益气通脉方对气虚血瘀型慢性心力衰竭患者心肌重塑、氧化应激及血管内皮功能的影响

Effect of Yiqi Tongmai Prescription on Myocardial Remodeling,Oxidative Stress and Vascular Endothelial Function in Patients with Chronic Heart Failure

目的:研究益气通脉方治疗气虚血瘀型慢性心力衰竭(CHF)及对心肌重塑、氧化应激和血管内皮功能的影响。方法:选择2015-07—2020-06本院收治的CHF患者136例,按照随机数字表法将其分为试验组(n=68)和对照组(n=68)。对照组给予美洛托尔+曲美他嗪治疗,试验组给予美洛托尔+曲美他嗪+益气通脉方治疗。观察治疗前及治疗3个月后两组患者6min步行距离(6MWT)、左室射血分数(LVEF)等心功能指标;左室舒张末期内径(LVEDd)、左室收缩末期内径(LVESd)等心肌重塑指标,血清超氧化物歧化酶(SOD)、一氧化氮(NO)、丙二醛(MDA)等氧化应激指标,血清血管内皮生长因子(VEGF)、血栓素(TVB2)、内皮素(ET-1)等血管内皮功能指标。同时观察不良反应。结果:治疗前,两组上述各观察指标差异均无统计学意义(P>0.05)。治疗后,两组6MWT、LVEF、SOD、VEGF较治疗前升高,LVEDd、LVESd、NO、MDA、TVB2、ET-1水平均较治疗前降低(P<0.01),且试验组较对照组升高/降低更明显(P<0.01);试验组总有效率高于对照组(95.29%vs 81.28%,P<0.05);治疗期间,两组均无显著不良反应发生。结论:美洛托尔、曲美他嗪两药及其联合益气通脉方治疗CHF均可缓解机体氧化应激,保护血管内皮,抑制心肌重塑,改善心肌功能,安全可靠,且三药联合效果更优。

Objective:To study the effect of Yiqi Tongmai prescription on myocardial remodeling,oxidative stress and vascular endothelial function in patients with chronic heart failure(CHF).Method:136 patients with CHF were selected and treated in our hospital from July 2015 to June 2020.According to the random number table method,136 patients with CHF were divided into the experimental group(n=68)and the control group(n=68).The control group was treated with melotol+trimetazidine,while the experimental group was treated with Melotol+trimetazidine+Yiqi Tongmai formula.Cardiac function indexes such as 6min walking distance(6MWT)and left ventricular ejection fraction(LVEF)were observed before and after treatment.Left ventricular end-diastolic diameter(LVEDd),left ventricular end systolic diameter(LVESd)and so on myocardial remodeling index,serum superoxide dismutase(SOD),nitric oxide(NO),malondialdehyde(MDA),such as oxidative stress index,serum vascular endothelial growth factor(VEGF),thromboxane(TVB2),endothelin(ET)and other index of endothelial function.Adverse reactions.Results:After treatment,6MWT and LVEF in the experimental group were all higher than those in the control group,while LVEDd and LVESd were all lower than those in the control group(P<0.05).After treatment,the levels of Serum SOD and VEGF in the experimental group were higher than those in the control group,and the levels of NO,MDA,TVB2 and ET-1 were all lower than those in the control group(P<0.05).The total effective rate in the experimental group(95.29%)was higher than that in the control group(81.28%)(P<0.05).During the treatment period,no significant adverse reactions occurred in both groups.Conclusion:Both melotol and trimetazidine and their combination of yiqi tongmai prescription in the treatment of CHF can relieve oxidative stress,protect vascular endothelium,inhibit myocardial remodeling and improve myocardial function,which are safe and reliable.And the latter effect is better than the former.