生脉养心颗粒对慢性心力衰竭患者免疫机制的影响和临床研究

发布时间：2018-03-16 09:19

本文选题：慢性心力衰竭　切入点：气阴两虚　出处：《山东中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:通过对生脉养心颗粒的临床观察,探讨生脉养心颗粒对气阴两虚型慢性心力衰竭(CHF)患者临床症状、实验室检查结果(免疫炎性指标)的影响;评价生脉养心颗粒在气阴两虚型慢性心力衰竭患者中使用的有效性、安全性。方法:将50例气阴两虚型CHF患者随机分为试验组25例,对照组25例。对照组给予单纯常规西药治疗,试验组在常规西药治疗基础上加用生脉养心颗粒;两组分别治疗6周后,观察两组治疗前后中医证候及综合疗效、明尼苏达生活质量评分、心脏超声指标(左室射血分数)、心功能分级(NHYA分级)、脑钠肽(BNP)、免疫炎性指标(白介素-6、肿瘤坏死因子-α、内皮素-1)等指标的变化情况。结果:1.试验组与对照组治疗前后中医症候均明显改善(P0.01),且试验组明显优于对照组(P0.01)。两组中医综合疗效总有效率96%,两组综合疗效进行非参数检验,有显著统计学意义(P0.01),试验组明显优于对照组。2.两组生活质量积分进行统计学分析,试验组与对照组均明显改善患者生活质量(P0.01),且试验组明显优于对照组(P0.01)。3.生脉养心颗粒:试验组与对照组对左室射血分数的影响统计学结果均得到P0.01,说明两组治疗在改善患者左室射血分数方面均有明显疗效;试验组与对照组疗效相比,在改善左室射血分数方面有统计学差异,且试验组优于对照组(P0.05)。4.生脉养心颗粒对心功能分级(NHYA)的影响:两组治疗前组内比较(P0.05)及治疗后组间比较(P0.05)均无统计学差异。5.两组治疗在降低慢性心衰患者BNP方面均有明显疗效(P=0.01);试验组与对照组疗效相比,在降低BNP方面有统计学差异,且试验组优于对照组(P0.05)。6.两组组内统计学分析均P0.01,有显著统计学意义;两组组间进行统计学分析P0.05(肿瘤坏死因子-αP=0.045、白介素-6 P=0.031、内皮素-1 P=0.038)均具有统计学意义,说明试验组在改善患者心衰免疫炎性方面优于对照组。结论:本试验结果提示,试验组与对照组均能明显改善慢性心衰患者的疗效指标,但试验组能进一步减轻患者症状及体征,提高运动耐量及生活质量,提示西药基础上加用生脉养心颗粒治疗慢性心力衰竭的疗效优于单纯西药治疗。说明运用生脉养心颗粒联合西药治疗慢性心力衰竭安全有效,值得临床参考及推广。
[Abstract]:Objective: to investigate the effect of Shengmai Yangxin granule on the clinical symptoms and laboratory results (immune inflammatory index) of CHF patients with chronic heart failure with deficiency of Qi and Yin through the clinical observation of Shengmai Yangxin granule. To evaluate the efficacy and safety of Shengmai Yangxin granule in patients with chronic heart failure with deficiency of both qi and yin. Methods: fifty patients with CHF with deficiency of both qi and yin were randomly divided into two groups. There were 25 cases in the control group. The control group was treated with simple routine western medicine, the experimental group was treated with Shengmai Yangxin granule on the basis of routine western medicine treatment, the two groups were treated for 6 weeks, and the syndromes of TCM and comprehensive curative effect were observed before and after treatment. Minnesota quality of Life score, Changes of echocardiographic parameters (left ventricular ejection fraction (LVEF), cardiac function grading (NHYA), brain natriuretic peptide (BNPN), immune inflammatory markers (interleukin-6, tumor necrosis factor- 伪, endothelin -1). Results 1. The experimental group and the control group were treated. The symptoms of TCM were significantly improved before and after treatment, and the experimental group was obviously superior to the control group (P 0.01). The total effective rate of the two groups was 96%. There was significant statistical significance (P 0.01), and the quality of life (QOL) score in the experimental group was significantly better than that in the control group (.2.). Both the experimental group and the control group significantly improved the quality of life of the patients, and the test group was obviously superior to the control group in P0.01n.3.Shengmai Yangxin granule: the effects of the experimental group and the control group on left ventricular ejection fraction were all significantly improved, indicating that the two groups were treated with P0.01. It has obvious curative effect in improving left ventricular ejection fraction. There was significant difference in the improvement of left ventricular ejection fraction between the experimental group and the control group. The effect of Shengmai Yangxin granule on the classification of cardiac function was better in the experimental group than that in the control group. There was no statistical difference between the two groups before and after treatment. There was no statistical difference between the two groups in reducing BNP in patients with chronic heart failure. Compared with the control group, the therapeutic effect of the test group was higher than that of the control group. There was statistical difference in reducing BNP, and the test group was better than the control group (P0.05A. 6. both P 0.01), there was significant statistical significance in the two groups. Statistical analysis of P0.05 (tumor necrosis factor- 伪 P0. 045, interleukin-6 P0. 031, endothelin-1-P0. 038) between the two groups showed that the experimental group was superior to the control group in improving the immune inflammation of patients with heart failure. Both the experimental group and the control group could obviously improve the curative effect index of the patients with chronic heart failure, but the experimental group could further alleviate the symptoms and signs of the patients, and improve the exercise tolerance and quality of life. It is suggested that the effect of adding Shengmai Yangxin granule in the treatment of chronic heart failure is better than that of western medicine alone, which indicates that the combination of Shengmai Yangxin granule and western medicine is safe and effective in the treatment of chronic heart failure, which is worthy of clinical reference and popularization.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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