益气回阳汤联合西药对慢性心力衰竭患者外周血N-末端B型利钠肽原、和肽素水平的影响

Effect of Yiqi Huiyang Tang Combined with Western Medicine on Levels of N-Terminal B-Type Natriuretic Peptide and Copeptide in Peripheral Blood of Patients with Chronic Heart Failure

目的:观察益气回阳汤联合西药对慢性心力衰竭(CHF)患者外周血N-末端B型利钠肽原(NTproBNP)、和肽素水平的影响。方法:选取117例CHF患者作为研究对象,按随机数字表法分为观察组58例及对照组59例。对照组给予西药治疗,观察组在对照组基础上给予益气回阳汤治疗。观察2组临床疗效及治疗期间不良反应发生率,比较2组治疗前后NYHA心功能分级、中医证候积分、Lee氏心衰评分、NTproBNP、和肽素、心钠肽(ANP)、血浆基质金属蛋白酶抑制因子1(TIMP1)、醛固醇、血管紧张素Ⅱ(AngⅡ)、基质金属蛋白酶1(MMP1)水平、左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)指标值的变化。结果:观察组临床疗效总有效率为87.93%,对照组为72.88%,2组比较,差异有统计学意义(P<0.05)。治疗后,2组NYHA心功能分级均较治疗前改善(P<0.05),观察组NYHA心功能分级改善优于对照组(P<0.05)。治疗后,2组中医证候积分、Lee氏心衰评分均较治疗前下降,观察组上述2项评分均低于对照组,差异均有统计学意义(P<0.05)。治疗后,2组LVEF指标值均较治疗前上升,LVESD、LVEDD指标值均较治疗前下降,差异均有统计学意义;治疗后,观察组LVEF指标值高于对照组,LVESD、LVEDD指标值均低于对照组,差异均有统计学意义(P<0.05)。治疗后,2组NT-proBNP、和肽素、ANP水平均较治疗前下降,观察组上述3项水平均低于对照组,差异均有统计学意义(P<0.05)。治疗后,2组TIMP1、醛固醇、AngⅡ及MMP1水平均较治疗前下降,观察组上述4项水平均低于对照组,差异均有统计学意义(P<0.05)。治疗后,观察组不良反应发生率为6.90%,对照组为10.17%,2组比较,差异无统计学意义(P>0.05)。结论:益气回阳汤联合西药治疗CHF,可减轻患者心肌损伤程度,缓解临床症状,抑制心室重构,改善心功能。

Objective:To observe the effect of Yiqi Huiyang tang combined with western medicine on levels of N-terminal B-type natriuretic peptide(NT-proBNP)and copeptide in peripheral blood of patients with chronic heart failure(CHF).Methods:A total of 117 cases of CHF patients were selected as study objects and divided into the observation group and the control group according to the random number table method,with 58 and 59 cases in each group respectively.The control group was treated with western medicine,and the observation group was additionally treated with Yiqi Huiyang tang based on the treatment of the control group.The clinical effects and the incidence of adverse reactions during treatment were observed in the two groups.The changes in NYHA cardiac function grade,Chinese medicine syndrome score,Lee’s Heart Failure Score,NT-proBNP,copeptide,atrial natriuretic peptide(ANP),plasma tissue inhibitor of matrix metalloproteinases-1(TIMP-1),Aldosteron,angiotensinⅡ(AngⅡ),matrix metalloproteinase 1(MMP1),left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD)and left ventricular end systolic diameter(LVESD)in the two groups before and after treatment were compared.Results:The total effective rate of clinical effect was 87.93%in the observation group and72.88%in the control group,the difference being significant(P<0.05).After treatment,NYHA cardiac function grade in the two groups were improved when compared with those before treatment(P<0.05),and the NYHA cardiac function grade in the observation group was better than that in the control group(P<0.05).After treatment,Chinese medicine syndrome score and Lee’s Heart Failure Score in the two groups were decreased when compared with those before treatment(P<0.05),and the two scores in the observation group were better than those in the control group,differences being significant(P<0.05).After treatment,LVEF indexes in the two groups were increased when compared with those before treatment(P<0.05),and LVESD and LVEDD were decreased,differences being significant(P<0.05);LVEF index in the observation group was higher than that in the control group,and LVESD and LVEDD were lower,differences being significant(P<0.05).After treatment,levels of NT-proBNP,copeptide,and ANP in the two groups were decreased when compared with those before treatment,and the above three levels in observation group were lower than those in the control group,differences being significant(P<0.05).After treatment,levels of TIMP1,Aldosteron,AngⅡand MMP1 in the two groups were decreased when compared with those before treatment,and the above four levels in observation group were lower than those in the control group,differences being significant(P<0.05).After treatment,the incidence of adverse reactions was 6.90%in the observation group and 10.17%in the control group,there being no significance in the difference(P>0.05).Conclusion:Yiqi Huiyang tang combined with western medicine for CHF can reduce the degree of myocardial injury,alleviate clinical symptoms,inhibit ventricular remodeling,and improve heart function.