温阳利水法治疗慢性心力衰竭合并肠屏障功能障碍的临床观察

目的 观察温阳利水法治疗慢性心力衰竭合并肠屏障功能障碍的临床疗效.方法 采用平行、随机、对照试验方案,选择符合慢性心力衰竭合并肠屏障功能障碍(心脾肾阳虚)诊断标准患者60例,随机分为观察组与对照组各30例.对照组仅予常规治疗,观察组在常规治疗基础上联合温阳利水法,疗程4周.分别记录两组患者治疗前与治疗后NYHA分级、中医证候积分、心脏彩超;血浆hs-CRP、NT-proBNP、endotoxin含量;并记录相关安全性指标及不良反应.结果 临床疗效比较:观察组总有效率90.00%,对照组66.67%,观察组优于对照组(P<0.05),且中医证候积分观察组比对照组降低更明显(P<0.01).治疗后两组患者LVEF均比治疗前提高(P<0.01),NT-proBNP比治疗前降低(P<0.01).两组均可降低血浆endotoxin水平(P<0.01),且观察组优于对照组(P<0.01).观察组显著降低血浆hs-CRP水平(P<0.01).结论 温肾利水法显著减少心衰合并肠道屏障功能障碍患者临床症状,改善患者心功能,提高生活质量.其作用机制可能通过抑制体内炎症反应发挥治疗作用.

Objective To observe clinical effect of Yang-warming and diuresis-promoting therapy on chronic heart failure combined with intestinal barrier dysfunction. Methods In a parallel,randomized trial,60 patients with CHF and IBD(syndrome of heart-spleen-kidney Yang Deficiency)were enrolled and divided into the treatment group and control group,30 in each group. While the control group was given routine treatment,the treatment group was given Yang-warming and diuresis-promoting therapy combined with a routine treatment. The grade of NYHA, TCM syndrome scores,echocardiography,hypersensitive C-reactive protein(hs-CRP),N-terminal prohormone of brain natriuretic peptide (NT-proBNP)and endotoxin were recorded respectively for each patient before the treatment and 4 weeks after the treatment,as well as security indicators of blood,urine and excrement tests,liver and kidney functions,and adverse events. Results 4 weeks after the treatment,the total effective rate of the treatment group was 90.00%,while that of the control group was 66.67%,which suggested that the treatment group worked better(P<0.05). TCM syndrome scores of treatment group were significantly lower than those of control group(P<0.01). After treatment,LVEF was higher and the level of NT-proBNP and endotoxin were lower than before in both groups(P<0.01),but the level of endotoxin in the treatment group was decreased significantly in compared to the control group(P<0.01). The level of hs-CRP was only decreased in treatment group(P<0.01). Conclusions The results of the clinical study shows that the treatment of chronic heart failure combined with intestinal barrier dysfunction with the therapy of Yang-warming and diuresis-promoting is effective in improving patients’ clinical symptoms,heart function and the quality of life. The mechanism of action may be related to the inhibition the body's inflammatory response.