真武汤加减联合西药治疗慢性心力衰竭的疗效及其对心功能、NT-proBNP的影响

Clinical Efficacy of Modified Zhenwu Decoction Combined with Western Medicine in the Treatment of Chronic Heart Failure and Its Effects on Cardiac Function and NT-proBNP

目的观察真武汤加减联合西药治疗慢性心力衰竭的疗效及其对心功能、NT-proBNP的影响。方法选取2019年2月—2021年2月期间南阳市中医院收治的阳虚水泛型慢性心衰患者120例,按随机数表法分为对照组和治疗组,每组各60例。对照组采用西医常规治疗,治疗组采用中西医结合治疗。治疗4周后观察比较两组患者:①临床总疗效;②中医症状积分;③心功能指标及血管活性物质水平[左室舒张末期内径(Left ventricular end diastolic dimension,LVEDD)、左室射血分数(Left Ventricular Ejection Fractions,LVEF)、氨基端前脑钠素(N-Terminal Pro-Brain Natriuretic Peptide,NT-proBNP)、血清6-酮-前列腺素F1α(6-keto-prostaglandin F1 alpha,6-keto-PGF1α)、血栓素B2(Thromboxane B2 TXB2 thromboxane B2,TXB2)、内皮素(Endothelin 1,ET-1)];④心血管事件发生率;⑤不良反应发生率。结果治疗后治疗组总有效率89.29%(50/56)明显高于对照组79.31%(46/58),差异有统计学意义(P<0.05)。治疗后两组患者中医症状心悸,水肿,气喘,身寒肢冷积分均较治疗前降低,差异有统计学意义(P<0.05);且治疗组中医症状心悸,水肿,气喘,身寒肢冷积分均较对照组明显降低,差异有统计学意义(P<0.05)。治疗后两组患者LVEDD、LVEF、6MWT、NT-proBNP、6-keto-PGF1、TXB2、ET-1水平均较治疗前明显改善,差异有统计学意义(P<0.05);且治疗组LVEDD、LVEF、6MWT、NT-proBNP、6-keto-PGF1、TXB2、ET-1水平均较对照组明显改善,差异有统计学意义(P<0.05)。治疗后治疗组心功能NYHA分级改善程度明显优于对照组,差异有统计学意义(P<0.05)。治疗后6个月,治疗组心血管事件发生率6.25%(3/48)明显低于对照组28%(14/50),差异有统计学意义(P<0.05)。治疗期间,治疗组药物不良反应发生率31.03%与对照组28.57%比较,差异无统计学意义(P>0.05)。结论真武汤加减联合西药可有效提高阳虚水泛型慢性心力衰竭的临床疗效,改善中医临床症状积分、心功能指标,调节血管内皮细胞功能和NYHA分级,降低心血管事件发生,减少不良反应发生。

Objective To study the clinical efficacy of Zhenwu Decoction combined with western medicine in the treatment of chronic heart failure and its effects on cardiac function and N-terminal pro-brain natriuretic peptide(NT-proBNP).Methods A total of 120 patients with chronic heart failure with yang deficiency and water diffusion type in Nanyang Traditional Chinese Medicine Hospital from February 2019 to February 2021 were included and randomly divided into a control group and a treatment group,with 60 cases in each group.The control group was treated with conventional western medicine,and the treatment group was treated with integrated traditional Chinese and western medicine.After 4 weeks of treatment,the clinical efficacy,traditional Chinese medicine(TCM)syndrome scores,cardiac function indexes,and vasoactive substance levels[left ventricular end-diastolic dimension(LVEDD),left ventricular ejection fractions(LVEF),NT-proBNP,6-keto-prostaglandin F1 alpha(6-keto-PGF1α),thromboxane B2(TXB2),and endothelin 1(ET-1)]of the two groups were compared.Results After treatment,the total clinical effective rate of the treatment group was 89.29%(50/56),which was higher than that of the control group[79.31%(46/58)](P<0.05).After treatment,the TCM syndrome(palpitations,edema,asthma,and cold body and limbs)scores of patients in the treatment group were significantly lower than those in the control group(P<0.05).After treatment,the levels of LVEDD,LVEF,6-min walking test(6 MWT),NT-proBNP,6-keto-PGF1α,TXB2,and ET-1 were improved(P<0.05),and the levels of these indexes in the treatment group were significantly improved as compared with the control group(P<0.05).After treatment,the New York Heart Association(NYHA)Functional Classification of cardiac function in the treatment group was significantly improved as compared with the control group(P<0.05).Six months after treatment,the incidence of cardiovascular events in the treatment group was 6.25%(3/48),which was lower than that in the control group[28%(14/50)](P<0.05).During treatment,the incidence of adverse reactions in the treatment group and the control group was 36%and 33.33%,respectively,and the difference was not statistically significant(P>0.05).Conclusion Zhenwu Decoction combined with western medicine can effectively improve the total clinical efficacy of the treatment of chronic heart failure with yang deficiency and water diffusion type,improve the TCM syndrome scores and cardiac function indexes,regulate vascular endothelial cell function and NYHA Functional Classification,and reduce the incidence of cardiovascular events and adverse reactions.