加减复脉汤对甲亢合并阵发性房颤患者炎症因子和相关激素水平的影响

Effect of Modified Fumai Decoction on Inflammatory Factors and Related Hormone Levels in Hyperthyroidism Complicated with Paroxysmal Atrial Fibrillation

目的观察加减复脉汤加减治疗甲亢合并阵发性房颤(气阴两虚证)的临床疗效及对炎症因子和激素水平的影响。方法将90例甲亢合并阵发性房颤患者随机分为对照组与观察组各45例。对照组给予甲巯咪唑片和盐酸普萘洛尔治疗,观察组在对照组治疗的基础上给予加减复脉汤治疗。比较每周房颤发作次数、最长持续时间、左心房最大容积(LAV_(max))、左心房容积指数(LAVI)、左心房存储应变(LASr)和左心房通道应变(LAScd);检测游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)和促甲状腺激素(TSH)、肿瘤坏死因子-α(TNF-α)、白细胞介素-2(IL-2)和白细胞介素-6(IL-6)水平;进行气阴两虚证评分和房颤特异生活质量评估量表(AFEQT)评分;比较临床疗效。结果治疗后,观察组临床疗效总有效率高于对照组(P<0.05)。治疗后,两组患者每周房颤发作次数、最长持续时间和平均心率明显降低(P<0.05),且观察组低于对照组(P<0.05)。治疗后,两组患者LAV_(max)和LAVI下降(P<0.05),LASr和LAScd升高(P<0.05),且以观察组为显著(P<0.05);两组患者FT3和FT4水平下降,TSH水平升高(P<0.05),且以观察组为显著(P<0.05);两组患者外周血TNF-α、IL-2和IL-6水平降低(P<0.05),且观察组低于对照组(P<0.05);两组患者各主要症状评分和总分均降低(P<0.05),且观察组低于对照组(P<0.05);两组患者AFEQT量表评分均升高(P<0.05),且观察组高于对照组(P<0.05)。结论在常规西医干预的基础上,联用加减复脉汤治疗甲亢合并阵发性房颤患者可调节相关激素水平,抑制炎症因子的表达,改善左心房的结构和功能,减少房颤的发生,提高患者的生活质量,临床疗效显著。

Objective:To evaluate the clinical effect of Modified Fumai Decoction on hyperthyroidism complicated with paroxysmal atrial fibrillation(syndrome of deficiency of both qi and yin)and its influence on related inflammatory factors and hormone levels.Methods:A total of 90 patients with hyperthyroidism complicated with paroxysmal atrial fibrillation were randomly divided into the control group and observation group,45 cases for each group.The control group was given thiamazole tablets and propranolol hydrochloride tablets;the observation group was given Modified Fumai Decoction on the basis of the control group.The number of atrial fibrillation episodes per week,longest duration,average heart rate,maximum left atrial volume(LAVmax),left atrial volume index(LAVI),left atrial storage strain(LASr)and left atrial channel strain(LAScd)were compared;free triiodothyronine(FT3),free thyroxine(FT4)and thyroid-stimulating hormone(TSH),tumor necrosis factor-α(TNF-α),interleukin-2(IL-2)and interleukin-6(IL-6)levels were measured;Qi and Yin deficiency syndrome scores and atrial fibrillation specific quality of life assessment scale(AFEQT)were performed;the clinical efficacies were compared.Results:After treatment,the clinical efficacy of the observation group was higher than that of the control group(P<0.05).After treatment,the frequency and longest duration of atrial fibrillation per week were significantly lower in the two groups(P<0.05),and the observation group was lower than the control group(P<0.05).After treatment,LAVmax and LAVI decreased(P<0.05),LASr and LAScd increased(P<0.05)in both groups,and were more significant in the observation group(P<0.05).After treatment,FT3 and FT4 levels decreased and TSH levels increased in both groups(P<0.05),and were more significant in the observation group(P<0.05).After treatment,the levels of TNF-α,IL-2 and IL-6 in peripheral blood of the two groups decreased(P<0.05),and the observation group was lower than the control group(P<0.05).After treatment,the main symptom scores and the total score of deficiency of both qi and yin decreased in both groups(P<0.05),and the observation group was lower than the control group(P<0.05).After treatment,the AFEQT scores of the two groups were increased(P<0.05),and the observation group was higher than the control group(P<0.05).Conclusion:On the basis of conventional western medicine intervention,Modified Fumai Decoction can regulate the levels of related hormones,inhibit the expression of inflammatory factors,improve the structure and function of left atrium,reduce the occurrence of atrial fibrillation,and improve the quality of life of patients with hyperthyroidism and paroxysmal atrial fibrillation,with significant clinical efficacy.