自拟健脾益心祛痰汤辅助治疗肥厚型心肌病的疗效及对左心功能的影响

Efficacy of self-made Jianpi Yixin Qutan Decoction in the adjuvant treatment of HCM and its effect on left heart function

目的:探讨自拟健脾益心祛痰汤辅助治疗肥厚型心肌病(Hypertrophic cardiomyopathy,HCM)患者的疗效及对左心功能、心率变异性(Heart rate variability,HRV)及心室重构指标的影响。方法:选取2018年8月至2020年10月期间我院收治的83例HCM患者作为研究对象。按照随机数字表法将所有患者分为对照组(n=41)和观察组(n=42)。对照组采用常规西药治疗,观察组在对照组基础上联合自拟健脾益心祛痰汤治疗。观察比较两组患者的临床疗效、左心功能指标、HRV以及心室重构指标。结果:治疗后,观察组总有效率明显高于对照组(P<0.05),观察组左室舒张末期压(Left ventricular end diastolic pressure,LVEDP)、左室流出道压力阶差(Left chamber outflow pressure step,LVOTPG)、左室舒张末内径(Left ventricular end diastolic diameter,LVEDD)、左室收缩末内径(Left ventricular end systolic inner diameter,LVESD)低于对照组,左室后壁厚度(Left posterior wall thickness,LVPW)高于对照组(P<0.05);观察组24 h正常RR间期的标准差(Standard deviation of NN intervals,SDNN)、全程按5min分成连续的时间段(Standard deviation of the average NN intervals for each 5 min segment of a 24 h HRV recording,SDANN)、24h内相邻正常RR间期差值均方的平方根(Root mean square of successive RR interval differences,rMMSD)以及24 h内相邻正常RR间期差值大于50 ms计数占总RR间期数的百分比(Percentage of successive RR intervals that differ by more than 50 ms,PNN50)均高于对照组(P<0.05);观察组血管紧张素Ⅱ(AngiotensinⅡAngⅡ)、血浆基质金属蛋白酶-2(Plasma matrix metalloproteinase-2,MMP-2)均低于对照组(P<0.05)。结论:自拟健脾益心祛痰汤用于HCM的辅助治疗可调节左心功能、改善HRV、抑制心室重构,进而提高临床疗效。

Objective:To investigate the therapeutic effect of self-made Jianpi Yixin Qutan decoction on patients with Hypertrophic cardiomyopathy(HCM)and the effects on left heart function,heart rate variability(HRV)and ventricular remodeling indexes.Methods:According to the random number table method,83 HCM patients in our hospital were divided into two groups,41 cases in the control group were treated with conventional western medicine,and 42 cases in the observation group were treated with self-made Jianpi Yixin Qutan decoction on the basis of the control group,and the clinical efficacy,left heart function index,HRV and ventricular remodeling index of the two groups were observed.Results:After treatment,the total effective rate of observation group was higher than that of control group(P<0.05).The left ventricular end diastolic pressure(LVEDP),left chamber outflow pressure step(LVOTPG),left ventricular end diastolic diameter(LVEDD),left ventricular end systolic inner diameter(LVESD)in the observation group were lower than those in the control group,the left posterior wall thickness(LVPW)in the observation group was lower than the control group(P<0.05).The standard deviation of NN intervals(SDNN),standard deviation of the average NN intervals for each 5 min segment of a 24 h HRV recording(SDANN),root mean square of successive RR interval differences(rMMSD)and percentage of successive RR intervals that differ by more than 50 ms(PNN50)in the observation group were higher than those in the control group(P<0.05).AngiotensinⅡ(AngⅡ)and Plasma matrix metalloproteinase-2(MMP-2)in the observation group were lower than those in the control group(P<0.05).Conclusion:Self-made Jianpi Yixin Qutan Decoction can improve HRV and inhibit ventricular remodeling by regulating left heart function in HCM patients,leading to an improvement of the clinical efficacy.