温肾活血汤对老年慢性心衰阳虚血瘀证患者活动耐量的改善

发布时间：2018-11-16 17:25

【摘要】：目的:探讨温肾活血汤对老年慢性心衰阳虚血瘀证患者活动耐量的改善作用,及对N末端B型利钠肽原(NT-proBNP),和肽素,心肌肌钙蛋白T(CTnT)和血浆糖类抗原125(CA125)水平的影响。方法:将158例患者随机分为对照组和观察组。对照组在调整生活方式的基础上口服复方卡托普利片,2片/次,3次/d;阿替洛尔片,12.5 mg/次,2次/d;螺内酯片,10 mg/次,1次/d;地高辛片,0.125 mg/次,必要时服用。观察组在对照组治疗的基础上加服温肾活血汤,1剂/d。两组疗程均为16周。活动耐量采用6 min步行试验(6 MWT),于治疗前、治疗后8周和16周各评价1次;生活质量采用明尼苏达心衰生活质量调查表(MLHFQ)和简明健康问卷(SF-36),治疗前后各评价1次;进行治疗前后Lee氏心衰评分,NYHA心功能分级和中医证候评分;采用超声心动图记录治疗前后左室射血分数(LVEF),心输出量(CO),左室收缩末内径(LVESD)和舒张早期血流峰值(E)和舒张晚期血流峰值(A)之比(E/A),检测治疗前后NT-proBNP,和肽素,CTn T和CA125水平。结果:观察组心功能疗效总有效率为88.73%,高于对照组的71.43%(χ~2=6.631,P0.05);观察组心衰疗效总有效率为85.92%,高于对照组的67.14%(χ~2=6.929,P0.01);观察组在治疗后8周和16周,6 min步行距离均多于对照组(P0.01);观察组SF-36量表各维度评分均较对照组高(P0.01);治疗后观察组Lee氏心衰,MLHFQ,阳虚血瘀证和NYHA心功能分级评分均低于对照组(P0.01);治疗后观察组LVEF,CO和E/A均高于对照组(P0.05,P0.01);治疗后观察组NT-proBNP,CTnT,CA125和和肽素水平低于对照组(P0.01)。结论:温肾活血汤治疗老年CHF阳虚血瘀证患者,能减轻心衰症状,改善心功能,并能调节NT-proBNP,CTnT,CA125和和肽素水平,起到提高患者活动耐量和生活质量的作用。
[Abstract]:Objective: to investigate the effect of Wenshen Huoxue decoction (WXD) on the activity tolerance of elderly patients with chronic heart failure with yang deficiency and blood stasis syndrome, and to study the effect of warming kidney and activating blood decoction on N-terminal B-type natriuretic peptide (NT-proBNP) and peptide. Effects of cardiac troponin T (CTnT) and plasma carbohydrate antigen 125 (CA125) levels. Methods: 158 patients were randomly divided into control group and observation group. The control group was treated with compound captopril tablets (2 tablets, 3 times per day), atenolol tablets (12. 5 mg/, 2 times per day), spironolactone tablets (10 mg/, 1 time per day), while the control group took compound captopril tablets once a day on the basis of lifestyle adjustment. Digoxin tablets, 0.125 mg/, if necessary. The observation group was treated with Wenshen Huoxue decoction, 1 dose per day. The course of treatment in both groups was 16 weeks. The activity tolerance was measured by 6 min walking test (6 MWT), before treatment, 8 weeks and 16 weeks after treatment respectively). The quality of life (QOL) was evaluated once before and after treatment by Minnesota Heart failure questionnaire (MLHFQ) and brief Health questionnaire (SF-36). Lee's heart failure score, NYHA cardiac function grading and TCM syndromes score were performed before and after treatment. Left ventricular ejection fraction (LVEF),) cardiac output (CO), left ventricular end-systolic diameter (LVESD), early diastolic peak value (E) and late diastolic peak value (A) ratio (E / A) were recorded by echocardiography before and after treatment. The levels of NT-proBNP, CTn T and CA125 were measured before and after treatment. Results: the total effective rate of cardiac function in the observation group was 88.73, which was higher than that in the control group (71.43%) (蠂 ~ 2, 6.631, P 0.05). The total effective rate of heart failure in the observation group was 85.92, which was higher than that in the control group (67.14%), and the walking distance in the observation group at 8 and 16 weeks after treatment was higher than that in the control group (P0.01). The scores of each dimension of SF-36 scale in the observation group were higher than those in the control group (P0.01), the scores of Lee's heart failure, MLHFQ, yang deficiency and blood stasis syndrome and NYHA cardiac function grading in the observation group were lower than those in the control group after treatment (P0.01). After treatment, the levels of LVEF,CO and EPA in the observation group were higher than those in the control group (P 0.05 P 0.01), and the levels of NT-proBNP,CTnT,CA125 and peptide in the observation group were lower than those in the control group (P 0.01). Conclusion: Wenshen Huoxue decoction can relieve the symptoms of heart failure, improve cardiac function, regulate the levels of NT-proBNP,CTnT,CA125 and peptide, and improve the activity tolerance and quality of life in the elderly patients with CHF syndrome of yang deficiency and blood stasis.
【作者单位】：重庆市中医院;
【基金】：重庆市科技计划项目(cste2016jcyjAX0010)
【分类号】：R259

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