椒目瓜蒌汤结合比索洛尔对心力衰竭患者心肌微循环及氧化/抗氧化平衡的影响

Effect of Jiaomu Gualou Decoction combined with bisoprolol on myocardial microcirculation and oxidation/antioxidant balance in patients with heart failure

目的探讨椒目瓜蒌汤结合比索洛尔对心力衰竭患者心肌微循环及氧化/抗氧化平衡的影响。方法将符合入选标准的2020年3月-2021年2月天津市滨海新区大港中医医院128例心力衰竭患者采用随机数字表法分为2组,每组64例。在常规治疗基础上,对照组口服比索洛尔,研究组在对照组基础上服用椒目瓜蒌汤。2组均连续治疗4周。分别于治疗前后进行中医证候评分;采用超声诊断仪检测左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD),记录24 h心电图ST段下降频次、持续时间及心肌缺血总负荷情况;采用荧光法检测脂质过氧化物(LPO),比色法检测SOD、MDA、GSH-Px活性;记录不良反应,评价临床疗效。结果研究组总有效率为93.75%(60/64)、对照组为79.69%(51/64),2组比较差异有统计学意义(χ^(2)=5.49,P=0.019)。研究组治疗后气短、痰多、胸肋胀满、疲倦乏力评分均低于对照组(t值分别为8.48、8.15、8.86、6.88,P值均<0.001)。治疗后,研究组LVEF[(53.26±5.18)%比(48.65±5.27)%,t=4.99]高于对照组,LVESD[(42.59±3.26)mm比(46.98±3.55)mm,t=7.29]、LVEDD[(52.79±4.15)mm比(57.48±4.60)mm,t=6.06]低于对照组(P<0.01);ST段下降频次[(2.51±0.42)次/24 h比(3.79±0.55)次/24 h,t=14.80]、持续时间[(15.26±3.45)min/24 h比(22.65±3.71)min/24 h,t=11.67]及心肌缺血总负荷[(25.79±5.13)mm/min比(38.02±5.44)mm/min,t=13.09]均低于对照组(P<0.01)。治疗后,研究组血清GSH-Px、SOD水平高于对照组(t值分别为10.97、14.37,P值均<0.001),LPO、MDA水平低于对照组(t值分别为7.50、11.04,P值均<0.001)。治疗期间,研究组不良反应发生率为4.69%(3/64)、对照组为7.81%(5/64),2组比较差异无统计学意义(χ^(2)=0.13,P=0.715)。结论椒目瓜蒌汤结合比索洛尔可有效改善心力衰竭患者的心功能及心肌微循环,促进机体氧化/抗氧化平衡,减轻患者临床症状,提高疗效,且安全性良好。

Objective To investigate the effect of Jiaomu Gualou Decoction combined with bisoprolol on myocardial microcirculation and oxidative/antioxidant balance in patients with heart failure.Methods A total of 128 patients with heart failure who met the inclusion criteria from March 2020 to February 2021 in Dagang Hospital of Traditional Chinese Medicine,Binhai New Area,Tianjin were divided into 2 groups by random number table method,with 64 in each group.On the basis of conventional treatment,the control group was given oral bisoprolol,and the study group was given Jiaomu Gualou Decoction and oral bisoprolol.Both groups were treated continuously for 4 weeks.TCM syndrome scores were performed before and after treatment.The left ventricular ejection fraction(LVEF),left ventricular end-systolic diameter(LVESD),and left ventricular end-diastolic diameter(LVEDD)were detected by ultrasonic diagnostic equipment,and the frequency,duration and total myocardial ischemia load of the 24-hour ECG were recorded.Lipid peroxide(LPO)was detected by fluorescence method,SOD,MDA and GSH-Px were detected by colorimetric method.The adverse events were recorded and clinical response was evaluated.Results The response rate was 93.75%(60/64)in the study group and 79.69%(51/64)in the control group,and the difference between the two groups was statistically significant(χ^(2)=5.49,P=0.019).After treatment,the scores of shortness of breath,phlegm,sternocostal fullness,and fatigue in the study group were significantly lower than those in the control group(t values were 8.48,8.15,8.86,and 6.88,respectively,all Ps<0.001).After treatment,the LVEF of the study group[(53.26±5.18)%vs.(48.65±5.27)%,t=4.99]was significantly higher than that of the control group,and the LVESD[(42.59±3.26)mm vs.(46.98±3.55)mm,t=7.29],LVEDD[(52.79±4.15)mm vs.(57.48±4.60)mm,t=6.06]significantly lower than the control group(P<0.01).After treatment,frequency of ST segment fall[(2.51±0.42)times/24 h vs.(3.79±0.55)times/24 h,t=14.80],duration[(15.26±3.45)min/24 h vs.(22.65±3.71)min/24 h,t=11.67]and total myocardial ischemia load[(25.79±5.13)mm/min vs.(38.02±5.44)mm/min,t=13.09]were significantly lower than those in the control group(P<0.01).After treatment,the levels of serum GSH-Px and SOD in the study group were significantly higher than those in the control group(t values were 10.97,14.37,respectively,all Ps<0.001),while the levels of LPO and MDA were significantly lower than those in the control group(t values were 7.50,11.04,respectively,all Ps<0.001).During the treatment period,the incidence of adverse events was 4.69%(3/64)in the study group and 7.81%(5/64)in the control group,with no significant difference between the two groups(χ^(2)=0.13,P=0.715).Conclusion The Jiaomu Gualou Decoction combined with bisoprolol can improve the cardiac function and myocardial microcirculation in patients with heart failure,promote the body's oxidation/antioxidant balance,relieve the clinical symptoms of patients,and improve the response effect safely.