生脉散合血府逐瘀汤加减方对气阴两虚、心血瘀阻型慢性心力衰竭患者相关疗效性指标及NT-proBNP、ACR的影响

Effects of Modified Formula of Shengmai Powder Plus Xuefu Zhuyu Decoction on the Efficacy Indicators and NT-proBNP and Albumin-Creatinine Ratio in Patients with Chronic Heart Failure of Qi-Yin Deficiency and Heart-Blood Stasis Obstruction Type

【目的】探究生脉散合血府逐瘀汤加减方对气阴两虚、心血瘀阻型慢性心力衰竭(CHF)患者的相关疗效性指标及N末端B型脑钠肽(NT–proBNP)、尿白蛋白/肌酐比值(ACR)水平的影响。【方法】将80例气阴两虚、心血瘀阻型CHF患者随机分为对照组和观察组,每组各40例。对照组给予常规西药抗心衰治疗,观察组在对照组的基础上加用生脉散合血府逐瘀汤加减方治疗,疗程为6周。观察2组患者治疗前后心功能指标、血流动力学指标、6 min步行距离、血清NT–proBNP及ACR水平的变化情况。【结果】(1)心功能方面,治疗后,2组患者的左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)等心功能指标均较治疗前改善(P<0.05),且观察组对各项心功能指标的改善作用均明显优于对照组(P<0.01)。(2)血流动力学方面:治疗后,2组患者的平均二尖瓣跨瓣压差(MVPG)、左心房平均压(MLAP)、肺动脉平均压(MPAP)等血流动力学指标均较治疗前改善(P<0.05),且观察组对各项血流动力学指标的改善作用均明显优于对照组(P<0.05或P<0.01)。(3)6 min步行距离方面,治疗后,2组患者的6 min步行距离均较治疗前明显提高(P<0.01),且观察组对6 min步行距离的提高幅度明显优于对照组(P<0.05)。(4)生化指标方面,治疗后,2组患者的血清NT-proBNP、ACR水平均较治疗前明显降低(P<0.05),且观察组对血清NT-proBNP、ACR水平的降低作用均明显优于对照组(P<0.01)。【结论】生脉散合血府逐瘀汤加减方能有效改善气阴两虚、心血瘀阻型CHF患者的各项疗效性指标,降低血清NT–proBNP水平,并可防治CHF患者的早期肾功能损害。

Objective To investigate the effects of the modified formula of Shengmai Powder plus Xuefu Zhuyu Decoction on the efficacy indicators and levels of N-terminal pro-brain natriuretic peptide(NT-proBNP)and urinary albumin-creatinine ratio(ACR)in the patients with chronic heart failure(CHF)of qi-yin deficiency and heart-blood stasis obstruction type.Methods Eighty cases of CHF with qi-yin deficiency and heart-blood stasis obstruction type were randomly divided into the control group and the observation group,with 40 cases in each group.The control group was treated with conventional western medicine against heart failure,while the observation group was treated with modified formula of Shengmai Powder plus Xuefu Zhuyu Decoction on the basis of treatment for the control group.Both groups were treated for 6 weeks.Changes in cardiac function indexes,hemodynamic indexes,6-minute walking distance,and serum NT-proBNP and ACR levels in the two groups were observed before and after treatment.Results(1)After treatment,the cardiac function indices of left ventricular end diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF)and left ventricular end systolic diameter(LVESD)were improved in both groups compared with those before treatment(P<0.05),and the improvement of each cardiac function index in the observation group was significantly superior to that in the control group(P<0.01).(2)After treatment,the hemodynamic indexes of mean mitral valve pressure gradient(MVPG),mean left atrial pressure(MLAP),and mean pulmonary artery pressure(MPAP)in both groups were improved compared with those before treatment(P<0.05),and the improvement of each hemodynamic index in the observation group was significantly superior to that in the control group(P<0.05 or P<0.01).(3)The 6-minute walking distance of both groups was significantly increased after treatment compared with that before treatment(P<0.01),and the increase of the distance in the observation group was more significant than that in the control group(P<0.05).(4)After treatment,the levels of biochemical indexes of serum NT-proBNP and ACR in both groups were significantly decreased compared with those before treatment(P<0.05),and the decrease of serum NT-proBNP and ACR levels in the observation group was more significant than that in the control group(P<0.01).Conclusion The modified formula of Shengmai Powder plus Xuefu Zhuyu Decoction can effectively improve the efficacy indexes of CHF patients with qi-yin deficiency and heart-blood stasis obstruction syndrome,decrease serum NT-proBNP levels and prevent early renal impairment in CHF patients.