摘要
目的:观察自拟补肾活血汤治疗无法进行血运重建的冠心病的疗效及对血清N端脑利钠肽前体(NT-proBNP)、D-二聚体(D-D)、同型半胱氨酸(Hcy)和超敏C反应蛋白(hs-CRP)的影响。方法:将300例不能进行血运重建的严重冠心病患者随机分为治疗组(n=150例)和对照组(n=150例),对照组患者给予常规西医治疗,治疗组患者在对照组基础上加用自拟补肾活血汤治疗,治疗12个月。观察两组患者治疗前后心电图、心功能、运动耐量变化情况;检测患者治疗前后血清NT-proBNP、D-D、Hcy、hs-CRP水平。并随访12个月观察心脏不良事件(MACE)发生情况。结果:两组患者治疗后24 h动态心电图(Holter)中ST段总压低次数、ST段压低时间、ST段压低幅度、QRS波时限、矫正QT间期(QTc)均显著减少或降低,治疗组患者治疗后上述指标均低于对照组(P<0.05);两组患者治疗后左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、E/A值、NYHA心功能分级均显著改善,治疗组患者治疗后上述指标均优于对照组(P<0.05);两组患者治疗后6 min步行试验距离(6MWD)分级和平均值均显著改善,治疗组患者治疗后的上述指标均优于对照组(P<0.05);两组患者治疗后血清NT-proBNP、D-D、Hcy、hsCRP水平均显著降低,治疗组患者治疗后上述指标均低于对照组(P<0.05)。治疗组患者MACE发生率显著低于对照组(P<0.05)。结论:自拟补肾活血汤能显著改善无法进行血运重建的冠心病患者的缺血性心电图,改善心功能和运动耐量,降低MACE发生率,其机制可能与其降低血清NT-proBNP、D-D、Hcy、hs-CRP水平有关。
Objective: To observe the efficacy of self-made Bushen Huoxue Decoction on coronary heart disease that cannot be reconstructed by blood transport and to explore the influence on nitrogen in serum brain natriuretic peptide precursor(NT-proBNP), D-dimer(D-D), and homocysteine(Hcy) and hypersensitive c-reactive protein(hs-CRP). Methods: A total of 300 cases patients were randomly divided into treatment group(n=150) and control group(n=150). Patients were given conventional western medicine treatment in control group, and selfmade Bushen Huoxue Decoction based on the control group in treatment group, for 12 months. The changes of electrocardiogram, cardiac function and exercise tolerance were observed before and after treatment in two groups. Serum nt-probnp, D-D, Hcy and hs-crp levels were detected before and after treatment. The incidence of cardiac adverse events(MACE) was followed up at 24 months. Results: The 24 h dynamic electrocardiogram(Holter) ST segment total down times, ST segment down time, low ST segment, duration of QRS wave amplitude and phase correction between QT(QTc) were significantly reduced in the two groups after treatment, and thetreatment group showed lower above indicators than the control group after treatment(P<0.05); The left ventricular ejection fraction(LVEF), left ventricular end-diastolic diameter(LVEDD), E/A value, average NYHA heart function classification and grading were significantly improved in the two groups after treatment, and the treatment group showed better above indicators than the control group after treatment(P<0.05); The walking distance(6 MWD) grading and mean value of both groups improved significantly after treatment in the two groups, and treatment group showed better above indexes than the control group after treatment(P<0.05). Serum nt-probnp,D-D, Hcy and hs-CRP levels significantly decreased in the two groups after treatment, and the treatment group showed lower above indexes than the control group after treatment(P<0.05). The incidence of MACE in the observation group was significantly lower than that in the control group(P<0.05). Conclusions: Self-made Bushen Huoxue Decoction can significantly improve to reascularization ischemic electrocardiogram(ecg) in patients with coronary heart disease, improve heart function and exercise tolerance and decrease the incidence of MACE; its mechanism may be related to reduce serum NT-proBNP, D-D, Hcy and hs-CRP levels.
作者
杨志偲
王坤锋
罗文平
YANG Zhi-cai;WANG Kun-feng;LUO Wen-ping(The Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine,Xianyang Shaanxi 712000,China)
出处
《中医药导报》
2018年第23期77-81,共5页
Guiding Journal of Traditional Chinese Medicine and Pharmacy
基金
国家中医药管理局国家中医临床研究基地业务建设科研专项课题(JDZX2015252)
陕西省中医管理局中医药科研课题(15-LC011)
关键词
冠心病
血运重建
自拟补肾活血汤
N端脑利钠肽前体
D-二聚体
同型半胱氨酸
超敏C反应蛋白
coronary heart disease
revascularization
self-made Bushen Huoxue Decoction
nitrogen terminal brain natriuretic peptide precursor
D-dimer
homocysteine
hypersensitive C-reactive protein
