参苏饮加减治疗肺气不足型成人病毒性心肌炎的临床观察

Clinical Efficacy of Shensuyin in Treating Adult Viral Myocarditis with Syndrome of Insufficiency of Lung-Qi

目的:探讨参苏饮加减治疗病毒性心肌炎(VMC)肺气不足证的临床疗效及对辅助性T细胞17(Th17),调节性T细胞(Treg)及相关炎性指标水平的影响。方法:收治VMC慢性期患者104例作为研究对象,采用随机按数字表法分为对照组和观察组各52例,对照组参照《中国心力衰竭诊断和治疗指南2014》常规治疗。观察组在对照组治疗的基础上内服参苏饮加减,1剂/d,分早晚2次温服。两组均连续治疗8周。比较两组患者肺气不足证症状积分、血清肌钙蛋白I(c Tn I)和心型游离脂肪酸结合蛋白(H-FABP)水平、心功能评价及临床疗效。流式细胞仪检测两组外周血Th17细胞和Treg细胞水平。检测两组血清白细胞介素(IL)-17,IL-21,IL-10水平。结果:观察组患者肺气不足证症状(气短、乏力、胸闷隐痛、自汗恶风、咳嗽)评分均明显低于对照组(P <0. 01);观察组治疗后血清c Tn I和H-FABP水平均明显低于对照组,左心室射血分数(LVEF)及舒张早期/舒张晚期最大血流速度(E/A)值水平均显著高于对照组(P <0. 01);观察组临床疗效总有效率为92. 16%,多于对照组的74%(P <0. 05);观察组治疗后Th17细胞和Th17/Treg水平均明显低于对照组,Treg细胞高于对照组(P <0. 01);观察组患者血清IL-17,IL-21,IL-10水平均明显低于对照组(P <0. 01)。结论:在病毒性心肌炎常规治疗基础上,加服参苏饮加减治疗病毒性心肌炎肺气不足证疗效显著,调节Th17细胞和Treg细胞及相关因子水平可能是其作用途径之一。

Objective: To investigate the efficacy of Shensuyin in treating viralmyocarditis(VMC) with syndrome of insufficiency of lung-qi and the effect on levels of Th17 and Treg cells and relevant factors. Method:One hundred-four VMC cases were regaded as object of study and randomly divided into control group and observation group,with 52 cases in each group. Control group was treated with routine therapy by reference to‘Chinese Guidelines for Diagnosis and Treatment of Heart Failure 2014’. In addition to the therapy of control group,observation group on the basis of treatment in the control group with Shensuyin,1 dose/d,bid. One course of treatment was 8 weeks for both groups. Scores of Shensuyin,serum levels of Troponin I(cTnI) and cardiac free fatty acid binding protein(H-FABP),heart function and total efficacy were compared for both groups. Flow cytometry was used to detect peripheral blood levels of Th17 and Treg cells for the two groups. Serum levels of interleukin(IL)-17,IL-21,IL-10 were detected in both groups. Result: After treatment,scores of syndrome of Yin and Yang deficiency(shortness of breath,fatigue,dull chest pain,bad breath,cough) of observation group were obviously lower than those of control group(P < 0. 01). Serum levels of H-FABP and cTnI of observation group were remarkably lower,while LVEF and E/A were higher than those of control group after treatment(P <0. 01). Total efficacy of observation group was 92. 16%,which was higher than 74% of control group(P <0. 05). After treatment,peripheral blood levels of Th17 cell and Th17/Treg were obviously lower,while Treg cell was higher thancontrol group(P < 0. 01). Serum level of IL-17,IL-21 of observation group was remarkably lower,while IL-10 was higher than control group after treatment(P < 0. 01). Conclusion: In addition to the routine therapy of VMC,the efficacy of Shensuyin has a significant effect in treating VMC with syndrome of lung qi deficiency,and the regulatory effect on levels of Th17 and Treg cells and relevant factors may be one of the effective ways.