椒目瓜蒌汤治疗慢性心力衰竭的效果及对心肌微循环的影响

Effect of Jiaomu Gualou Decoction in the Treatment of Chronic Heart Failure and Its Influence on Myocardial Microcirculation

目的:探究椒目瓜蒌汤治疗慢性心力衰竭的效果及对心肌微循环的影响。方法:在2019年11月-2022年11月展开此次研究,选取此期间在泰安市中医二院治疗的慢性心力衰竭患者92例,应用随机数字表法将其分为对照组(n=46,采用常规西医治疗)和研究组(n=46,采用常规西医联合椒目瓜蒌汤治疗)。对比两组中医症候积分(气短、痰多、胸肋胀满、疲倦乏力)、心功能指标[左室射血分数(LVEF)、左室收缩期末内径(LVESD)、左室舒张期末内径(LVEDD)]、炎症因子[白细胞介素-8(IL-8)、白细胞介素-17(IL-17)、超敏C反应蛋白(hs-CRP)]、心肌微循环指标(ST段下降频次、持续时间、心肌缺血总负荷)及氧化应激指标[脂质过氧化物(LPO)、超氧化物歧化酶(SOD)、丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-Px)]。结果:治疗前,两组气短、痰多、胸肋胀满、疲倦乏力评分比较,差异均无统计学意义(P>0.05);治疗后,两组气短、痰多、胸肋胀满、疲倦乏力均下降,研究组均低于对照组(P<0.05)。治疗前,两组LVEF、LVESD、LVEDD比较,差异均无统计学意义(P>0.05);治疗后,两组LVEF均升高,LVESD、LVEDD均降低,研究组LVEF高于对照组,LVESD、LVEDD均低于对照组(P<0.05)。治疗前,两组IL-8、IL-17、hs-CRP水平比较,差异均无统计学意义(P>0.05);治疗后,两组IL-8、IL-17、hs-CRP水平均降低,研究组均低于对照组(P<0.05)。治疗前,两组ST段下降频次、持续时间、心肌缺血总负荷比较,差异均无统计学意义(P>0.05);治疗后,两组ST段下降频次、持续时间、心肌缺血总负荷均降低,研究组均低于对照组(P<0.05)。治疗前,两组LPO、SOD、MDA、GSH-Px比较,差异均无统计学意义(P>0.05);治疗后,两组GSH-Px、SOD水平均升高,LPO、MDA水平均降低,研究组GSH-Px、SOD水平均高于对照组、LPO、MDA水平均低于对照组(P<0.05)。结论:慢性心力衰竭患者采用椒目瓜蒌汤治疗,可改善患者心功能、心肌微循环,减轻炎症反应及氧化应激程度。

Objective:To investigate the effect of Jiaomu Gualou Decoction in the treatment of chronic heart failure and its influence on myocardial microcirculation.Method:This study was conducted from November 2019 to November 2022.92 patients with chronic heart failure treated in Tai’an Second Hospital of Traditional Chinese Medicine during this period were selected and divided into a control group(n=46,treated with conventional western medicine)and a study group(n=46,treated with conventional western medicine combined with Jiaomu Gualou Decoction)by applying the random number table method.The TCM symptoms scores(shortness of breath,phlegm,chest and rib swelling,fatigue),cardiac function indexes[left ventricular ejection fraction(LVEF),left ventricular end systolic diameter(LVESD),left ventricular end diastolic diameter(LVEDD)],inflammatory factors[interleukin-8(IL-8),interleukin-17(IL-17),hypersensitive C reactive protein(hs-CRP)],myocardial microcirculatory indexes(ST-segment drop frequency,duration,total myocardial ischemic load)and oxidative stress indexes[lipid peroxidation(LPO),superoxide dismutase(SOD),malondialdehyde(MDA),glutathione peroxidase(GSH-Px)].Result:Before treatment,there were no significant differences in the scores of shortness of breath,phlegm,chest and rib swelling and fatigue between the two groups(P>0.05).After treatment,the scores of shortness of breath,phlegm,chest and rib swelling,and fatigue decreased in both groups,and those in the study group were lower than those in the control group(P<0.05).Before treatment,there were no significant differences in LVEF,LVESD and LVEDD between the two groups(P>0.05).After treatment,LVEF increased,LVESD and LVEDD decreased in both groups,and LVEF in the study group was higher than that in the control group,LVESD and LVEDD in the study group were lower than those in the control group(P<0.05).Before treatment,there were no significant differences in the levels of IL-8,IL-17 and hs-CRP between the two groups(P>0.05).After treatment,the levels of IL-8,IL-17 and hs-CRP decreased in both groups,and those in the study group were lower than those in the control group(P<0.05).Before treatment,there were no significant differences in the frequency,duration and total myocardial ischemia load of ST-segment between the two groups(P>0.05).After treatment,the frequency,duration and total myocardial ischemia load of ST-segment decreased in both groups,and those in the study group were lower than those in the control group(P<0.05).Before treatment,there were no significant differences in LPO,SOD,MDA and GSH-Px between the two groups(P>0.05).After treatment,the levels of GSH-Px and SOD increased,LPO and MDA decreased in both groups,and the levels of GSH-Px and SOD in the study group were higher than those in the control group,and the levels of LPO and MDA were lower than those in the control group(P<0.05).Conclusion:Treatment of patients with chronic heart failure with Jiaomu Gualou Decoction can improve patients'cardiac function,myocardial microcirculation and reduce the degree of inflammatory response and oxidative stress.