黄芪对心气阳虚证扩张型心肌病患者的干预作用及对抗心肌抗体的影响
发布时间：2019-07-23 10:48
【摘要】：目的:观察黄芪颗粒剂对心气虚和(或)阳虚证素的扩张型心肌病(dilated cardiomyopathy,DCM)患者干预作用及对抗心肌抗体的影响,为黄芪的临床应用提供理论依据。方法:选择无锡市中医医院和无锡市人民医院2013年5月至2016年1月期间住院的DCM心气虚和(或)阳虚证素患者134例为DCM组,随机分为常规组(采用西医常规治疗)67例,中药组(在常规组治疗基础上+黄芪60 g)67例。并随机抽取30例健康体检者作为正常组。在治疗第1,28天观察N终端脑钠肽(NT-pro BNP),左室射血分数(LVEF),左室舒张期末内径(LVEDD),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)水平,临床症状、体征、纽约心脏病协会(NYHA)心功能分级等的变化。结果:临床疗效,中药组患者中医证候疗效总有效率为91.9%,常规组患者中医证候疗效总有效率为71.0%,中药组高于常规组(P0.05)。心功能,中药组与常规组患者治疗后NYHA分级的疗效总有效率分别为82.3%,83.9%,两组比较差异无统计学意义。中药组治疗后NT-pro BNP水平低于常规组同期水平(P0.05)。治疗后两组LVEF明显升高(P0.05);LVEDD明显下降(P0.05)。两组治疗后各指标差异无统计学意义。抗心肌抗体,与正常组比较,DCM组各抗心肌抗体明显升高(P0.05)。治疗后两组患者血清抗心肌抗体ant-β1,ant-MHC,ant-M2水平明显降低(P0.05),中药组治疗后ant-ANT水平较治疗前显著降低(P0.05)。中药组治疗后ANT水平低于常规组同期水平(P0.05)。中药组低血压及心律失常发生率低于常规组(P0.05)。两组肾功能不全及刺激性干咳发生率无统计学差异。结论:黄芪能调节心气虚和(或)阳虚证素的DCM患者抗心肌抗体水平,降低血清NT-pro BNP水平,提高中医证候疗效,减轻患者症状,改善心功能,减少不良事件的发生。
[Abstract]:Objective: to observe the intervention effect of Huangqi granule on dilated cardiomyopathy (dilated cardiomyopathy,DCM) patients with deficiency of heart qi and / or yang deficiency syndrome and the effect of anti-myocardial antibody, so as to provide theoretical basis for clinical application of Astragalus membranaceus. Methods: from May 2013 to January 2016, 134 patients with DCM heart qi deficiency and / or yang deficiency syndrome hospitalized in Wuxi traditional Chinese Medicine Hospital and Wuxi people's Hospital were randomly divided into routine group (67 cases treated with routine western medicine) and traditional Chinese medicine group (60 g astragalus membranaceus 60 g on the basis of routine treatment). The patients with heart qi deficiency and / or yang deficiency syndrome were randomly divided into routine group (67 cases) and traditional Chinese medicine group (60 g astragalus membranaceus group). 30 healthy subjects were randomly selected as normal group. On the 1st and 28th day of treatment, the levels of N terminal brain natriuretic peptide (NT-pro BNP), left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD), anti-myocardial antibody anti-尾 1 suprarenal adenoreceptor autoantibody (ant- 尾 1), anti myosin heavy chain autoantibody (ant-MHC), anti muscarinic 2 receptor autoantibody (ant-M2), anti adenine nucleosides (ADP/ATP) translocation enzyme autoantibody (ant-ANT) were observed on the 1st and 28th day of treatment. Signs, changes in (NYHA) cardiac function classification of the New York Heart Association. Results: the total effective rate of TCM syndrome in traditional Chinese medicine group was 91.9%, and that in routine group was 71.0%. The total effective rate of TCM syndrome in traditional Chinese medicine group was higher than that in routine group (P 0.05). The total effective rate of NYHA grading in traditional Chinese medicine group and routine group was 82.3% and 83.9%, respectively. there was no significant difference between the two groups. After treatment, the level of NT-pro BNP in the traditional Chinese medicine group was lower than that in the routine group (P 0.05). After treatment, LVEF in the two groups increased significantly (P 0.05,); LVEDD decreased significantly (P 0.05). There was no significant difference in the indexes between the two groups after treatment. Compared with the normal group, the anti-myocardial antibodies in DCM group were significantly higher than those in the normal group (P 0.05). After treatment, the levels of serum anti-myocardial antibody ant- 尾 1 and ant-MHC,ant-M2 in the two groups were significantly lower than those before treatment (P 0.05), and the levels of ant-ANT in the traditional Chinese medicine group were significantly lower than those before treatment (P 0.05). After treatment, the level of ANT in the traditional Chinese medicine group was lower than that in the routine group (P 0.05). The incidence of hypotension and arrhythmia in the traditional Chinese medicine group was lower than that in the routine group (P 0.05). There was no significant difference in the incidence of renal insufficiency and irritating dry cough between the two groups. Conclusion: Astragalus membranaceus can regulate the level of anti-myocardial antibody in DCM patients with heart-qi deficiency and / or yang deficiency syndrome, reduce the level of serum NT-pro BNP, improve the curative effect of TCM syndrome, alleviate the symptoms of patients, improve cardiac function and reduce the occurrence of adverse events.
【作者单位】： 南京中医药大学无锡附属医院;无锡市惠山区中医院;
【基金】：无锡市医院管理中心科研项目(YGZXM14047)
【分类号】：R259
[Abstract]:Objective: to observe the intervention effect of Huangqi granule on dilated cardiomyopathy (dilated cardiomyopathy,DCM) patients with deficiency of heart qi and / or yang deficiency syndrome and the effect of anti-myocardial antibody, so as to provide theoretical basis for clinical application of Astragalus membranaceus. Methods: from May 2013 to January 2016, 134 patients with DCM heart qi deficiency and / or yang deficiency syndrome hospitalized in Wuxi traditional Chinese Medicine Hospital and Wuxi people's Hospital were randomly divided into routine group (67 cases treated with routine western medicine) and traditional Chinese medicine group (60 g astragalus membranaceus 60 g on the basis of routine treatment). The patients with heart qi deficiency and / or yang deficiency syndrome were randomly divided into routine group (67 cases) and traditional Chinese medicine group (60 g astragalus membranaceus group). 30 healthy subjects were randomly selected as normal group. On the 1st and 28th day of treatment, the levels of N terminal brain natriuretic peptide (NT-pro BNP), left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD), anti-myocardial antibody anti-尾 1 suprarenal adenoreceptor autoantibody (ant- 尾 1), anti myosin heavy chain autoantibody (ant-MHC), anti muscarinic 2 receptor autoantibody (ant-M2), anti adenine nucleosides (ADP/ATP) translocation enzyme autoantibody (ant-ANT) were observed on the 1st and 28th day of treatment. Signs, changes in (NYHA) cardiac function classification of the New York Heart Association. Results: the total effective rate of TCM syndrome in traditional Chinese medicine group was 91.9%, and that in routine group was 71.0%. The total effective rate of TCM syndrome in traditional Chinese medicine group was higher than that in routine group (P 0.05). The total effective rate of NYHA grading in traditional Chinese medicine group and routine group was 82.3% and 83.9%, respectively. there was no significant difference between the two groups. After treatment, the level of NT-pro BNP in the traditional Chinese medicine group was lower than that in the routine group (P 0.05). After treatment, LVEF in the two groups increased significantly (P 0.05,); LVEDD decreased significantly (P 0.05). There was no significant difference in the indexes between the two groups after treatment. Compared with the normal group, the anti-myocardial antibodies in DCM group were significantly higher than those in the normal group (P 0.05). After treatment, the levels of serum anti-myocardial antibody ant- 尾 1 and ant-MHC,ant-M2 in the two groups were significantly lower than those before treatment (P 0.05), and the levels of ant-ANT in the traditional Chinese medicine group were significantly lower than those before treatment (P 0.05). After treatment, the level of ANT in the traditional Chinese medicine group was lower than that in the routine group (P 0.05). The incidence of hypotension and arrhythmia in the traditional Chinese medicine group was lower than that in the routine group (P 0.05). There was no significant difference in the incidence of renal insufficiency and irritating dry cough between the two groups. Conclusion: Astragalus membranaceus can regulate the level of anti-myocardial antibody in DCM patients with heart-qi deficiency and / or yang deficiency syndrome, reduce the level of serum NT-pro BNP, improve the curative effect of TCM syndrome, alleviate the symptoms of patients, improve cardiac function and reduce the occurrence of adverse events.
【作者单位】： 南京中医药大学无锡附属医院;无锡市惠山区中医院;
【基金】：无锡市医院管理中心科研项目(YGZXM14047)
【分类号】：R259
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