益气温阳活血利水方治疗慢性心力衰竭临床疗效及对血清B型利钠肽和心功能的影响

Clinical efficacy of Yiqi Wenyang Huoxue Lishui Formula for chronic heart failure and how to impact on serum B-type natriuretic peptide and cardiac function

目的观察益气温阳活血利水方治疗慢性心力衰竭(CHF)的临床疗效及对血清B型利钠肽(BNP)和心功能的影响。方法将124例CHF患者按照随机数字表法分为2组,对照组62例予西药治疗,治疗组62例在对照组治疗基础上联合益气温阳活血利水方治疗。2组均治疗3周。比较2组治疗前后中医证候评分,治疗前及治疗1、2、3周血清BNP水平和心功能指标[左室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)],并比较2组疗效,治疗结束28 d后统计死亡率、心力衰竭再住院率,分析近期预后情况。结果治疗组总有效率88.71%(55/62),对照组总有效率74.19%(46/62),治疗组疗效优于对照组(P<0.05)。治疗后2组中医证候各项评分及总分均较本组治疗前降低(P<0.05),且治疗后治疗组均低于对照组(P<0.05)。治疗1、2、3周2组血清BNP水平均较本组治疗前降低(P<0.05),治疗2、3周2组均较本组治疗1周降低(P<0.05),治疗3周2组均较本组治疗2周降低(P<0.05),且治疗1、2、3周治疗组血清BNP水平均低于对照组同期(P<0.05)。治疗1、2、3周2组LVEDD、LVESD均较本组治疗前降低(P<0.05),LVEF均较本组治疗前升高(P<0.05),治疗2、3周2组LVEDD、LVESD均较本组治疗1周降低(P<0.05),LVEF均较本组治疗1周升高(P<0.05),治疗3周2组LVEDD、LVESD均较本组治疗2周降低(P<0.05),LVEF均较本组治疗2周升高(P<0.05),且治疗1、2、3周治疗组LVEDD、LVESD均低于对照组同期(P<0.05),LVEF均高于对照组同期(P<0.05)。治疗组死亡率、心力衰竭再住院率均低于对照组(P<0.05)。Cox回归分析结果显示对照组治疗方式发生死亡风险几率是治疗组的29.169倍[B=3.373,Exp(B)=29.169,P<0.05]。结论益气温阳活血利水方治疗CHF疗效确切,能有效改善患者中医证候及心功能,降低血清BNP水平,改善患者预后。

Objective To observe the clinical efficacy of Yiqi Wenyang Huoxue Lishui Formula for chronic heart failure(CHF)and how to impact on serum B-type natriuretic peptide(BNP)and cardiac function.Methods Totally 124 CHF patients were randomly divided into two equal groups,in addition to Western medicine treatment,and treatment group additionally received Yiqi Wenyang Huoxue Lishui Formula.The treatment period was 3 weeks,aiming to compare curative effect,traditional Chinese medicine(TCM)syndrome scores,serum BNP,cardiac function indexes[left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD)]on weeks 0,1,2,3;the 28-day mortality,readmission rate and recent prognosis were counted.Results The overall effective rate in treatment group was better than that in control group[88.71%(55/62)vs 74.19%(46/62),(P<0.05),respectively].After treatment,TCM syndrome scores in groups were decreased(P<0.05),treatment group was lower than control group(P<0.05).On the weeks 1,2,3,serum BNP in groups was decreased(P<0.05),which decreased in treatment group than concurrent cortrol group(P<0.05);serum BNP on weeks 2,3 in groups was lower than week 1(P<0.05),which on week 3 was lower than week 2(P<0.05).On the weeks 1,2,3,LVEDD and LVESD in groups were decreased(P<0.05),treatment group was more common(P<0.05);LVEDD and LVESD on weeks 2,3 in groups were lower than week 1(P<0.05),which on week 3 were lower than week 2(P<0.05).On the weeks 1,2,3,LVEF in groups was increased(P<0.05),treatment group was more prevalent(P<0.05);LVEF on weeks 2,3 in groups was higher than week 1(P<0.05),which on week 3 was higher than week 2(P<0.05).The mortality and readmission rate in treatment group were lower than those in control group(P<0.05).The Cox analysis showed that the probability of mortality risk in control group was 29.169 times higher than that in the treatment group[B=3.373,Exp(B)=29.169,P<0.05].Conclusion For CHF patients,Yiqi Wenyang Huoxue Lishui Formula has definite curative effect,which is effectively capable of improving TCM syndrome,cardiac function,and prognosis,reducing serum BNP.