芪苈强心胶囊联合静脉补铁治疗慢性心力衰竭合并缺铁患者的临床疗效

Clinical Effect of Qiliqiangxin Capsule Combined with Intravenous Iron Supplement on Patients with Chronic Heart Failure and Iron Deficiency

目的研究芪苈强心胶囊联合静脉补铁治疗慢性心力衰竭合并缺铁患者的临床疗效。方法收集2020年9月至2021年9月张家口市第一医院收治的106例慢性心力衰竭合并缺铁患者的临床资料,根据治疗方式不同分为对照组(51例)和研究组(55例)。两组均给予常规抗心力衰竭治疗,对照组在常规治疗基础上联合静脉补铁治疗,5 ml蔗糖铁溶于100 ml 0.9%氯化钠溶液中静脉滴注;研究组在对照组的基础上口服芪苈强心胶囊,每次4粒,每日3次。两组均连续治疗3个月。比较两组的临床疗效,治疗前后血清铁指标[铁蛋白(SF)、血红蛋白(Hb)、总铁结合力(TIBC)、转铁蛋白饱和度(TS)]、6 min步行试验(6MWT)距离、左心室射血分数(LVEF)、美国纽约心脏病协会(NYHA)心功能分级、血清脑钠肽(BNP)、左心室舒张末期内径(LVEDd)水平以及不良反应发生情况。结果研究组临床总有效率高于对照组[89.09%(49/55)比68.63%(35/51)](χ^(2)=6.737,P=0.009)。治疗前后血清SF、Hb、TIBC、TS水平的主效应、组间的主效应差异有统计学意义(P<0.01),各指标组间和时点间存在交互作用(P<0.01);治疗后,两组血清SF、Hb、TIBC、TS水平均高于治疗前(P<0.05),且研究组高于对照组(P<0.05)。治疗前后6MWT距离、LVEF水平的主效应、组间的主效应差异有统计学意义(P<0.01),各指标组间和时点间存在交互作用(P<0.01);治疗后,两组6MWT距离、LVEF水平均高于治疗前(P<0.05),且研究组高于对照组(P<0.05)。治疗后,两组NYHA心功能分级均优于治疗前(P<0.01),且研究组优于对照组(P<0.01)。治疗前后BNP、LVEDd水平的主效应、组间的主效应差异有统计学意义(P<0.01),各指标组间和时点间存在交互作用(P<0.01);治疗后,两组血清BNP、LVEDd水平均低于治疗前(P<0.05),且研究组低于对照组(P<0.05)。两组不良反应发生率比较差异无统计学意义(P>0.05)。结论芪苈强心胶囊联合静脉补铁治疗慢性心力衰竭合并缺铁患者的临床效果显著,更有利于改善铁指标,提高患者运动能力、心功能,降低BNP、LVEDd水平,且安全性高。

Objective To study the clinical effect of Qiliqiangxin capsule combined with intravenous iron supplement on patients with chronic heart failure and iron deficiency.Methods The clinical data of 106 patients with chronic heart failure combined with iron deficiency admitted to Zhangjiakou First Hospital from Sep.2020 to Sep.2021 were collected and divided into a control group(51 cases)and a study group(55 cases)according to different treatment methods.Both groups were given conventional anti-heart failure treatment,and the control group was combined with intravenous iron supplementation(5 ml of iron sucrose dissolved in 100 ml 0.9%sodium chloride solution by intravenous drip),whilethe study group was added with Qiliqiangxin capsule(4 capsules each time,3 times a day,oral)on the basis of the control group′s regimen.Both groups were treated continuously for 3 months.The clinical effects of the two groups were compared,including serum iron indicators[ferritin(SF),hemoglobin(Hb),total iron binding capacity(TIBC),transferrin saturation(TS)],6-minute walk test(6MWT)distance,left ventricular ejection fraction(LVEF),NYHA cardiac function classification,serum brain natriuretic peptide(BNP),left ventricular end diastolic diameter(LVEDd)level before and after treatment,as well as adverse reactions.Results The total effective rate of the study group was higher than that of the control group[89.09%(49/55)vs 68.63%(35/51)](χ^(2)=6.737,P=0.009).The main effects of serum SF,Hb,TIBC and TS levels before and after treatment and between groups were statistically significantly different(P<0.01),and there were interactions between groups and time points(P<0.01).After treatment,serum SF,Hb,TIBC and TS levels in both groups were higher than before treatment(P<0.05),and the study group higher than the control group(P<0.05).The main effect of 6MWT distance and LVEF levels before and after treatment and between groups were statistically significantly different(P<0.01),and there were interactions between groups and time points(P<0.01).After treatment,the levels of 6MWT distance and LVEF in both groups were higher than before treatment(P<0.05),and the study group higher than the control group(P<0.05).After treatment,NYHA cardiac function grades in both groups were better than before treatment(P<0.01),and the study group better than the control group(P<0.01).The main effects of BNP and LVEDd levels before and after treatment and between groups were statistically significantly different(P<0.01),and there were interactions between groups and time points(P<0.01).After treatment,serum BNP and LVEDd levels in both groups were lower than before treatment(P<0.05),and the study group lower than the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Qiliqiangxin capsule combined with intravenous iron supplementation has significant clinical therapeutic effect in the treatment of patients with chronic heart failure and iron deficiency,which is more conducive to improving iron indicators,improving patients′exercise capacity and cardiac function,reducing patients′BNP and LVEDd levels,and has high safety.