心通颗粒联合依洛尤单抗辅助治疗慢性心力衰竭合并高脂血症的疗效及对机体炎症介质的影响

Efficacy of Xintong Granules combined with evolocumab in adjuvant treatment of chronic heart failure complicated with hyperlipidemia and its effect on inflammatory mediators

目的探究心通颗粒联合依洛尤单抗辅助治疗慢性心力衰竭(CHF)合并高脂血症的疗效及对机体炎症介质的影响。方法回顾性选取2019年1月—2021年6月山西省心血管病医院收治的150例CHF合并高脂血症患者作为研究对象,根据治疗方案分为对照组和试验组,每组各75例。对照组在常规化学药抗CHF及调脂治疗基础上加用依洛尤单抗注射液治疗,每2周sc 140 mg。试验组在对照组基础上加用心通颗粒,每次10.6 g,每天3次,口服。两组均治疗8周。比较两组疗效,分别于治疗前后测定两组患者心功能[心输出量(CO)、左室舒张末期内径(LVEDD)、左心室射血分数(LVEF)、左室收缩末期内径(LVESD)]、血脂[三酰甘油(TG)、低密度脂蛋白-胆固醇(LDL-C)、总胆固醇(TC)、高密度脂蛋白-胆固醇(HDL-C)]水平及炎症介质[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、基质金属蛋白酶-9(MMP-9)]水平,记录治疗后随访6个月两组不良心血管事件(MACE)发生情况,记录治疗期间两组不良反应发生情况。结果治疗8周后,试验组总有效率(93.33%)显著高于对照组(81.33%、P<0.05)。治疗前两组患者CO、LVEDD、LVEF、LVESD水平比较,差异无统计学意义(P>0.05),治疗后两组患者CO、LVEDD、LVEF、LVESD水平均较治疗前改善(P<0.05),且试验组CO、LVEF较对照组显著升高(P<0.05),LVEDD、LVESD水平较对照组显著降低(P<0.05)。治疗前两组患者TG、LDL-C、TC、HDL-C水平比较,差异无统计学意义(P>0.05),治疗后两组TG、LDL-C、TC、HDL-C水平均较治疗前显著改善(P<0.05),且试验组TG、LDL-C、TC均显著低于对照组(P<0.05),HDL-C显著高于对照组(P<0.05)。治疗前两组患者血清IL-6、TNF-α、CRP、MMP-9水平比较,差异无统计学意义(P>0.05),治疗后两组患者血清IL-6、TNF-α、CRP、MMP-9水平均较治疗前显著降低(P<0.05),且试验组较对照组降低更显著(P<0.05)。两组MACE、不良反应发生率比较,差异无统计学意义(P>0.05)。结论心通颗粒联合依洛尤单抗辅助治疗CHF合并高脂血症患者效果显著,可有效提高心功能,降低血脂水平,减轻机体炎症,且安全性高。

Objective To investigate the efficacy of Xintong Granule combined with evolocumab in adjuvant treatment of chronic heart failure(CHF)complicated with hyperlipidemia and its effect on inflammatory mediators.Methods A total of 150 patients with CHF complicated with hyperlipidemia treated in Shanxi Provincial Cardiovascular Hospital from January 2019 to June 2021 were retrospectively selected as the research objects.According to the treatment plan,they were divided into control group and experimental group,with 75 cases in each group.Patients in control group were treated with Evolocumab Injection on the basis of conventional chemical anti CHF and lipid-lowering therapy,sc 140 mg every two weeks.On the basis of the control group,patients in experimental group were added Xinxintong Granules,10.6 g each time,three times a day,orally.Both groups were treated for eight weeks.The curative effects of two groups were compared.The levels of cardiac function[cardiac output(CO),left ventricular end diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),left ventricular end systolic diameter(LVESD)],blood lipids[triacylglycerol(TG),low density lipoprotein cholesterol(LDL-C),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C)]and inflammatory mediators[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),C-reactive protein(CRP)and matrix metalloproteinase-9(MMP-9)]were measured before and after treatment.Incidence of adverse cardiovascular events(MACE)in two groups was recorded during the six-month follow-up after treatment.The adverse reactions of two groups during treatment were recorded.Results After eight weeks of treatment,the total effective rate of experimental group(93.33%)was significantly higher than that of control group(81.33%,P<0.05).There was no significant difference in levels of CO,LVEDD,LVEF and LVESD between two groups before treatment(P>0.05).After treatment,the levels of CO,LVEDD,LVEF and LVESD in two groups were improved compared with those before treatment(P<0.05),and the levels of CO and LVEF in experimental group were significantly higher than those in control group(P<0.05),and the levels of LVEDD and LVESD in experimental group were significantly lower than those in control group(P<0.05).There was no significant difference in levels of TG,LDL-C,TC and HDL-C between two groups before treatment(P>0.05).After treatment,the levels of TG,LDL-C,TC and HDL-C in two groups were significantly improved compared with those before treatment(P<0.05),and TG,LDL-C and TC in experimental group were significantly lower than those in control group(P<0.05),and HDL-C was significantly higher than those in control group(P<0.05).There was no significant difference in the levels of serum IL-6,TNF-α,CRP and MMP-9 in two groups before treatment(P>0.05).After treatment,the levels of serum IL-6,TNF-α,CRP and MMP-9 in two groups were significantly lower than those before treatment(P<0.05),and the levels of serum IL-6,TNF-α,CRP and MMP-9 in experimental group were significantly lower than those in control group(P<0.05).There was no significant difference in the incidence of MACE and adverse reactions between two groups(P>0.05).Conclusion Xintong Granule combined with evolocumab is effective in adjuvant treatment of CHF patients with hyperlipidemia,which can effectively improve cardiac function,reduce blood lipid level,reduce body inflammation,and has high safety.