摘要
背景:充血性心力衰竭是各种心脏病的严重或终末阶段的一种临床综合征,约半数以上的器质性心脏病患者在其晚期都将发生心力衰竭。心力衰竭不仅发病率高,其死亡率也极高,五年存活率远不及恶性肿瘤。目的:观察鹿角方治疗充血性心力衰竭的临床疗效并分析其作用机制。设计:以充血性心力衰竭患者为研究对象的对比观察,前后对照试验。单位:上海中医药大学附属曙光医院心血管内科。对象:实验于1996-01/1998-12在上海中医药大学附属曙光医院心血管内科完成。选择心血管病房及专科门诊的充血性心力衰竭患者60例,男31例,女29例。纳入标准:①临床症状符合Framinham心力衰竭诊断标准。②纽约心脏病学会心功能Ⅲ级以上。③病史3个月以上。④接受适量的利尿剂或扩血管药物(血管紧张素转换酶抑制剂除外)作基础治疗。⑤胸部X片及超声心动图有左室扩大的证据。⑥中医辨证按中国中西医结合研究会1986年中医虚证辨证参考标准。两组充血性心力衰竭患者基础疾患及一般情况差异无显著性。方法:将60例充血性心力衰竭患者随机抽签法按2:1比例分为鹿角方组40例、地高辛组20例,给予鹿角方组患者口服鹿角方口服液35mL(每毫升含生药1.6g),2次/日,4周为1疗程。地高辛组患者口服地高辛片0.125-0.25mg,1次/日,4周为1疗程。于4周后观察两组患者临床疗效、肾虚症状积分、纽约心脏病学会心功能分级、Lee心衰评分、心率、心肌耗氧量、心胸比例、超声心动图(射血分数、心输出量、舒张期室间隔厚度、舒张期左室后壁厚度、左室重量指数)、放射免疫法测定血浆心钠素、血管紧张素Ⅱ水平等指标。主要观察指标:①临床疗效。②肾虚症状积分。③纽约心脏病学会心功能分级。④Lee心衰评分。⑤心率、心肌耗氧量。⑥心胸比例。⑦超声心动图检查。⑧血浆心钠素、血管紧张素Ⅱ放射免疫测定。结果:纳入60患者全部进入结果分析,无脱落。①鹿角方组患者经鹿角方口服液治疗后临床总有效率为90%,与地高辛组(90%)相比差异无显著性(P>0.05)。②鹿角方组患者治疗后肾虚症状总积分显著下降(P<0.01),而地高辛组患者经治疗后未见显著改变(P>0.05)。③鹿角方组、地高辛组患者治疗后纽约心脏病学会心功能分级均显著改善(P<0.01)。④鹿角方组、地高辛组患者治疗后Lee心衰评分均显著改善(P<0.01)。⑤鹿角方组患者心率,心肌耗氧量均显著下降(P<0.01),地高辛组患者治疗后心率、心肌耗氧量亦均显著下降(P<0.01)。⑥鹿角方组、地高辛组患者治疗后心胸比例均显著改善(P<0.01)。⑦鹿角方组患者治疗后射血分数、心输出量、舒张期室间隔厚度、舒张期左室后壁厚度、左室质量指数均显著改善(P<0.01);地高辛组患者治疗后射血分数、心输出量显著改善(P<0.01),而舒张期室间隔厚度、舒张期左室后壁厚度、左室重量指数未见显著下降(P>0.05)。⑧鹿角方组患者治疗后血浆心钠素和血管紧张素Ⅱ水平均显著下降(P<0.01);地高辛组患者仅血浆心钠素水平显著下降(P<0.01),而血浆血管紧张素Ⅱ水平上升无显著差异(P>0.05)。结论:鹿角方可增强心肌收缩功能,并逆转左室肥厚,对充血性心力衰竭的治疗较地高辛具有一定优势,该作用可能与改善循环内分泌(血管紧张素Ⅱ、血浆心钠素)水平的紊乱有关。
BACKGROUND： Congestive heart failure （CHF） is the clinical syndrome of all kinds of heart disease on the serious or final stage. About half of patients with organic heart disease will have heart failure that has a high incidence rate and mortality. The survival of heart failure was inferior to that of malignant tumor.
OBJECTIVE： To confirm the clinical effect of Lujiao preseription on CHF and elucidate its possible mechanism.
DESIGN： A control observation on CHF patients.
SETTING： Department of Cardiovasology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine.
PARTICIPANTS： A total of 60 patients with CHF were selected from the department of eardiovasology in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from January 1996 to December 1998. There were 31 male and 29 female. Included criteria： ①All of patients were consistent with Framinham diagnostic criteria. ② Above Ⅲ dery gree by New York Heart Association（NYHA）. ③ Three months ease history. ④Aecept quantity sufficient diuretic and vasodilating agent （exclude angiotensin converting enzyme inhibitor ）. ⑤ Left ventricle hypertrophy was proved by eehocardiogram or chest X-ray. ⑥ Differentiation of symptoms and signs of Traditional Chinese Medicine refers to asthenia syndrome of differentiation of symptoms and signs of Traditional Chinese Medicine （1986, Researching Association of Chinese integrated medicine） General state of health and basic disease of the patients in the two groups were not significant deviation.
METHODS： 60 patients of CHF were randomly divided into Lujiao prescription group（n=40） and Digoxin group （n=20） at the rate of 2：1. Lujiao prescription group： Orally liquid decoction of Lujiao Prescription 35 mL （1 mL contain crude drug 1.6 g） Bid. po. Course of treatment： 4 weeks. Digoxin group： Digoxin tablet, 0.125-0.25 mg, qd. po. course of treatment： 4 weeks. After 4-week treatment, the patients＇ clinical effect, integrals of the symptoms of renal deficiency, classification of function capacity of the NYHA, Lee＇s heart failure score, heart rate（HR）, myoeardium oxygen consumption （MOC）, proportion of heart to chest, eehocardiogram, measurement of plasma angitention Ⅱ （Ang Ⅱ ） and plasma atrial natriuretie factor （ANF） were observed.
MAIN OUTCOME MEASURES： ① The total clinic effective rate. ② Integrals of the symptoms of renal deficiency. ③ Classification of function capacity of the NYHA. ④ Lee＇ s heart failure score. ⑤HR and MOC. ⑥ The proportion of heart to chest. ⑦ Ejection fraction （EF）, eardie output （CO）, interventrieular septal thickness （IVST）, posterior wall thickness （PWT） and left ventrieular mass index （LVMI） through eehoeardiogram. ⑧ The measurement of plasma Ang Ⅱ and plasma ANF.
RESULTS：Totauy 60 patients entered the final analysis. ① The total clinical effective rate of the Lujiao prescription group was 90 %, which showed no significant difference from the Digoxin group （90 %, P 〉 0.05）. ② Improvement was significantly observed in the integrals of the symptom of renal deficiency of the patients in the Lujiao prescription group after treatment （P 〈 0.01）, but which was not significant in the Digoxin group（P〉 0.05）. ③ It was found that classification of functional capacity of NYHA between Lujiao prescription group and Digoxin group after treatment was obviously decreased （P 〈 0.01）. ④ Lee＇s heart failure score of patients in Lujiao prescription group and Digoxin group after treatment was decreased （P 〈 0.01）.⑤Myoeardium oxygen consumption and HR of the patients in the Lujiao prescription group and Digoxin group after treatment was decreased （P 〈 0.01）. ⑥ The proportion of heart to chest between Lujiao prescription group and Digoxin group after treatment was decreased （P 〈 0.01）. ⑦ EF and CO were increased by Lujiao prescription and by Digoxin（P 〈 0.01,vs pretreatment, respectively）. IVST, PWT, LVMI of Lujiao prescription group after treatment were obviously decreased （P 〈 0.01）, while those of the Digoxin group were not obviously decreased （P 〉 0.05）. ⑧ The level of plasma Ang Ⅱ of the patients in the Lujiao prescription group after treatment were obviously decreased （P 〈 0.01）, while that of the Digoxin group were not obviously decreased （P 〉 0.05）. The level of plasma ANF was decreased by Lujiao prescription and by digoxin（P 〈 0.01, vs pretreatment, respectively）.
CONCLUSION： There is increasing cardiac constriction power and regressing left ventricular hypertrophy of patients with CHF by Lujiao prescription. The therapeutical effect of Lujiao prescription for CHF is better than that of Digoxin. The effect may be related to the regulation of circular or local endocrine（plasma Ang Ⅱ and ANF） disorder.
出处
《中国临床康复》
CSCD
北大核心
2006年第27期152-155,共4页
Chinese Journal of Clinical Rehabilitation
