补阳还五汤联合环磷腺苷葡胺对气虚血瘀型冠心病心力衰竭患者心功能及血清sST2和NT-proBNP水平的影响

Effects of union of Buyang Huanwu Decoction and meglumine adenosine cyclophosphate on cardiac function and serum sST2 and NT-proBNP in patients with qi deficiency and blood stasis type coronary heart disease and heart failure

关键词:  可溶性生长刺激表达基因2蛋白  氨基末端B型利钠肽前体  气虚血瘀证  冠心病心力衰竭  心功能

Key words:  soluble growth stimulation expressed gene 2  N-terminal pro-B-type natriuretic peptide  qi deficiency and blood stasis syndrome  coronary heart disease and heart failure  cardiac function

摘要:

[目的] 冠心病（CHD）心力衰竭是心血管疾病的主要死亡因素之一，气虚血瘀证为其常见中医证型。研究旨在探讨补阳还五汤联合环磷腺苷葡胺对该类患者心功能及血清可溶性生长刺激表达基因2蛋白（sST2）、氨基末端B型利钠肽前体（NT-proBNP）水平的影响。[方法] 采用前瞻性随机对照试验设计，选取90例气虚血瘀型CHD心力衰竭患者为研究对象，按照随机数字表法将纳入患者分为A、B、C3组，每组各30例。除基础治疗外，A组给予环磷腺苷葡胺注射液，B组给予补阳还五汤，C组给予环磷腺苷葡胺注射液+补阳还五汤。观察治疗前（T₀）和治疗4周后（T₁）3组患者中医证候、实验室指标、心功能指标、血清sST2、NT-proBNP水平，并综合评估两组的临床疗效及不良反应发生情况。[结果] T₁时刻，3组患者中医证候评分、左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）及血清红细胞压积（HCT）、血清纤维蛋白原（FIB）、sST2、NT-proBNP水平均较同组T₀时刻显著降低（P<0.05），且C组显著低于A、B组（P<0.05）；3组患者LVEF水平显著升高，且C组显著高于A、B组（P<0.05）。C组患者总有效率（93.33%）显著高于A组（70.00%）和B组（66.67%），P<0.05。3组患者不良反应总发生率比较差异无统计学意义（P>0.05）。[结论] 补阳还五汤联合环磷腺苷葡胺可改善气虚血瘀型CHD心力衰竭患者心功能，降低患者血清sST2、NT-proBNP水平。

Abstract:

[Objective] Coronary heart disease（CHD）with heart failure is one of the main causes of death from cardiovascular diseases，and qi deficiency with blood stasis syndrome is a common traditional Chinese medicine（TCM）syndrome type in such patients. To explore the effects of Buyang Huanwu Decoction combined with meglumine adenosine cyclophosphate on cardiac function and the levels of serum soluble growth stimulation expressed gene 2（sST2）and N-terminal pro-B-type natriuretic peptide（NT-proBNP）in these patients. [Methods] A prospective randomized controlled trial design was adopted. Ninety patients with qi deficiency and blood stasis type CHD and heart failure admitted were included as the research subjects. The patients were randomly assigned into three groups A，B，and C according to the random number table，each had 30 cases. In addition to basic treatment，group A was given intravenous injection of meglumine adenosine cyclophosphate，group B was given Buyang Huanwu Decoction，and group C was given intravenous injection of meglumine adenosine cyclophosphate+Buyang Huanwu Decoction. The TCM syndromes，laboratory indicators， cardiac function indicators，serum sST2，and NT- proBNP were observed in three groups before treatment（T₀）and after 4 weeks of treatment（T₁），and the clinical efficacy and adverse reactions were comprehensively evaluated. [Results] At T₁，the scores of traditional Chinese medicine syndrome，LVEDD，LVESD，serum HCT，FIB，sST2，and NT-proBNP in the three groups were prominently lower than those in the same group at T₀（P<0.05），and with group C being prominently lower than groups A and B（P<0.05）. The LVEF of the three groups were prominently increased，and with C group being prominently higher than the A and B groups （P<0.05）. The total effective rate of group C（93.33%）was prominently higher than that of group A（70.00%）and group B（66.67%）， P<0.05. There was no statistically significant difference in the overall incidence of adverse reactions among the three groups（P>0.05）. [Conclusion] The union of Buyang Huanwu Decoction and meglumine adenosine cyclophosphate can improve the cardiac function of patients with qi deficiency and blood stasis type CHD and heart failure，and reduce serum sST2 and NT-proBNP.