补肾活血汤联合左西孟旦治疗肾虚血瘀型慢性心力衰竭疗效观察及对血清Nt-proBNP水平的影响

Curative Effect of Bushen Huoxue Decoction Combined with Levosimendan on Chronic Heart Failure of Kidney Deficiency and Blood Stasis Type and Its Effects on Serum NtproBNP Level

目的:观察补肾活血汤联合左西孟旦治疗肾虚血瘀型慢性心力衰竭(CHF)的临床疗效及对血清N末端B型利钠肽原(Nt-proBNP)水平的影响。方法:按随机数字表法将82例肾虚血瘀型CHF患者分为治疗组与对照组,各41例。对照组采用左西孟旦注射液治疗,治疗组在对照组基础上联合自拟补肾活血汤治疗。比较2组治疗前后中医证候评分、心功能指标[左室射血分数(LVEF)、每搏输出量(SV)和6 min步行距离(6MWD)]、Nt-proBNP和超敏C-反应蛋白水平(hs-CRP)水平,并统计总有效率和不良反应发生率。结果:治疗组总有效率为97.56%,对照组为80.49%,2组比较,差异有统计学意义(P<0.05)。治疗后,2组心悸气短、疲倦乏力、胸闷疼痛、腰膝酸软、五心烦热、畏寒肢冷等中医证候评分均较治疗前下降(P<0.05),且治疗组各项评分均低于对照组(P<0.05)。治疗后,2组LVEF、SV、6MWT水平均较治疗前升高(P<0.05),且治疗组上述3项指标均高于对照组(P<0.05)。治疗后,2组血清Nt-proBNP、hs-CRP水平均较治疗前下降(P<0.05),且治疗组Nt-proBNP、hs-CRP水平均低于对照组(P<0.05)。治疗组不良反应发生率为4.88%,对照组为19.51%,2组比较,差异有统计学意义(P<0.05)。结论:补肾活血汤联合左西孟旦治疗肾虚血瘀型CHF疗效显著,能够改善患者中医证候及心功能,减缓CHF进展,且不良反应较少。

Objective:To observe the clinical effect of Bushen Huoxue Decoction combined with Levosimendan on chronic heart failure(CHF)of kidney deficiency and blood stasis type and its effects on levels of serum N-terminal pro B-type natriuretic peptide(Nt-proBNP).Methods:A total of 82 cases of CHF patients of kidney deficiency and blood stasis type were divided into the treatment group and the control group according to the random number table method,with 41 cases in each group.The control group was treated with Levosimendan Injection,and the treatment group was additionally treated with self-made Bushen Huoxue Decoction based on the treatment of the control group.Traditional Chinese medicine(TCM)syndrome scores,heart function indicators[left ventricular ejection fraction(LVEF),stroke volume(SV),and 6-minute walking distance(6MWD)],Nt-proBNP,and hypersensitivity C-reactive protein(hs-CRP)were compared between the two groups before and after treatment.Total effective rates and adverse reactions were counted.Results:The total effective rate was 97.56%in the treatment group and 80.49%in the control group,the difference being significant(P<0.05).After treatment,TCM syndrome scores of palpitations and shortness of breath,fatigue and lack of strength,chest tightness and pain,soreness and weakness in the waist and knees,vexing heat in the chest,palms and soles,and fear of cold and cold limbs in the two groups were decreased when compared with those before treatment(P<0.05),and each score in the treatment group was lower than that in the control group(P<0.05).After treatment,the levels of LVEF,SV,and 6MWD in the two groups were increased when compared with those before treatment(P<0.05),and the above three indicators in the treatment group were higher than those in the control group(P<0.05).After treatment,the levels of Nt-proBNP and hs-CRP in serum in the two groups were declined when compared with those before treatment(P<0.05),and the levels of NtproBNP and hs-CRP in the treatment group were lower than those in the control group(P<0.05).The incidence of adverse reactions was 4.88%in the treatment group and 19.51%in the control group,the difference being significant(P<0.05).Conclusion:Bushen Huoxue Decoction combined with Levosimendan has significant curative effects on the treatment of CHF of kidney deficiency and blood stasis type,which can improve TCM syndrome scores and heart function of patients,slow down the progression of CHF with fewer adverse reactions.