“毒”邪在重症心力衰竭中的发病机制及其治法研究

发布时间：2018-02-01 19:50

本文关键词： 毒邪重症心力衰竭发病机制解毒法肌酐总胆红素高敏C反应蛋白　出处：《南京中医药大学》2017年博士论文　论文类型：学位论文

【摘要】：目的重症心力衰竭是最严重的心血管疾病之一。近年来,虽然中西医学对其发病机制的认识逐渐深入,治疗理念、方法和药物不断进步,临床疗效亦有所提高,但是该病的再住院率及死亡率仍居高不下。本研究拟通过中医理论研究,明确提出"毒"邪在重症心力衰竭中的发病机制,提出解毒法是其基本治疗大法之一。通过临床研究证实"毒"邪是重症心力衰竭的重要发病机制,探究解毒法祛除重症心力衰竭"毒"邪的重要价值,为提高重症心力衰竭患者的临床疗效水平,深化相关研究提供有益的思路与参考。方法依据重症心力衰竭现代医学及中医学研究的既往资料,从中医理论上明确提出并论述了"毒"邪在重症心力衰竭中的发病机制,详述了毒邪与瘀水互因互生的关系。提出解毒法是其基本治疗大法之一。指出了利水解毒法、扶正解毒法、活血解毒法、利湿解毒法、清热解毒法、凉血解毒法、通便解毒法等7种解毒法。选取重症心力衰竭阳虚血瘀水停毒聚患者,对照组治疗采用基础西药治疗(对照组),常规中药组在对照组基础上配合中药常规温阳活血利水法治疗,解毒组在常规中药组治法基础上配合解毒法。观察治疗前后有关临床和理化指标(症状积分疗效、入院到达干体重的天数、心功能分级变化、生活质量评估、6分钟步行试验、左室射血分数(LVEF)、血肌酐和尿素氮、血谷丙转氨酶和总胆红素(TBIL)、血高敏C反应蛋白(hs-CRP)和B型利钠肽(BNP)、尿α 1微球蛋白和微量白蛋白的变化。结果重症心力衰竭患者解毒组和常规中药疗法治疗后比较,症状积分疗效(显效率66.7:53.3,%)、心功能分级疗效(显效率63.3:56.7,%)、6分钟步行距离(434.9::393.1,m)、BNP 水平(621.2:710.2,pg/ml)、LVEF(47.8:46.8,%)、血尿素氮(7.8:8.4,mmol/L)以及尿α 1MG(12.2:14.6,mg/L),均有一定改善,但尚未达到统计学差异。重症心力衰竭患者解毒组和常规中药疗法比较,明尼苏达心力衰竭生活质量评分(积分35.1:40.3)、达干体重患者的平均天数(6.46:7.38,天)、血肌酐(72.1:81.7,umol/L)、血TBIL(11.7:14.2,mmol/L)、hs-CRP(6.5:8.l,mg/L)、尿 mALB(12.1:15.2,mg/L)等结果均有显著差异(P0.05)。重症心力衰竭患者解毒组和对照组比较,以上各项观察指标均有不同程度差异(P0.05 或 P0.01)。临床研究结果提示解毒法能进一步改善重症心力衰竭患者的临床疗效、缩短达干体重疗程、降低BNP水平,促进心功能恢复、降低重症心力衰竭患者的肾毒(肌酐和尿素氮)水平、炎毒反应水平、保护肝肾功能、降低肝毒(TBIL)水平、防治早期肾损害等作用。结论"毒"邪是重症心力衰竭发病的重要机制,解毒法是治疗重症心力衰竭的有效措施。解毒法的实质是"减毒"、"消毒"和"排毒"。该法具有协同增强心肌收缩力、降低利尿钠肽水平、抗炎"毒"反应、清除肾毒(肌酐和尿素氮)、保肝清毒(如总胆红素)、保护肾小球和肾小管等作用,该法对重症心力衰竭治疗作用可能与拮抗交感神经系统活性和拮抗RAAS有关。
[Abstract]:The purpose of severe heart failure is one of the most serious cardiovascular disease. In recent years, although the Chinese and Western medicine understanding of its pathogenesis gradually, treatment concept, methods and progress of clinical medicine, also increased, but the disease hospitalization rate and mortality rate is still high. This study proposed by the theory of traditional Chinese medicine research, clear put forward the "pathogenesis of toxic evil in severe heart failure, the detoxification is the basic treatment of. Through clinical research confirmed that the poison is an important pathogenesis of severe heart failure, an important value of detoxification removing poison in severe heart failure, in order to improve the level of clinical efficacy in patients with severe heart failure, providing ideas and reference to deepen the related research. Research methods based on severe heart failure in modern medicine and traditional Chinese medicine in the past data, from the TCM theory and put forward clearly Discusses the pathogenesis of toxic evil in severe heart failure in detail, pathogenic toxin and stasis water due to alternate relationship. Proposed detoxification is the basic treatment of law. It is pointed out that the water detoxification method, removing toxin, blood detoxification method, dampness detoxification, detoxification, detoxification method. 7 laxative detoxification detoxification method. Selected patients with severe heart failure Yang deficiency and blood stasis of water stop drug accumulation patients, control group treated by Western Medicine (control group), conventional Chinese medicine group on the basis of the control group with routine Chinese herbal medicine Wenyang Huoxue Lishui treatment group with detoxification detoxification method in the conventional treatment based on traditional Chinese medicine group. Observed before and after treatment of clinical and physiochemical indexes (symptom efficacy, hospitalization days to dry weight, heart function change, quality of life assessment, the 6 minute walk test, left ventricular ejection fraction (LVEF), serum creatinine and blood urea nitrogen, serum alanine. Aspartate aminotransferase and total bilirubin (TBIL), serum high-sensitivity C reactive protein (hs-CRP) and B type natriuretic peptide (BNP), the changes of urinary albumin and alpha 1 microglobulin. Results the detoxification group and conventional medicine therapy in patients with severe heart failure after treatment, symptom efficacy (the effective rate was 66.7: 53.3,%), heart function classification effect (the effective rate was 63.3:56.7,%), 6 minutes walking distance (434.9:: 393.1, m), BNP (621.2:710.2, pg/ml), LVEF (47.8:46.8,%), blood urea nitrogen (7.8:8.4, mmol/L) and urine 1MG (12.2:14.6, mg/L) alpha, have certain improvement, but there were no significant differences between groups comparison of patients with severe heart failure. Detoxification group and conventional medicine therapy, quality of life score (Minnesota heart failure score 35.1:40.3), the average number of days up to dry weight patients (6.46:7.38 days), serum creatinine (72.1:81.7, umol/L), blood TBIL (11.7:14.2, mmol/L), hs-CRP (6.5:8.l, mg/L), urine mALB (12.1:15.2, mg/ L) were significant difference (P0.05) in patients with severe heart failure. Detoxification group and control group, the above indexes have different degrees of difference (P0.05 or P0.01). The clinical results suggest that detoxification method can further improve clinical efficacy in patients with severe heart failure, shorten the course of dry weight, decrease the level of BNP, improve heart function recovery, reduce renal toxicity in patients with severe heart failure (creatinine and urea) level, inflammatory toxicity level, protect liver and kidney function, reduce liver toxicity (TBIL) level of prevention and treatment effects of early renal damage. Conclusion poison is an important mechanism in the pathogenesis of severe heart failure, detoxification method is an effective approach for treatment of severe heart failure. The essence of detoxification is "attenuated", "sterilization" and "Detox". This method has enhanced myocardial contractility, reduce natriuretic peptide levels, inflammatory reaction, removal of the "poison" of renal toxicity (creatinine and urea nitrogen), Paul Liver clearing toxin (such as total bilirubin) protects glomeruli and renal tubules, which may play a role in antagonizing sympathetic nervous system activity and antagonizing RAAS.

【学位授予单位】：南京中医药大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R259

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