补益强心片联合曲美他嗪对老年慢性心力衰竭患者疗效的影响

Influence of Buyi Qiangxin Tablets combined with trimetazidine on curative effect in elderly patients with chronic heart failure

目的探讨补益强心片联合曲美他嗪治疗老年慢性心力衰竭(CHF)的临床疗效及对血管活性物质和炎性因子的影响。方法选取2019年1月至2020年6月于商丘市立医院内科收治的152例老年CHF患者,随机分为对照组和观察组,每组各76例,对照组给予曲美他嗪治疗,观察组在对照组基础上联合补益强心片,均连续治疗4周。治疗后,比较两组患者心功能指标[左室射血分数(LVEF)、心输出量(CO)、6 min步行试验(6-MWT)及血浆脑钠肽(BNP)水平]、心室重构指标[左室心肌质量指数(LVMI)、左室平均室壁应力(MWS)]、血管活性物质[血管型血友病因子(vWF)、内皮素-1(ET-1)、一氧化氮(NO)、6-酮-前列腺素F1α]和炎性因子[肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、半乳糖凝集素-3(G-3)、C-反应蛋白(CRP)]的变化及不良反应。结果两组患者治疗后心功能指标、心室重构指标、血管活性物质、炎性因子均较治疗前有所改善(P<0.05)。治疗后,观察组心功能指标LVEF、CO和6-MWT明显高于对照组(P<0.05),BNP水平明显低于对照组(P<0.05);观察组心室重构指标LVMI和MWS明显低于对照组(P<0.05);炎性因子TNF-α、IL-6、G-3、CRP水平明显低于对照组(P<0.05);观察组血管活性物质vWF、ET-1水平明显低于对照组(P<0.05),NO、6-酮-前列腺素F1α水平明显高于对照组(P<0.05);两组患者不良反应总发生率差异无统计学意义(P>0.05)。结论补益强心片联合曲美他嗪治疗老年CHF疗效较好,可有效改善心功能,延缓心室重构,调节血管活性物质和炎性因子水平,安全性较高。

Objective To discuss the influence of Buyi Qiangxin Tablets combined with trimetazidine on clinical efficacy,vasoactive substances and inflammatory factors in elderly patients with chronic heart failure(CHF).Methods Elderly CHF patients(n=152)were chosen from Department of Internal Medicine in Shangqiu Municipal Hospital from Jan.2019 to June 2020,and divided randomly into control group and observation group(each n=76).The control group was treated with trimetazidine,and observation group was treated with trimetazidine combined with Buyi Qiangxin Tablets for 4 weeks.After treatment,the changes of indexes of heart function[left ventricular ejection fraction(LVEF),cardiac output(CO),6-minute walk test(6MWT),brain natriuretic peptide(BNP)],indexes of ventricular remodeling[left ventricular mass index(LVMI),left ventricular mean wall stress(MWS)],vasoactive substances[vascular Willebrand factor(vWF),endothelin-1(ET-1),nitric oxide(NO),6-keto-prostaglandin F1α(6-keto-PGF1α)],inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),galectin-3(Gal-3),C-reactive protein(CRP)]and adverse reactions were compared between 2 groups.Results The indexes of heart function,indexes of ventricular remodeling,vasoactive substances and inflammatory factors were improved in 2 groups after treatment(P<0.05).After treatment,LVEF,CO and 6-MWT were significantly higher(P<0.05)and BNP level was significantly lower(P<0.05)in observation group than those in control group.LVMI and MWS were significantly lower(P<0.05),and levels of TNF-α,IL-6,Gal-3 and CRP were significantly lower in(P<0.05)in observation group than those in control group.The levels of vWF and ET-1 were significantly lower(P<0.05),and levels of NO and 6-keto-PGF1αwere significantly higher(P<0.05)in observation group than those in control group.The difference in incidence rates of adverse reactions had no statistical significance(P>0.05)between 2 groups.Conclusion Buyi Qiangxin Tablets combined with trimetazidine has a higher curative effect in elderly CHF patients,and it can effectively improve heart function,delay ventricular remodeling and regulate levels of vasoactive substances and inflammatory factors with higher safety.