摘要
目的：观察芪苈强心胶囊联合糖皮质激素辅助治疗扩张型心肌病（DCM）难治性心力衰竭（心衰）患者的临床疗效。方法采用前瞻性研究方法，选择河北省沧州市中心医院收治的48例DCM难治性心衰患者，按随机数字表法分为对照组、治疗Ⅰ组及治疗Ⅱ组，每组16例。对照组予以常规抗心衰西药治疗；治疗Ⅰ组在常规治疗基础上加用泼尼松40 mg/d，每5 d减5 mg，至5 mg/d维持；治疗Ⅱ组在治疗Ⅰ组的基础上，加用芪苈强心胶囊4粒（每粒0.3 g），每日3次。3组疗程均为2个月。于治疗后1周、2个月观察3组临床疗效、心功能指示左室舒张期末容积（LVEDV）、左室收缩期末容积（LVESV），左室射血分数（LVEF）、血浆B型脑钠肽（BNP）等指标，同时观察心电图、天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、尿素氮（BUN）、血肌酐（SCr）、血常规、尿常规的变化及不良反应的发生情况。结果治疗Ⅰ组及治疗Ⅱ组治疗后总有效率均明显高于对照组〔治疗后1周：81.2%（13/16），81.2%（13/16）比43.8%（7/16）；治疗后2个月：87.5%（14/16），93.7%（15/16）比50.0（8/16），均P＜0.05〕，3组治疗后LVEDV、LVESV、BNP降低，LVEF均升高，且治疗后2个月治疗Ⅱ组上述指标的改善程度明显优于治疗Ⅰ组〔LVEDV（mL）：142.4±33.0比174.8±52.5，LVESV（mL）：111.6±23.7比132.4±29.0，LVEF：0.421±0.037比0.390±0.045，BNP（μg/L）：1.944±0.751比3.038±1.905，均P＜0.05〕。结论芪苈强心胶囊联合糖皮质激素能有效改善DCM难治性心衰患者的近期及远期临床症状，改善心功能，提高生活质量。
Objective To observe the therapeutic effect of Qili Qiangxin capsule combined with glucocorticoid for treatment of patients with dilated cardiomyopathy accompanied by refractory heart failure. Methods A prospective study was conducted. Forty-eight patients with dilated cardiomyopathy and refractory heart failure in Hebei Cangzhou Central Hospital were enrolled,and they were randomly divided into three groups：control group,treatmentⅠand treatmentⅡgroups（each,16 cases）. All groups were treated with conventional anti-heart failure western treatment, meanwhile additionally prednisone was given to treatment groupⅠand groupⅡ,firstly 40 mg/d,then the dosage of 5 mg was decreased in every 5 days until reaching 5 mg per day;in treatment groupⅡ,besides the same treatment of group I,the traditional Chinese medicine therapy Qili Qiangxin capsule 4 granules（one capsule 0.3 g）each time and 3 times a day was added,2 months being the therapeutic course in all the patients. The clinical efficacy and cardiac functional indexes,such as the left ventricular end-diastolic volume（LVEDV）,the left ventricular end-systolic volume（LVESV）,the left ventricular ejection fraction（LVEF）and the plasma B type brain natriuretic peptide （BNP）,etc. were observed in 1 week and 2 months after treatment. Meanwhile the electrocardiogram（ECG）,aspartate transaminase（AST）,alanine aminotransferase（ALT）,urea nitrogen（BUN）,serum creatinine（SCr）,blood routine, urine routine examination and the adverse effects were investigated. Results The total effective rates in treatment groupⅠand treatment groupⅡwere significantly higher than those in the control group〔after treatment for 1 week：81.2%（13/16）,81.2%（13/16）vs. 43.8%（7/16）;after 2 months：87.5%（14/16）,93.7%（15/16）vs. 50.0%（8/16）, all P〈0.05〕. After treatment,the LVEDV,LVESV and BNP were lowered and the LVEF was increased in the three groups,and the above indexes in treatment groupⅡwere improved more significantly than those in groupⅠ〔LVEDV （mL）：142.4±33.0 vs. 174.8±52.5,LVESV（mL）：111.6±23.7 vs. 132.4±29.0,LVEF：0.421±0.037 vs. 0.390±0.045,BNP（μg/L）：1.944±0.751 vs. 3.038±1.905,all P〈0.05〕. Conclusion Qili Qiangxin capsule combined with glucocorticoid may effectively improve the cardiac function and clinical symptoms in near and forward future in patients with dilated cardiomyopathy accompanied by refractory heart failure,thus it may elevate the patients＇ life quality.
出处
《中国中西医结合急救杂志》
CAS
北大核心
2014年第6期442-445,共4页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
河北省沧州市科技计划项目（131302058）
关键词
芪苈强心胶囊
糖皮质激素
难治性心力衰竭
中西医结合疗法
Qili Qiangxin capsule
Glucocorticoid
Refractory heart failure
Combined therapy of traditional Chinese and western medicine
