穿心莲内酯治疗慢性心力衰竭的临床研究

Clinical Efficacy of Andrographolide in the Treatment of Chronic Heart Failure

目的:通过穿心莲内酯治疗观察慢性心力衰竭(CHF)患者临床疗效及其对心力衰竭生物标志物的影响。方法:选取2017年9月—2019年6月南通大学第四附属医院(盐城市第一人民医院)心血管内科收治的慢性心力衰竭住院患者80例,入院后根据住院编号采用随机法分为对照组40例和观察组40例,对照组治疗方案为采用慢性心力衰竭的标准药物治疗,观察组在CHF标准药物治疗基础上加用穿心莲内酯治疗。两组患者均连续治疗10 d,比较两组患者临床疗效、治疗前后血清生物标志物,B型脑钠肽(BNP)、白细胞介素-6 (IL-6)、脂联素(APN)、可溶性生长刺激表达基因-2蛋白(ST-2蛋白)变化。结果:通过穿心莲内酯治疗的观察组患者临床疗效优于对照组,差异有统计学意义(χ^(2)=4.58,P<0.01)。两组患者治疗前不同NYHA分级其血清生物标志物比较,差异有统计学意义(F=83.3、90.9、58.4、190.1,P<0.01)。观察组的血清生物标志物水平差值大于对照组,差异有统计学意义(P<0.01)。相关分析显示慢性心力衰竭患者治疗前的NYHA分级与血清生物标志物水平呈正相关,差异有统计学意义(t=5.5、9.0、5.8、4.5,P<0.01)。两组患者治疗期间不良反应发生率比较,差异无统计学意义(χ^(2)=0.21,P=0.5)。结论:穿心莲内酯可有效降低血清BNP、APN、ST-2蛋白、IL-6水平,治疗慢性心力衰竭的临床疗效确切,且安全性较高。

Objective: To observe the clinical efficacy of andrographolide in the treatment of chronic heart failure(CHF) and its impact on heart failure biomarkers. Methods: A total of 80 inpatients with chronic heart failure who were admitted to the hospital from September 2017 to June 2019 were selected. After admission, they were randomly divided into the control group and the observation group according to the hospitalization number, with 40 cases in each group. The control group was given standard medications for CHF, and the observation group was given the andrographolide on the basis of the control group. Both groups were treated for 10 d. The clinical efficacy, serum biomarkers before and after treatment, B-type brain natriuretic peptide(BNP), interleukin-6(IL-6), adiponectin(APN), soluble growth stimulating expression gene-2 protein(ST-2 protein) changes were compared between the two groups. Results: The clinical efficacy of the observation group treated with andrographolide was better than that of the control group, with statistically significant difference(χ^(2)=4.58, P<0.01). There were statistically significant differences in serum biomarkers of different NYHA grades between the two groups before treatment(F=83.3, 90.9, 58.4, 190.1, P<0.01). The difference of serum biomarker levels in the observation group was greater than that in the control group, and the difference was statistically significant(P<0.01). Correlation analysis showed that the NYHA classification before treatment in patients with chronic heart failure was positively correlated with serum biomarker levels, and the difference was statistically significant(t=5.5, 9.0, 5.8, 4.5, P<0.01).There was no significant difference in the incidence of adverse reactions between the two groups during treatment(χ^(2)=0.21,P=0.5). Conclusion: Andrographolide can effectively reduce serum BNP, APN, ST-2 protein and IL-6 levels, and has definite clinical efficacy and high safety in the treatment of chronic heart failure.