复方真武冲剂对心肾阳虚型心衰患者IL-6、NT-pro-BNP及生活质量影响的临床研究

发布时间：2018-04-18 13:18

本文选题：复方真武冲剂 + 慢性心力衰竭　；参考：《安徽中医药大学》2016年硕士论文

【摘要】：目的:本课题以复方真武冲剂与常规西药相结合治疗心肾阳虚型慢性心力衰竭(CHF)患者,通过观察患者血清中IL-6、NT-pro BNP和hs-CRP变化以及治疗前后患者心功能(NYHA)、心衰积分、中医证候积分、MLHFQ评分及LVEF的变化,判定复方真武冲剂的临床疗效并探讨其作用机制。方法:1.遵循慢性心力衰竭诊断标准、NYHA心功能分级标准以及中医诊断标准,收集符合病例纳入标准中的中医及西医诊断的患者共52例,随机分为研究组及对照组,每组各26例。2.研究组均予以复方真武冲剂联合常规西药治疗,对照组则仅予常规西药治疗。以8周为一疗程。3.对比治疗前后的心功能(NYHA)、心衰积分、中医证候积分、MLHFQ评分及LVEF变化;于治疗前后提取患者血清进行IL-6、NT-pro BNP及hs-CRP的实验室检测并记录相关数据。4.收集全部相关数据并制作成病例资料表格。用SPSS17.0对数据进行统计学分析并以“—xE±s”表示数据,用配对资料t检验进行组间治疗前后的对比,用独立样本t检验进行治疗前后两组之间的对比,当p0.05时差异具有统计学意义,若p0.01则差异具有显著统计学意义。结果:1.研究组治疗前与治疗后对比:治疗后患者心功能(NYHA)、心衰积分、中医证候积分、MLHFQ评分及LVEF均较前改善;血清IL-6、NT-pro BNP及hs-CRP数值较前下降明显,具统计学意义(P0.01)。2.对照组治疗前与治疗后对比:治疗后患者心功能(NYHA)、心衰积分、中医证候积分、MLHFQ评分及LVEF均较前改善;血清IL-6、NT-pro BNP及hs-CRP数值下降明显,具有统计学意义(P0.01)。3.研究组、对照组治疗后数值对比:NYHA心功能分级研究组优于对照组(P0.05);心衰积分两组均有所改善,以研究组更显著(P0.05);中医证候积分两组均有所改善,以研究组更显著(P0.01);MLHFQ评分两组均较前改善,以研究组更显著(P0.05);LVEF数值两组均有改善,以研究组疗效更优(P0.05);NT-pro BNP两组均有改善,研究组疗效更优(P0.05);治疗后两组血清IL-6及hs-CRP平均下降,以研究组下降更为明显(P0.01);两组均未发生现严重不良反应。结论:复方真武冲剂与常规西药相结合治疗心肾阳虚型心衰,疗效优于单纯西药,对患者心功能及生活质量有明显改善作用,其机制可能为:1.通过调控炎性细胞因子的异常表达,抑制免疫炎症反应,从而减少心肌细胞损伤,改善心功能;2.通过抑制胶原降解和基质重构延缓心肌重塑;3.通过对RAAS系统的作用减少钠水潴留,减轻心脏负荷,改善心功能;4.通过调整自主神经功能,兴奋迷走神经,抑制交感神经活性,减轻心肌缺血缺氧,改善心功能。
[Abstract]:Objective: to observe the changes of IL-6 NT-pro BNP and hs-CRP in the serum of patients with heart and kidney yang deficiency chronic heart failure (CHF) treated with compound Zhenwu granule combined with routine western medicine, and to observe the cardiac function of patients before and after treatment.The changes of MLHFQ score and LVEF in TCM syndromes were used to evaluate the clinical efficacy of compound Zhenwu granule and to explore its mechanism.Method 1: 1.According to NYHA criteria and TCM diagnostic criteria, 52 patients were randomly divided into study group and control group (n = 26, n = 26, n = 26, n = 26, n = 26, n = 26, n = 26, n = 26, n = 26, n = 26, n = 26, n = 26, n = 26, n = 26).The study group were treated with compound Zhenwu granules combined with conventional western medicine, while the control group were only treated with conventional western medicine.Take 8 weeks as a course of treatment.The changes of cardiac function, heart failure score, TCM syndrome score and LVEF were compared before and after treatment, and the serum samples were collected before and after treatment for IL-6 NT-pro BNP and hs-CRP in laboratory and recorded the relevant data. 4.Collect all relevant data and make case data form.The data were statistically analyzed by SPSS17.0 and represented by "-xE 卤s". The data were compared before and after treatment with paired data t test, and the comparison between two groups before and after treatment with independent sample t test.When p0.05, the difference was statistically significant, if p0.01, the difference was statistically significant.The result is 1: 1.The study group before and after treatment: after treatment, the heart function of patients with NYHA, heart failure score, TCM syndrome score and MLHFQ score and LVEF were improved, serum IL-6 NT-pro BNP and hs-CRP values were significantly lower than before, with statistical significance.The comparison between the control group and the control group before and after treatment: after treatment, the cardiac function, heart failure score, TCM syndrome score and MLHFQ score and LVEF were improved, and the serum IL-6 NT-pro BNP and hs-CRP decreased significantly (P 0.01 路3).In the study group, the value of the control group was compared with that of the control group after treatment. The heart failure score in the study group was better than that in the control group (P 0.05); the score of heart failure was improved in both groups, especially in the study group; the score of TCM syndromes was improved in both groups.The score of MLHFQ in the study group was significantly improved than that in the previous group, and the value of P0.05 / L LVEF in the study group was significantly improved. The better effect of the study group was improved in both groups (P 0.05 / NT-pro BNP), and the curative effect in the study group was better than that in the control group (P 0.05), and the serum IL-6 and hs-CRP in the two groups decreased on average after treatment.In the study group, the decrease was more obvious than that in the study group, and there was no serious adverse reaction in both groups.Conclusion: the combination of compound Zhenwu granule and routine western medicine in the treatment of heart failure with deficiency of heart and kidney yang is better than that of western medicine alone. It can obviously improve the heart function and quality of life of the patients, and its mechanism may be 1: 1.By regulating the abnormal expression of inflammatory cytokines, inhibiting the immune inflammatory response, thereby reducing myocardial cell injury, improving cardiac function.Myocardial remodeling was delayed by inhibiting collagen degradation and matrix remodeling.Through the effect of RAAS system to reduce sodium and water retention, reduce cardiac load, improve cardiac function. 4.By regulating autonomic nervous function, stimulating vagus nerve, inhibiting sympathetic nerve activity, alleviating myocardial ischemia and hypoxia, improving cardiac function.
【学位授予单位】：安徽中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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