参附救心汤联合沙库巴曲缬沙坦治疗射血分数保留型心力衰竭的疗效

Curative effect of Shenfu Jiuxin Decoction combined with sacubitril/valsartan in thetreatment of heart failure with ejection fraction preservation

目的观察参附救心汤联合沙库巴曲缬沙坦治疗射血分数保留型心力衰竭的临床疗效。方法选择2020年6月至2023年6月于陕西中医药大学第二附属医院治疗的射血分数保留型心力衰竭患者80例,按随机数字表法分为两组。对照组40例,17例男性,23例女性,年龄51~83(62.53±4.17)岁,纽约心脏病学会(NYHA)分级:21例Ⅱ级,19例Ⅲ级;研究组40例,16例男性,24例女性,年龄50~84(63.14±4.65)岁,NYHA分级:22例Ⅱ级,18例Ⅲ级。对照组在基础治疗的同时进行沙库巴曲缬沙坦片治疗(起始剂量为每次50 mg,2周后增加至每次100 mg,每日2次),研究组在对照组治疗的同时进行参附救心汤治疗(每次服用100 ml,每日2次),连续治疗2个月。比较两组临床疗效,治疗前、后进行畏寒肢冷,面肢浮肿,心悸气喘/不得卧,咯吐泡沫痰,尿少腹胀,口唇青紫,或伴腹水、胸水,颜面灰白,烦躁汗出评价;治疗前、后评价患者6 min步行距离、明尼苏达心功能不全生命质量量表(MLHFQ)评分,检测左心室射血分数、左心室质量指数、E峰减速时间,检测肿瘤坏死因子α(TNF-α)、白细胞介素33(IL-33)、可溶性基质裂解素2(sST2)、N末端B型利钠肽原(NT-proBNP)水平。采用t检验、χ^(2)检验。结果研究组患者总有效率为97.50%(39/40),对照组总有效率为80.00%(32/40),研究组患者总有效率较对照组高(P<0.05)。治疗后,研究组畏寒肢冷,面肢浮肿,心悸气喘/不得卧,咯吐泡沫痰,尿少腹胀,口唇青紫,或伴腹水、胸水,颜面灰白,烦躁汗出评分较对照组低(均P<0.05);研究组6 min步行距离较对照组长(P<0.05),研究组MLHFQ评分较对照组低(P<0.05);研究组左心室射血分数较对照组高(P<0.05),研究组左心室质量指数、E峰减速时间较对照组低(均P<0.05);研究组TNF-α、IL-33、sST2、NT-proBNP水平较对照组低(均P<0.05)。结论参附救心汤联合沙库巴曲缬沙坦治疗射血分数保留型心力衰竭患者,可抑制炎症,降低sST2、NT-proBNP水平,改善心室重构,提升心功能、运动耐力、临床疗效及生活质量。

Objective To observe the clinical effect of Shenfu Jiuxin Decoction combined with sacubitril/valsartan in the treatment of heart failure with preserved ejection fraction.Methods A total of 80 patients with heart failure with ejection fraction preservation were selected from the Second Affiliated Hospital of Shanxi University of Traditional Chinese Medicine from June 2020 to June 2023,and were divided into two groups according to the random number table method. In the control group, there were 17 males and 23 females, aged 51-83 (62.53±4.17) years,New York Heart Association (NYHA) classification: 21 cases of grade II and 19 cases of grade III. Inthe study group, there were 16 males and 24 females, aged 50-84 (63.14±4.65) years, NYHAclassification: 22 cases of grade II and 18 cases of grade III. The control group was treated withsacubitril/valsartan tablets (the initial dose was 50 mg each time, and increased to 100 mg each timeafter 2 weeks, twice a day) based on the basic treatment, and the study group was treated withShenfu Jiuxin Decoction (taking 100 ml each time, twice a day) based on the control group for 2months. The clinical efficacies of the two groups were compared. Before and after treatment, coldlimbs, facial edema, palpations, asthma/inability to sleep, foaming sputum, oliguria and abdominaldistension, blue lips, accompanied by ascites, pleural fluid, face gray, irritability, and sweating wereevaluated. Before and after treatment, the patients' 6-min walking distance, Minnesota Living withHeart Failure Questionnaire (MLHFQ) score, left ventricular ejection fraction, left ventricular massindex, and E peak deceleration time were evaluated. The levels of tumor necrosis factor α (TNF-α),interleukin 33 (IL-33), soluble stromal lysin 2 (sST2), and N-terminal B-type natriuretic peptide(NT-proBNP) were detected. t test and χ^(2) test were used. Results The total effective rate of thestudy group was 97.50% (39/40), which was higher than that of the control group [80.00% (32/40)](P<0.05). After treatment, the scores of cold limbs, facial edema, palpations, asthma/inability tosleep, foaming sputum, oliguria and abdominal distension, blue lips, accompanied by ascites, pleuralfluid, face gray, irritability, and sweating in the study group were lower than those in the controlgroup (all P<0.05);the 6-min walking distance of the study group was longer than that of the controlgroup (P<0.05);the MLHFQ score of the study group was lower than that of the control group (P<0.05);the left ventricular ejection fraction of the study group was higher than that of the controlgroup (P<0.05);the left ventricular mass index and E peak deceleration time of the study group werelower than those of the control group (both P<0.05);the levels of TNF-α, IL-33, sST2, and NT-proBNPin the study group were lower than those in the control group (all P<0.05). Conclusion Shenfu JiuxinDecoction combined with sacubitril/valsartan can inhibit the inflammation, reduce the sST2 andNT-proBNP levels, improve the ventricular remodeling, cardiac function, exercise endurance, clinicalefficacy, and quality of life in patients with heart failure with preserved ejection fraction.