益气温阳活血利水方治疗慢性心力衰竭阳气亏虚、血瘀兼痰饮证的疗效及对心室重构和肾素-血管紧张素-醛固酮系统的影响

Effect of YiqiWenyangHuoxueLishuiFormula on ventricular remodeling and renin-angiotensin-aldosterone system in patients with chronic heart failure of Yang qi deficiency,blood stasis and phlegm syndrome

目的观察益气温阳活血利水方治疗慢性心力衰竭(CHF)阳气亏虚、血瘀兼痰饮证的疗效及对心室重构(VR)和肾素-血管紧张素-醛固酮系统(RAAS)的影响。方法将60例CHF阳气亏虚、血瘀兼痰饮证患者按照随机数字表法分为2组,对照组30例予常规西药治疗,治疗组30例在对照组治疗基础上应用益气温阳活血利水方治疗,2组均治疗4周。比较2组疗效;比较2组治疗前后中医证候评分、VR参数、心力衰竭标志物水平、RAAS相关指标变化;观察2组不良反应发生情况。结果治疗组总有效率93.33%(28/30),对照组总有效率73.33%(22/30),治疗组疗效优于对照组(P<0.05)。2组治疗后主症、次症评分及总评分均较本组治疗前降低(P<0.05),治疗后治疗组主症、次症评分及总评分均低于对照组(P<0.05)。2组治疗后左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、室间隔厚度(IVSd)、左心室质量指数(LVMI)均较本组治疗前降低(P<0.05),右心室内径(RVD)、左心室射血分数(LVEF)均较本组治疗前升高(P<0.05);治疗后治疗组LVEDD、LVESD、IVSd、LVMI均低于对照组(P<0.05),RVD、LVEF均高于对照组(P<0.05)。2组治疗后心肌钙蛋白I(cTnI)、N末端脑利钠肽前体(NT-proBNP)水平均较本组治疗前降低(P<0.05),治疗后治疗组cTnI、NT-proBNP水平均低于对照组(P<0.05)。2组治疗后肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)水平均较本组治疗前降低(P<0.05),治疗后治疗组PRA、AngⅡ、ALD水平均低于对照组(P<0.05)。2组不良反应发生率比较差异无统计学意义(P>0.05)。结论益气温阳活血利水方治疗CHF阳气亏虚、血瘀兼痰饮证,能抑制RAAS过度激活,减轻心肌损伤,改善VR,临床效果显著,安全性高。

Objective To investigate the effect of YiqiWenyangHuoxueLishuiFormula on ventricular remodeling(VR)and renin-angiotensin-aldosterone system(RAAS)in patients with chronic heart failure(CHF)of Yang qi deficiency,blood stasis and phlegm syndrome.Methods A total of 60 CHF patients(Yang qi deficiency,blood stasis and phlegm syndrome)were randomly assigned into treatment group(n=30)and control group(n=30).All patients were managed by conventional Western medicine,those in the treatment group were additionally YiqiWenyangHuoxueLishuiFormula.A 4-week treatment was performed in the both groups,aiming to compare the curative efficacy,traditional Chinese medicine(TCM)syndrome score,VR parameters,heart failure marker levels,RAAS,as well as the incidence of adverse reactions between the two groups before and after treatment.Results The total effective rate in the treatment group was better than that of the control group(93.33%[28/30]vs 73.33%[22/30],P<0.05).After treatment,the dimensions scores and total scores of TCM syndromes(main symptoms and secondary symptoms)in the two groups were significantly lower(P<0.05),which in the treatment group were significantly lower than those in the control group(P<0.05).The left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),interventricular septal thickness(IVSd)and left ventricular mass index(LVMI)in the two groups were significantly lower(P<0.05),and the right ventricular diameter(RVD)and left ventricular ejection fraction(LVEF)were significantly higher(P<0.05).The treatment group was superior to the control group for LVEDD,LVESD,IVSd,LVMI and RVD,LVEF(all P<0.05).The levels of cardiac troponin I(cTnI)and N-terminal pro-brain natriuretic peptide(NT-proBNP)in the two groups were significantly lower(P<0.05),which were more pronounced in the treatment group than in the control group(P<0.05).The levels of plasma renin activity(PRA),angiotensinⅡ(AngⅡ)and aldosterone(ALD)in the both groups were significantly lower(P<0.05),and this decrease was more common in the treatment group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion For CHF patients(Yang qi deficiency,blood stasis and phlegm syndrome),YiqiWenyangHuoxueLishuiFormula can inhibit the excessive activation of RAAS,reduce myocardial injury and improve VR,which has significant clinical effect and high safety.