摘要
目的探讨益气活血利水方联合醛固酮受体拮抗剂治疗老年射血分数保留心力衰竭(HFpEF)的临床效果。方法采用前瞻性、开放、空白对照的临床研究方法,收集2017年12月~2018年12月湖北省中医院门诊及住院HFpEF患者120例,按照随机数字表法将其分为中药组、螺内酯组、联合组及对照组,每组各30例。对照组采用西药基础治疗,中药组予益气活血利水方,螺内酯组予螺内酯20 mg/片/d,联合组同时予与中药组及螺内酯组相同的治疗干预,各组均连续治疗2周。记录并比较各组治疗前后患者氨基末端脑钠肽前体(NT-proBNP)水平、中医证候积分及6 min步行试验结果。结果研究过程中脱落5例,实际完成研究115例。其中对照组30例、中药组28例,螺内酯组29例、联合组28例。四组患者治疗前NT-proBNP水平比较,差异无统计学意义(P> 0.05)。联合组、中药组、螺内酯组治疗后NT-proBNP水平均低于治疗前,差异均有统计学意义(均P <0.05)。与对照组治疗后比较,联合组、螺内酯组和中药组NT-proBNP水平降低,且联合组低于螺内酯组,差异均有统计学意义(均P <0.05)。四组患者治疗前中医证候积分比较,差异无统计学意义(P> 0.05)。各组治疗后中医证候积分均低于治疗前,差异有统计学意义(P <0.05)。与对照组治疗后比较,联合组、中药组、螺内酯组中医证候积分均降低,其中联合组和中药组中医证候积分均低于螺内酯组,差异均有统计学意义(均P <0.05)。联合组与中药组中医证候积分比较,差异无统计学意义(P> 0.05)。四组患者治疗前6 min步行距离比较,差异无统计学意义(P> 0.05)。各组患者治疗后6 min步行距离均大于治疗前,差异均有统计学意义(均P <0.05)。联合组治疗后6 min步行距离大于螺内酯组及对照组,差异均有统计学意义(均P <0.05)。联合组与中药组6 min步行距离比较,差异无统计学意义(P> 0.05)。结论益气活血利水方的优势在于改善中医证候和提高活动耐力,螺内酯的优势在于降低NT-proBNP水平,两者联用是治疗HFpEF的有效方法。
Objective To investigate the clinical effect of treating heart failure and preserved ejection fraction(HFpEF)in elderly patients with Yiqi Huoxue Lishui Prescription combined with aldosterone receptor antagonist.Methods A prospective,open and blank controlled clinical study was conducted to collect 120 cases of HFp EF patients in the out-patient and in-patient department of Hubei Provincial Hospital of Traditional Chinese Medicine from December 2017 to December 2018.According to the random number table method,they were divided into the traditional Chinese medicine group,the Spironolactone group,the combined group and the control group,each group with 30 cases.The control group was treated withwestern medicine basic treatment,the traditional Chinese medicine group was treated with Yiqi Huoxue Lishui Prescription,the Spironolactone group was treated with Spironolactone 20 mg/tablet/day,and the combined group received the same therapeutic intervention as the traditional Chinese medicine group and spironolactone group at the same time.Each group was treated continuously for 2 weeks.The results of N terminal pro B type natriuretic peptide(NT-pro BNP)level,traditional Chinese medicine syndrome score and 6 min walking test were recorded and compared before and after treatment.Results Five cases were shed during the study,and 115 cases were actually completed.There were 30 cases in the control group,28 cases in the traditional Chinese medicine group,29 cases in the Spirolactone group and28 cases in the combined group.There was no statistically significant difference in the level of NT-pro BNP between the four groups before treatment(P>0.05).The level of NT-pro BNP after treatment in the combined group,the traditional Chinese medicine group and the Spironolactone group was lower than that before treatment,and the differences were statistically significant(all P<0.05).Compared with the control group after treatment,the level of NT-pro BNP in the combined group,the Spironolactone group and the traditional Chinese medicine group decreased,and the combined group was lower than the Spironolactone group,the differences were statistically significant(all P<0.05).There was no significant difference in traditional Chinese medicine syndrome score among the four groups before treatment(P>0.05).The traditional Chinese medicine syndrome scores of each group were lower after treatment than before treatment,and the differences were statistically significant(P<0.05).Compared with the control group after treatment,the traditional Chinese medicine syndrome scores of the combined group,the traditional Chinese medicine group and the Spironolactone group all decreased,and the traditional Chinese medicine syndrome scores of the combined group and the traditional Chinese medicine group were all lower than those of the Spironolactone group,with statistically significant differences(all P<0.05).There was no significant difference in traditional Chinese medicine syndrome scores between the combined group and the traditional Chinese medicine group(P>0.05).There was no statistically significant difference in 6 min walking distance among the four groups before treatment(P>0.05).The 6 min walking distance of each group after treatment was greater than that before treatment,and the differences were statistically significant(all P<0.05).After treatment,the 6 min walking distance of the combined group was greater than that of the Spirolactone group and the control group,and the differences were statistically significant(all P<0.05).There was no significant difference in 6 min walking distance between the combined group and the traditional Chinese medicine group(P>0.05).Conclusion The advantage of the Yiqi Huoxue Lishui Prescription lies in the improvement of traditional Chinese medicine syndrome and activity endurance,and the advantage of Spironolactone lies in the reduction of NT-pro BNP level.The combination of the two is an effective method for the treatment of HFp EF.
作者
彭朗
鲁晓斌
梅应兵
刘进进
倪维
PENG Lang;LU Xiaobin;MEI Yingbing;LIU Jinjin;NI Wei(Hubei Province Academy of Traditional Chinese Medicine,Hubei Province,Wuhan 430074,China;Department of Geriatrics,Hubei Provincial Hospital of Traditional Chinese Medicine,Hubei Province,Wuhan 430060,China;Department of Cardiovascular,Hubei Provincial Hospital of Traditional Chinese Medicine,Hubei Province,Wuhan 430060,China;Clinical Laboratory,Hubei Provincial Hospital of Traditional Chinese Medicine,Hubei Province,Wuhan 430060,China)
出处
《中国医药导报》
CAS
2020年第17期57-61,共5页
China Medical Herald
基金
中国中医科学院中医基础理论研究所“院所协同创新科研专项基金”资助项目(YZ-1753)
湖北省卫生健康委员会科研项目(WJ2019F164)。
关键词
益气活血利水
醛固酮受体拮抗剂
射血分数保留心力衰竭
临床观察
Yiqi Huoxue Lishui Prescription
Aldosterone receptor antagonist
Heart failure and preserved ejection fraction
Clinical observation
