芪苈强心胶囊辅助沙库巴曲缬沙坦钠治疗射血分数降低型慢性心力衰竭患者的临床疗效

Clinical efficacy of Qiliqiangxin capsule supplemented with Sacubitril valsartan sodium in the treatment of patients with chronic heart failure with reduced ejection fraction

目的:研究芪苈强心胶囊辅助沙库巴曲缬沙坦钠治疗射血分数降低型慢性心力衰竭(Heart failure with reduced ejection fraction,HFrEF)患者的临床疗效。方法:选取我院2020年12月至2022年12月收治的HFrEF患者78例,随机分为西药组、中药辅助组,各39例。西药组采用沙库巴曲缬沙坦钠治疗,中药辅助组采用芪苈强心胶囊辅助沙库巴曲缬沙坦钠治疗。治疗3 m后,比较两组临床疗效,四维心脏彩超仪检测心率、左心室射血分数(Left ventricular ejection fraction,LVEF)、左心室后壁厚度(Left ventricular posterior wall thickness,LVWP)、每搏输出量(Stroke volume,SV),24 h动态心电分析系统检测正常窦性心搏间期标准差(Standard deviation of NN intervals,SDNN)、相邻RR间期差值均方根(Root mean square of successive R-R interval differences,RMSSD),酶联免疫吸附法检测血清半乳糖凝集素3(Galectin-3,Gal-3)、心肌肌钙蛋白(Cardiac Troponin T,cTnT)、生长刺激表达基因2蛋白(Soluble growth stimulation expressed gene 2,sST2)、B型利钠肽(Brain natriuretic peptide,BNP)水平;治疗后随访6 m,比较两组主要不良心血管事件(Major adverse cardiovascular events,MACE)发生情况。结果:治疗后,中药辅助组临床总有效率高于西药组(P<0.05);与治疗前相比,两组治疗后心率、LVWP均降低,LVEF、SV均升高,其中中药辅助组改善更为显著(P<0.05);与治疗前相比,两组治疗后RMSSD、SDNN均升高,血清Gal-3、cTnT、sST2、BNP水平均降低,其中中药辅助组改善更为显著(P<0.05);治疗后随访6 m,中药辅助组MACE发生率略低于西药组,但组间比较,差异无统计学意义(P>0.05)。结论:芪苈强心胶囊辅助合沙库巴曲缬沙坦钠治疗HFrEF疗效显著,可改善心率变异性,增强心功能,减轻心肌损伤,改善心室重构,降低MACE发生的风险。

Objective:To study the clinical efficacy of Qiliqiangxin capsule supplemented with Sacubitril valsartan sodium in the treatment of chronic heart failure with reduced ejection fraction(HFrEF).Methods:A total of 78 patients with HFrEF admitted to our hospital from December 2020 to December 2022 were randomly divided into western medicine group and TCM adjuvant group,39 cases in each group.The western medicine group was treated with Sacubitril valsartan sodium,while the CM adjuvant group was treated with Qiliqiangxin capsule supplemented with Sacubitril valsartan sodium.After 3 months of treatment,the clinical efficacy was compared between the two groups.The heart rate,left ventricular ejection fraction(LVEF),left ventricular posterior wall thickness(LVWP),stroke volume(SV)were measured by four-dimensional color Doppler ultrasound;standard deviation of NN intervals(SDNN),root mean square of successive R-R interval differences(RMSSD)were measured by 24-hours dynamic ECG analysis system;serum related indexes Galectin-3(Gal-3),cardiac Troponin T(cTnT),soluble growth stimulation expressed gene(sST2)and brain natriuretic peptide(BNP)were detected by enzyme-linked immunosorbent assay;the incidence of major adverse cardiovascular events(MACE)after 6 months of follow-up was compared between the two groups.Results:After treatment,the total effective rate of the TCM adjuvant group was higher than that of the western medicine group(P<0.05).Compared with before treatment,heart rate and LVWP were significantly decreased,LVEF and SV were significantly increased in both groups after treatment,and especially in the TCM adjuvant group(P<0.05).Compared with before treatment,RMSSD and SDNN were significantly increased in both groups after treatment,and serum levels of Gal-3,cTnT,sST2 and BNP were significantly decreased,especially in the TCM adjuvant group(P<0.05).After 6 months of follow-up,the incidence of MACE in TCM adjuvant group was slightly lower than that in western medicine group,but there was no statistical significance between groups(P>0.05).Conclusion:Qiliqiangxin capsule supplemented with sacubitril valsartan sodium is effective in the treatment of HFrEF,which can improve heart rate variability,enhance heart function,reduce myocardial injury,improve ventricular remodeling and reduce the risk of MACE.