益气强心汤对冠脉慢性完全闭塞病变心衰患者心室重构影响

Effect of Yiqi Qiangxin decoction on ventricular remodeling in patients with chronic complete coronary occlusion-induced heart failure

目的 探讨益气强心汤对冠脉慢性完全闭塞病变(CTO)心衰患者心室重构影响。方法选取2018年8月至2020年8月于浙江省台州医院就诊的冠脉CTO心衰患者66例,根据随机数字表法分为对照组与观察组,每组33例。对照组在西医常规治疗基础上加用沙库巴曲缬沙坦钠片治疗,观察组在对照组基础上给予益气强心汤治疗。两组疗程均为3个月。观察两组患者治疗前后的临床疗效,中医证候评分,心肌损伤因子水平[N末端B型利钠肽原(NT-proBNP)、肌酸激酶同工酶(CK-MB)、肌酸激酶(CK)],心室重构参数[左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室射血分数(LVEF)、每搏输出量(SV)、左心室后壁厚度(LVPWT)、左心室内径缩短率(LLVFS)、室间隔收缩末期厚度(IVSS)],心室重构血清学指标[血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)、基质金属蛋白酶-2(MMP-2)、内皮素-1(ET-1)]。结果 与对照组比较,观察组总有效率升高(87.88%比69.70%,P<0.05);治疗后血清AngⅡ、ALD、ET-1、MMP-2水平[(73.81±22.67)pg/mL比(113.15±24.73)pg/mL,(198.44±26.93)pg/mL比(273.29±23.85)pg/mL,(65.74±21.15)ng/L比(81.32±20.38)ng/L,(122.14±13.03)μg/L比(145.39±17.58)μg/L,P<0.05]显著降低。与对照组比较,观察组治疗后LVEDD、LVESD、LVPWT、IVSS值[(47.63±6.95)mm比(51.94±6.67)mm,(32.34±6.06)mm比(35.91±6.85)mm,(8.03±0.68)mm比(11.94±0.73)mm,(8.25±0.17)mm比(11.26±0.28)mm,P<0.05]显著降低,LVEF、SV、LVFS值[(51.35±3.14)%比(46.26±4.08)%,(85.26±12.02)mL比(78.37±12.49)mL,(22.62±2.23)%比(18.87±2.31)%,P<0.05]显著升高。与对照组比较,观察组治疗后气短喘息、乏力、心悸、倦怠懒言、汗出、语声低微、面色紫暗评分[(1.04±0.27)分比(2.15±0.65)分,(0.96±0.21)分比(1.82±0.59)分,(0.87±0.15)分比(1.64±0.28)分,(0.78±0.23)分比(1.47±0.51)分,(0.87±0.22)分比(1.48±0.63)分,(0.69±0.19)分比(1.41±0.31)分,(0.91±0.22)分比(1.66±0.58)分,P<0.05]显著降低。与对照组比较,观察组治疗后血清NT-proBNP、CK-MB、CK水平[(536.23±91.81)pg/mL比(742.17±102.58)pg/mL,(19.35±2.66)U/L比(28.92±3.78)U/L,(135.59±18.26)U/L比(169.86±21.08)U/L,P<0.05]显著降低。结论 益气强心汤治疗冠脉CTO心衰患者疗效显著,可降低中医证候评分,减轻心肌损伤,逆转心室重构,保护受损心肌细胞,提高预后水平。

Objective To assess the effect of the Yiqi Qiangxin decoction on ventricular remodeling in patients with chronic complete coronary occlusion-induced heart failure.Methods A total of 66 patients with coronary heart failure with chronic total occlusion lesions were recruited from Taizhou Hospital(Taizhou,Zhejiang,China)between August 2018 and August 2020.The patients were then randomly divided into control and treatment groups(n=33 in each group).The control patients were given sacubitril and valsartan sodium tablets on the basis of conventional Western medicine treatment,whereas the treatment patients received the Yiqi Qiangxin decoction for 3months.These patients were then monitored for clinical efficacy,TCM syndrome score,level of myocardial injury factors,like N-terminal pro-B-type natriuretic peptide(NT-proBNP),creatine kinase isoenzyme(CK-MB),and creatine kinase(CK),ventricular remodeling parameters,such as the left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),left ventricular ejection fraction(LVEF),stroke volume(SV),left ventricular posterior wall thickness(LVPWT),left ventricular diameter shortening rate(LLVFS),and ventricular septal thickness at end-systolic(IVSS),and ventricular remodeling serological indicators,including the angiotensin Ⅱ(AngⅡ),aldosterone(ALD),matrix metalloproteinase-2(MMP-2),and endothelin-1(ET-1)].Results The total effective rate of the treatment group was higher than that of the control group(87.88% vs.69.70%;P<0.05).Compared with the controls,serum levels of AngⅡ (73.81±22.67 vs.113.15±24.73),ALD(198.44±26.93 vs.273.29±23.85),ET-1(65.74±21.15 vs.81.32±20.38),and MMP-2(122.14±13.03 vs.145.39±17.58) were reduced in the treatment group of patients(P<0.05),while values of LVEDD(47.63±6.95 vs.51.94±6.67),LVESD(32.34±6.06 vs.35.91±6.85),LVPWT(8.03±0.68 vs.11.94±0.73),and IVSS(8.25±0.17 vs.11.26±0.28)were also decreased after treatment vs.the controls(P<0.05).However,values of LVEF(51.35±3.14 vs.46.26±4.08),SV(85.26±12.02 vs.78.37±12.49),and LVFS(22.62±2.23 vs.18.87±2.31) were induced after treatment vs.the control patients(P<0.05).Moreover,compared with the control patients group,scores of shortness of breath and wheezing(1.04±0.27 vs.2.15±0.65),fatigue(0.96±0.21 vs.1.82±0.59),palpitations(0.87±0.15 vs.1.64±0.28),lassitude(0.78±0.23 vs.1.47±0.51),sweating(0.87±0.22 vs.1.48±0.63),low voice(0.69±0.19 vs.1.41±0.31),and dark complexion(0.91±0.22 vs.1.66±0.58)were all significantly reduced after treatment(P <0.05).Compared with the control patients,serum levels of NT-proBNP(536.23±91.81 vs.742.17±102.58),CK-MB(19.35±2.66 vs.28.92±3.78),and CK(135.59±18.26 vs.169.86 ±21.08)were also significantly reduced after treatment(P <0.05).Conclusion The Yiqi Qiangxin decoction showed a significant curative effect in patients with chronic complete coronary occlusion lesions-induced heart failure,like reduction of TCM syndrome scores and myocardial injury,reversion of ventricular remodeling,protection of damaged myocardial cells,and prognosis improvement.