雷火灸治疗阳虚水泛型慢性心力衰竭临床研究

Clinical Study on Thunder-Fire Moxibustion for Chronic Heart Failure of Yang Deficiency and Water Diffusion Type

目的:观察雷火灸治疗阳虚水泛型慢性心力衰竭的临床疗效。方法:选取102例阳虚水泛型慢性心力衰竭患者,按随机数字表法分为常规治疗组和雷火灸治疗组各51例,2组各剔除1例,最终各纳入50例。常规治疗组给予西药治疗,雷火灸治疗组在常规治疗组基础上给予雷火灸治疗。比较2组临床疗效、中医证候评分、6 min步行试验(6MWT)距离、明尼苏达心衰生活质量量表(MLHFQ)评分及心、肾功能指标水平,记录不良反应。结果:治疗后,雷火灸治疗组临床疗效优于常规治疗组(P<0.05)。2组中医证候、MLHFQ评分均较治疗前降低(P<0.05),雷火灸治疗组中医证候、MLHFQ评分均低于常规治疗组(P<0.05)。2组6MWT距离均较治疗前增大(P<0.05),雷火灸治疗组6MWT距离大于常规治疗组(P<0.05)。2组可溶性基质裂解素2 (sST2)、磷脂酰肌醇3激酶(PI3K)、嗜铬粒蛋白A (CgA)、游离脂肪酸(FFA)、血肌酐(SCr)水平及心肌能量消耗(MEE)、左室收缩末圆周室壁应力(cESS)值均较治疗前降低(P<0.05),雷火灸治疗组sST2、PI3K、CgA、FFA、SCr水平及MEE、左室cESS值均低于常规治疗组(P<0.05)。2组左室射血分数(LVEF),右室收缩期峰值应变率(SRs)、舒张早期峰值应变率(SRc)、舒张晚期峰值应变率(SRa),以及肾小球滤过率(GFR)均较治疗前升高(P<0.05),雷火灸治疗组LVEF,右室SRs、SRc、SRa,以及GFR均高于常规治疗组(P<0.05)。2组左室心肌质量指数(LVMI)、左室收缩末期内径(LVESd)均较治疗前缩小(P<0.05),雷火灸治疗组LVMI、LVESd均小于常规治疗组(P<0.05)。治疗期间2组均无不良反应发生。结论:雷火灸治疗阳虚水泛型慢性心力衰竭,可调节sST2、PI3K、CgA、FFA等指标水平,改善临床症状及心肾结局,减缓心室重构,提升活动耐力及生活质量。

Objective:To observe the clinical effect of thunder-fire moxibustion on chronic heart failure of yang deficiency and water diffusion type.Methods:A total of 102 cases of patients with chronic heart failure of yang deficiency and water diffusion type were selected and divided into the routine treatment group and the thunder-fire moxibustion group according to the random number table method,with 51 cases in each group.One case was excluded from each group,and 50 cases were included in each group ultimately.The routine treatment group received western medicine treatment,and the thunder-fire moxibustion group received thunder-fire moxibustion based on the treatment of the routine treatment group.The clinical effects,traditional Chinese medicine(TCM)syndrome scores,6-minute walking test(6MWT)distance,Minnesota Living with Heart Failure Questionnaire(MLHFQ)scores,and levels of heart and kidney function indicators were compared between the two groups.The adverse reactions were recorded.Results:After treatment,the clinical effect in the thunder-fire moxibustion group was better than that in the routine treatment group(P<0.05).The TCM syndrome scores and MLHFQ scores in the two groups were decreased when compared with those before treatment(P<0.05),and the TCM syndrome score and MLHFQ score in the thunder-fire moxibustion group were lower than those in the routine treatment group(P<0.05).The 6MWT distance in the two groups were increased when compared with those before treatment(P<0.05),and the 6MWT distance in the thunder-fire moxibustion group was greater than that in the routine treatment group(P<0.05).The levels of soluble ST2(sST2),phosphoinositide 3-kinase(PI3K),chromogranin A(CgA),free fatty acid(FFA)and serum creatinine(SCr),and the values of myocardial energy expenditure(MEE)and left ventricle circumferential end-systolic wall stress(cESS)in the two groups were decreased when compared with those before treatment(P<0.05),and the levels of sST2,PI3K,CgA,FFA and SCr,and the values of MEE and left ventricle cESS in the thunder-fire moxibustion group were lower than those in the routine treatment group(P<0.05).The left ventricular ejection fraction(LVEF),peak systolic strain rate(SRs),early diastolic peak strain rate(SRc)and late diastolic peak strain rate(SRa)of the right ventricle,and glomerular filtration rate(GFR)in the two groups were increased when compared with those before treatment(P<0.05),and LVEF,SRs,SRc,SRa of the right ventricle,and GFR in the thunder-fire moxibustion group were higher than those in the routine treatment group(P<0.05).The left ventricular mass index(LVMI)and left ventricular end systolic diameter(LVESd)in the two groups were decreased when compared with those before treatment(P<0.05),and the LVMI and LVESd in the thunder-fire moxibustion group were lower than those in the routine treatment group(P<0.05).During the treatment period,neither group experienced any adverse reactions.Conclusion:Thunder-fire moxibustion for chronic heart failure of yang deficiency and water diffusion type can regulate the levels of sST2,PI3K,CgA,FFA and other indicators,improve clinical symptoms and cardiac and renal outcomes,slow down ventricular remodeling,and enhance activity endurance and quality of life.