苓桂养心汤对心气阳虚证扩张型心肌病患者心功能和抗心肌抗体的影响

发布时间：2018-03-24 12:13

本文选题：苓桂养心汤　切入点：扩张型心肌病　出处：《中国实验方剂学杂志》2017年23期

【摘要】：目的:观察苓桂养心汤对心气虚和(或)阳虚证素的扩张型心肌病(dilated cardiomyopathy,DCM)患者的临床疗效、心功能及抗心肌抗体的影响,为苓桂养心汤的临床应用提供理论依据。方法:抽取无锡地区2013年5月—2016年9月住院的DCM[心气虚和(或)阳虚证素]患者142例,随机分为对照组(西医常规治疗)70例,治疗组(西医常规治疗基础上,加用苓桂养心汤治疗)72例。并随机抽取40例非DCM心力衰竭患者(心衰组)以及34例健康体检者(正常组)。对入选病例进行血清抗心肌抗体测定,4周后观察DCM组患者的临床疗效及治疗前后心功能、抗心肌抗体变化。结果:临床疗效,治疗组患者中医证候疗效总有效率为89.6%,对照组为71.9%,治疗组高于对照组(P0.05)。心功能,治疗组与对照组患者治疗后纽约心脏病学会(New York Heart Association,NYHA)分级疗效的总有效率分别为85.1%,81.2%,两组比较差异无统计学意义。治疗组治疗后N端前脑钠素(NT-Pro BNP)水平低于对照组同期水平(P0.05)。与治疗前比较,两组左心室射血分数(LVEF)明显升高;左心室舒张末期内径(LVEDd)明显下降(P0.05)。治疗后与对照组比较,治疗组各指标值差异均无统计学意义。抗心肌抗体,DCM组与正常组比较,各抗心肌抗体明显升高(P0.01)。DCM组与心衰组比较,抗心肌抗体抗β1肾上腺能受体自身抗体(ant-β1),抗肌球蛋白重链自身抗体(ant-MHC),抗毒蕈碱-2受体自身抗体(ant-M2),抗腺嘌呤核苷(ADP/ATP)转位酶自身抗体(ant-ANT)差异显著(P0.01);心衰组与正常组比较,4种抗心机抗体均无统计学差异。与治疗前比较,两组患者血清抗心肌抗体ant-β1,ant-MHC,ant-M2,ANT均显著降低(P0.05)。治疗后与对照组比较,治疗组ant-β1,ANT水平降低(P0.05)。治疗组低血压、心律失常及刺激性干咳发生率低于对照组(P0.05)。两组肾功能不全发生率无统计学差异。结论:苓桂养心汤可改善心气虚和(或)阳虚证素DCM患者的症状、体征,提高中医证候疗效,改善心功能,减少不良事件的发生,其作用机制可能与改善抗心肌抗体水平有关。
[Abstract]:Objective: to observe the effect of Linggui Yangxin decoction on the clinical effect, cardiac function and anti-myocardial antibody of dilated cardiomyopathy DCM in dilated cardiomyopathy of dilated cardiomyopathy with deficiency of heart qi and / or yang deficiency syndrome. Methods: 142 patients with DCM [Heart Qi deficiency and / or Yang deficiency Syndrome] hospitalized in Wuxi from May 2013 to September 2016 were randomly divided into control group (70 cases of routine western medicine treatment). Treatment group (on the basis of routine western medicine treatment, In addition, 72 patients were treated with Linggui Yangxin decoction. 40 patients with non DCM heart failure (heart failure group) and 34 healthy controls (normal control group) were randomly selected. Serum anti myocardial antibodies were measured for 4 weeks to observe the DCM patients. The clinical curative effect and cardiac function before and after treatment, Results: the total effective rate of TCM syndromes in the treatment group was 89.6 and that in the control group was 71.9. The heart function in the treatment group was higher than that in the control group (P 0.05). The total effective rate of the treatment group and the control group was 85.1% and 81.2%, respectively. The level of NT-Pro BNPs in the treatment group was lower than that in the control group. During the same period, the level of P0. 05 was compared with that before treatment. Left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDd) were significantly increased in both groups. Compared with the heart failure group, the anti-myocardial antibodies were significantly increased in the P0.01 + DCM group and in the heart failure group. There were significant differences in ant- 尾 1- 尾 1 autoantibody, ant-MHCI autoantibody against myosin heavy chain, anti muscarin-2 receptor autoantibody ant-M2P, anti adenosine nucleoside ADP- ATPase autoantibody against antant- 尾 1 receptor autoantibody against ant- 尾 1 adrenergic receptor autoantibody ant- 尾 1, anti myosin heavy chain autoantibody, anti muscarin-2 receptor autoantibody and anti adenosine nucleoside adenosine translocation enzyme autoantibody (ant ANT) in heart failure group compared with normal group (P 0 01). There was no statistical difference among the 4 kinds of anti-cardiogenic antibodies compared with those before treatment. The levels of ant- 尾 1 ant-MHCant-M2ANT in the treatment group were significantly lower than those in the control group. After treatment, the level of ant- 尾 1 and ant in the treatment group was lower than that in the control group, and the hypotension in the treatment group was significantly lower than that in the control group. The incidence of arrhythmia and irritating dry cough was lower than that of control group (P 0.05). There was no significant difference in the incidence of renal insufficiency between the two groups. Conclusion: Linggui Yangxin decoction can improve the symptoms and signs of DCM patients with deficiency of heart qi and / or yang deficiency syndrome, and improve the curative effect of TCM syndrome. The mechanism of improving cardiac function and reducing adverse events may be related to the improvement of anti-myocardial antibody level.
【作者单位】：南京中医药大学无锡附属医院;
【基金】：无锡市医院管理中心科研项目(YGZXM14047)
【分类号】：R259

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