and cold coagulation syndrome,which can improve symptoms and quality of life,improve heart function,relieve inflammatory reaction and regulate endocrine hormone level,and has high safety.