芪黄健脾滋肾颗粒干预系统性红斑狼疮心功能受累的临床疗效

Clinical Efficacy of Qihuang Jianpi Zishen Granules in Treating Cardiac Involvement in Systemic Lupus Erythematosus

目的:探讨芪黄健脾滋肾颗粒治疗系统性红斑狼疮(SLE)心功能受累的临床疗效及安全性。方法:选取安徽中医药大学附属第一医院风湿免疫科2021年6月至2022年12月的SLE心功能受累的患者62例,随机分为对照组和观察组(每组各31例),对照组给予甲泼尼龙片及硫酸羟氯喹片治疗,观察组在对照组治疗措施基础上加用芪黄健脾滋肾颗粒冲剂,经12周治疗,对比两组治疗效果、心功能指标[左心房舒张末期径(LADd)、左心室舒张末期内径(LVDd)、左室后壁厚度(LVPWTd)、舒张早期峰值血流速度(E峰)、舒张晚期峰值血流速度(A峰)、舒张早期与晚期峰值血流速度比值(E/A)、每搏输出量(SV)、左室射血分数(LVEF)、左室短轴缩短率(LVFS)、B型利钠肽(BNP)]、血管损害指标[一氧化氮(NO)、内皮素-1(ET-1)、血管内皮生长因子(VEGF)、同型半胱氨酸(Hcy)]、炎症指标[红细胞沉降率(ESR)、超敏C反应蛋白(Hs-CRP)]、抗双链DNA(dsDNA)抗体、疾病活动度(SLEDAI)评分、症状体征改善情况及不良反应发生情况。结果:经治疗,对照组患者总有效率为67.74%(21/31),观察组患者总有效率为87.09%(27/31),观察组患者总有效率明显高于对照组,差异具有统计学意义(χ^(2)=6.203,P<0.05),且两组不良反应的发生率差异无统计学意义。与本组治疗前比较,对照组LVDd、LVPWTd、BNP、ET-1、VEGF、Hcy水平均明显降低(P<0.05),E峰、E/A、SV、LVEF、LVFS指标均明显升高(P<0.05);观察组LADd、LVDd、LVPWTd、A峰、BNP、NO、ET-1、VEGF、Hcy水平明显降低(P<0.05),E峰、E/A、SV、LVEF、LVFS指标明显升高(P<0.05)。两组患者心悸、胸闷、呼吸困难、水肿等症状积分均明显降低(P<0.05),ESR、Hs-CRP、ds-DNA、SLEDAI水平均降低(P<0.05)。与对照组治疗后比较,观察组LADd、LVDd、LVPWTd、A峰、BNP指标降低,心悸、胸闷、呼吸困难、水肿等症状积分明显降低(P<0.05),E峰、E/A、SV、LVEF、LVFS指标升高(P<0.05);NO、ET-1、VEGF、Hcy水平明显降低(P<0.05);ESR、Hs-CRP、ds-DNA、SLEDAI水平降低更加明显(P<0.05)。结论:芪黄健脾滋肾颗粒联用硫酸羟氯喹、甲泼尼龙可显著改善SLE累及心脏损害患者的多项指标和症状、体征,具有一定的临床应用价值。

Objective:To investigate the clinical efficacy and safety of Qihuang Jianpi Zishen granules in the treatment of cardiac involvement in systemic lupus erythematosus(SLE).Method:A total of 62 SLE patients with cardiac involvement treated in the Department of Rheumatology and Immunology,the First Affiliated Hospital of Anhui University of Chinese Medicine from June 2021 to December 2022 were randomized into control and observation groups(n=31).The control group was treated with methylprednisolone tablets and hydroxychloroquine sulfate tablets,and the observation group with Qihuang Jianpi Zishen granules on the basis of the therapy in the control group.After 12 weeks of treatment,the two groups were compared in terms of the therapeutic effect,cardiac function indicators[left atrial end-diastolic diameter(LADd),left ventricular enddiastolic diameter(LVDd),left ventricular posterior wall thickness(LVPWTd),peak blood flow velocity in early diastolic period(peak E),peak blood flow velocity in late diastolic period(peak A),E/A ratio,stroke volume(SV),left ventricular ejection fraction(LVEF),left ventricular short axis shortening rate(LVFS),and B-type natriuretic peptide(BNP)],vascular damage indicators[nitric oxide(NO),endothelin-1(ET-1),vascular endothelial growth factor(VEGF),and homocysteine(Hcy)],inflammation indicators[erythrocyte sedimentation rate(ESR)and hypersensitive C-reactive protein(Hs-CRP)],anti-double-stranded DNA(dsDNA)antibodies,disease activity index(SLEDAI)score,mitigation of symptoms and signs,and occurrence of adverse reactions.Result:The total response rate in the observation group was 87.09%,which was higher than that(67.74%)in the control group(P<0.01),and the incidence of adverse reactions had no significant difference between the two groups.After treatment,the control group showed lowered LVDd,LVPWTd,BNP,ET-1,VEGF,and Hcy(P<0.05)and increased E peak,E/A ratio,SV,LVEF,and LVFS(P<0.05).In the observation group,LADd,LVDd,LVPWTd,peak A,BNP,NO,ET-1,VEGF,and Hcy decreased(P<0.05),while peak E,E/A ratio,SV,LVEF and LVFS increased(P<0.05)after treatment.The treatment in both groups decreased the scores of palpitation,chest tightness,dyspnea,and edema(P<0.05),reduced ESR,Hs-CRP,ds-DNA,and SLEDAI(P<0.05).After treatment,the observation group had lower LADd,LVDd,LVPWTd,peak A,BNP,and scores of palpation,chest tightness,dyspnea,and edema(P<0.05)and higher peak E,E/A ratio,SV,LVEF,and LVFS(P<0.05)than the control group.In addition,the observation group had lower NO,ET-1,VEGF,Hcy,ESR,Hs-CRP,ds-DNA,and SLEDAI than the control group(P<0.05).Conclusion:Qihuang Jianpi Zishen granules combined with hydroxychloroquine sulfate and methylprednisolone can improve multiple indicators and mitigate the symptoms and signs of SLE patients with cardiac involvement,demonstrating a clinical application value.