| 王鑫,侯跃辉,李小军,张立,陆弋.益气强心汤对冠脉慢性完全闭塞病变心衰患者心室重构影响[J].浙江中西医结合杂志,2023,33(2): |
| 益气强心汤对冠脉慢性完全闭塞病变心衰患者心室重构影响 |
| Effect of Yiqi Qiangxin Decoction combined with sacubatril and valsartan sodium tablets on ventricular remodeling in patients with chronic complete coronary occlusion and heart failure |
| 投稿时间：2022-03-25 修订日期：2023-01-13 |
| DOI： |
| 中文关键词: 益气强心汤 沙库巴曲缬沙坦钠片 冠脉慢性完全闭塞病变 慢性心衰 心室重构 |
| 英文关键词:Yiqi Qiangxin Decoction Sacubatril and Valsartan Sodium Tablets Chronic Complete Coronary Occlusion Chronic Heart Failure Ventricular Remodeling |
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| 中文摘要: |
| 摘要 目的 探讨益气强心汤对冠脉慢性完全闭塞病变心衰患者心室重构影响。方法 选取2018年8月至2020年8月于浙江省台州医院就诊的冠脉慢性完全闭塞病变心衰患者66例，根据随机数字表法随机分为对照组（n=33）、观察组（n=33），对照组在西医常规治疗基础上加用沙库巴曲缬沙坦钠片治疗，观察组在对照组基础上给予益气强心汤治疗。两组疗程均为3个月。观察两组患者治疗前后的临床疗效，中医证候评分，心肌损伤因子水平[N末端B型利钠肽原（NT-proBNP）、肌酸激酶同工酶（CK-MB）、肌酸激酶（CK）]，心室重构参数[左室舒张末期内径（LVEDD）、左室收缩末期内径（LVESD）、左室射血分数（LVEF）、每搏输出量（SV）、左心室后壁厚度(LVPWT)、左心室内径缩短率(LLVFS)、室间隔收缩末期厚度(IVSS)]，心室重构血清学指标[血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)、基质金属蛋白酶-2（MMP-2）、内皮素-1(ET-1)]。结 果 与对照组比较，观察组总有效率高于对照组(87.88%比69.70%,P＜0.05)。与对照组比较，观察组治疗后血清AngⅡ、ALD、ET-1、MMP-2水平[(73.81±22.67)比(113.15±24.73), (198.44±26.93)比(273.29±23.85), (65.74±21.15)比(81.32±20.38), (122.14±13.03)比(145.39±17.58),P＜0.05]显著降低。与对照组比较，观察组治疗后LVEDD、LVESD、LVPWT、IVSS值[(47.63±6.95)比(51.94±6.67), (32.34±6.06)比(35.91±6.85), (8.03±0.68)比(11.94±0.73), (8.25±0.17)比(11.26±0.28),P＜0.05]显著降低，LVEF、SV、LVFS值[(51.35±3.14)比(46.26±4.08), (85.26±12.02)比(78.37±12.49), (22.62±2.23)比(18.87±2.31),P＜0.05]显著升高。与对照组比较，观察组治疗后气短喘息、乏力、心悸、倦怠懒言、汗出、语声低微、面色紫暗评分[(1.04±0.27)比(2.15±0.65), (0.96±0.21)比(1.82±0.59), (0.87±0.15)比(1.64±0.28), (0.78±0.23)比(1.47±0.51), (0.87±0.22)比(1.48±0.63), (0.69±0.19)比(1.41±0.31), (0.91±0.22)比(1.66±0.58),P＜0.05]显著降低。与对照组比较，观察组治疗后血清NT-proBNP、CK-MB、CK水平[(536.23±91.81)比(742.17±102.58), (19.35±2.66)比(28.92±3.78), (135.59±18.26)比(169.86±21.08),P＜0.05]显著降低。结 论 益气强心汤治疗冠脉慢性完全闭塞病变心衰患者疗效显著，降低中医证候评分，减轻心肌损伤，逆转心室重构，保护受损心肌细胞，提高预后水平。 |
| 英文摘要: |
| ABSTRACT: Objective To investigate the effect of Yiqi Qiangxin Decoction on ventricular remodeling in patients with chronic total occlusion of coronary heart failure. Methods A total of 66 patients with coronary heart failure with chronic total occlusion lesions who were treated in Taizhou Hospital of Zhejiang Province from August 2018 to August 2020 were selected and randomly divided into control group (n=33) and observation group (n=33) according to the random number table method, the control group was given sacubitril and valsartan sodium tablets on the basis of conventional western medicine treatment, and the observation group was given Yiqiqiangxin decoction on the basis of the control group. The course of treatment in both groups was 3 months. The outcome indicators includes clinical efficacy, TCM syndrome score, myocardial injury factor levels [N-terminal pro-B-type natriuretic peptide (NT-proBNP), creatine kinase isoenzyme (CK-MB), creatine kinase ( CK)], ventricular remodeling parameters [left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular ejection fraction (LVEF), stroke volume (SV), left ventricular posterior wall thickness (LVPWT), left ventricular diameter shortening rate (LLVFS), ventricular septal thickness at end-systolic (IVSS)], ventricular remodeling serological indicators [angiotensin II (Ang II), aldosterone (ALD), matrix metalloproteinase-2 (MMP- 2), endothelin-1 (ET-1)]. Results The total effective rate of the observation group was higher than that of the control group (87.88% vs 69.70%, P<0.05). Compared with the control group, the serum levels of AngⅡ, ALD, ET-1 and MMP-2 in the observation group after treatment was lower [(73.81±22.67) vs (113.15±24.73), (198.44±26.93) vs (273.29±23.85), (65.74±21.15) vs (81.32±20.38), (122.14±13.03) vs (145.39±17.58), P＜0.05]. Compared with the control group, the LVEDD, LVESD, LVPWT, IVSS values of the observation group after treatment was lower than that of the control group [(47.63±6.95) vs (51.94±6.67), (32.34±6.06) vs (35.91±6.85), (8.03±0.68) vs(11.94) ±0.73), (8.25±0.17) vs (11.26±0.28), P<0.05].The LVEF, SV, LVFS values of the observation group after treatment was higher than that of the control group [(51.35±3.14) vs (46.26±4.08), (85.26±12.02) vs (78.37 ±12.49), (22.62±2.23) vs(18.87±2.31), P<0.05]. Compared with the control group, the scores of shortness of breath, wheezing, fatigue, palpitations, lassitude, sluggishness, sweating, low voice and dark complexion in the observation group after treatment were significantly lower[(1.04±0.27) vs. (2.15±0.65), (0.96±0.21) vs (1.82±0.59), (0.87±0.15) vs (1.64±0.28), (0.78±0.23) vs (1.47±0.51), (0.87±0.22) vs (1.48±0.63), (0.69±0.19) vs (1.41) ±0.31), (0.91±0.22)vs(1.66±0.58), P＜0.05]. Compared with the control group, the serum levels of NT-proBNP, CK-MB and CK in the observation group after treatment were significantly lower [(536.23±91.81) vs (742.17±102.58), (19.35±2.66)vs(28.92±3.78),(135.59±18.26)vs(169.86±21.08),P<0.05]. Conclusion Yiqi Qiangxin Decoction has significant curative effect in the treatment of coronary heart failure patients with chronic total occlusion lesions, reduces TCM syndrome scores, alleviates myocardial injury, reverses ventricular remodeling, protects damaged myocardial cells, and improves prognosis.
KEYWORDS: Yiqi Qiangxin Decoction; Sacubatril and Valsartan Sodium Tablets; Chronic Complete Coronary Occlusion; Chronic Heart Failure; Ventricular Remodeling |
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