稳心颗粒联合螺内酯对慢性心力衰竭患者左室功能、运动耐力及VEGF、NT-proBNP的影响

Effects of Wenxin granules combined with spironolactone on left ventricular function, exercise tolerance, VEGF and NT-proBNP in patients with chronic heart failure

目的观察稳心颗粒联合螺内酯对慢性心力衰竭(CHF)患者左室功能、运动耐力及血清血管内皮生长因子(VEGF)、N端前脑钠肽(NT-proBNP)的影响。方法前瞻性选择2021年5月至2023年1月芜湖市第一人民医院收治的106例CHF患者为研究对象,采用随机数字表法将其分为联合组和对照组,每组各53例。两组均给予常规治疗,在此基础上对照组给予螺内酯片治疗,联合组同时联合稳心颗粒口服。比较两组的中医证候疗效,治疗8周后的左室功能[左心室射血分数(LVEF)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左室相对室壁厚度(RWT)]、运动耐力(6 min步行距离)、生活质量评分、细胞因子[(血管内皮生长因子(VEGF)、N端前脑钠肽(NT-proBNP)]水平及不良反应发生情况。结果联合组临床总有效率为92.45%,高于对照组(77.36%),差异有统计学意义(P<0.05)。治疗8周后,联合组LVEF为(59.78±5.43)%,高于对照组[(50.22±5.68)%],LVEDV、LVESV及RWT分别为(52.08±5.34)mL、(52.08±5.34)mL、(0.39±0.05)%,均低于对照组[(61.94±4.67)mL、(112.79±6.51)mL、(0.43±0.08)%],差异均有统计学意义(P<0.05)。治疗8周后,联合组6 min步行距离为(413.42±14.39)m],明显长于对照组[(385.19±15.64)m],生活质量评分为(18.13±2.47)分,明显低于对照组[(21.02±2.83)分],差异均有统计学意义(P<0.05)。治疗8周后,联合组VEGF水平为(122.76±15.63)ng/L,明显高于对照组[(101.47±14.27)ng/L],NT-proBNP水平为(544.23±77.82)pg/mL,明显低于对照组[(687.49±95.63)pg/mL],差异均有统计学意义(P<0.05)。两组CHF患者用药后均未发生明显不良反应。结论稳心颗粒联合螺内酯疗效显著,可有效改善CHF患者左室功能、运动耐力及VEGF、NT-proBNP水平,进而提高生活质量,缓解病情进展,具有较高临床应用价值。

Objective To observe the effects of Wenxin granules combined with spironolactone on left ventricular function,exercise tolerance,vascular endothelial growth factor(VEGF)and N-terminal pro-brain natriuretic peptide(NT-proBNP)in patients with chronic heart failure(CHF).Methods A total of 106 patients with CHF treated in the First People's Hospital of Wuhu from May 2021 to January 2023 were prospectively selected as the research subjects,and were divided into combined group and control group by the random number table method,with 53 cases in each group.Both groups were given routine treatment,and the control group was given spironolactone tablets on this basis while the combined group was combined with oral administration of Wenxin granules.The efficacy of TCM symptoms,left ventricular function[left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular relative wall thickness(RWT)],exercise tolerance(6-min walking distance),quality of life score,levels of cytokines[vascular endothelial growth factor(VEGF),N-terminal pro-brain natriuretic peptide(NT-proBNP)]after 8 weeks of treatment and occurrence of adverse reactions were compared between the two groups.Results The total clinical effective rate of the combined group was 92.45%,which was higher than that of the control group(77.36%),the difference was statistically significant(P<0.05).After 8 weeks of treatment,the LVEF of the combination group was(59.78±5.43)%,which was higher than that of the control group[(50.22±5.68)%],the LVEDV,LVESV,and RWT were(52.08±5.34)mL,(52.08±5.34)mL,and(0.39±0.05)%,respectively,which were lower than those of the control group[(61.94±4.67)mL,(112.79±6.51)mL,and(0.43±0.08)%],the differences were statistically significant(P<0.05).After 8 weeks of treatment,the 6-minute walking distance of the combination group was(413.42±14.39)m,which was significantly longer than that of the control group[(385.19±15.64)m],and the quality of life score was(18.13±2.47)points,which was significantly lower than that of the control group[(21.02±2.83)points],the differences were statistically significant(P<0.05).The level of VEGF in the combined group was(122.76±15.63)ng/L,which was significantly higher than that in control group[(101.47±14.27)ng/L],while the level of NT-proBNP in the combined group was(544.23±77.82)pg/mL,which was significantly lower than that in control group[(687.49±95.63)pg/mL],the differences were statistically significant(P<0.05).Obvious adverse reactions occurred in both groups of patients with CHF.Conclusion Wenxin granules combined with spironolactone has a significant efficacy,and it can effectively improve the left ventricular function,exercise tolerance,VEGF and NT-proBNP in patients with CHF,thereby improving the quality of life and relieving the progression of disease,with high clinical application value.