摘要
目的 观察仲景温阳法辨证论治慢性心力衰竭（CHF）的临床疗效.方法 选择2016年4月至2017年10月衢州市柯城区人民医院门诊及住院的心肾阳虚型CHF患者62例,按治疗方法不同将患者分为西医治疗组和中西医结合治疗组,每组31例.西医治疗组按CHF常规方案治疗,中西医结合治疗组在常规治疗基础上联合仲景温阳方（熟附片20 g、桂枝20 g、黄芪30 g、党参15 g、炙甘草10 g、茯苓20 g、白术15 g、丹参20 g、白芍15 g、麦冬15 g、生姜10 g、大枣10 g水煎服）每日1次,两组疗程均为8周.观察两组患者治疗前后美国纽约心脏病学会（NYHA）心功能分级、中医证候积分、明尼苏达心力衰竭生存质量量表（MLHFQ）评分及心脏超声心功能指标的变化;检测血浆N末端钠尿肽前体（NT-proBNP）、超敏C-反应蛋白（hs-CRP）、血管紧张素Ⅱ（AngⅡ）、醛固酮（ALD）水平;并记录相关安全性指标（血、尿、粪常规和肝肾功能等）及不良反应发生率.结果 中西医结合治疗组治疗后总有效率明显高于西医治疗组〔87.10％（27/31）比64.52％（20/31）,P〈0.05〕.两组治疗后中医证候积分、MLHFQ评分、血浆NT-proBNP、AngⅡ、ALD、hs-CRP水平均较治疗前降低,左室射血分数（LVEF）、每搏量（SV）、心排血量（CO）均较治疗前升高,且中西医结合治疗组中医证候积分、MLHFQ评分、LVEF、SV、ALD、hs-CRP的改善程度明显优于西医治疗组〔中医证候积分（分）：9.16±2.66比10.97±3.30,MLHFQ评分（分）：38.00±8.45比43.16±8.26,LVEF：0.57±0.07比0.53±0.09,SV（L/min）：58.29±6.93比54.16±7.78,ALD（ng/L）：86.26±28.00比102.74±35.41,hs-CRP（mg/L）：6.71±3.59比8.58±3.59,均P〈0.05〕;两组治疗后CO和血浆NT-proBNP、AngⅡ比较差异无统计学意义（均P〉0.05）;中西医结合治疗组和西医治疗组不良反应发生率比较差异无统计学意义〔6.67％（2/31）比3.23％（1/31）,P〉0.05〕.结论 仲景温阳法可以显著改善心肾阳虚证CHF患者心功能,减轻临床症状,提高患者生活质量,其作用机制可能是通过阻断肾素-血管紧张素-醛固酮系统（RAAS）,减轻体内炎症反应两条关键途径起到治疗CHF作用的.
Objective To observe theclinical effect of traditional Chinese medicine （TCM）treatment according to differentiation of syndrome and Zhongjing＇s warming yang method for patients with chronic heart failure（CHF）. Methods Sixty-two patients of CHF with deficiency of the heart-yang and kidney-yang admitted to outpatient and inpatient of Quzhou City Kecheng Hospital from April 2016 to October 2017. According to different treatment methods, the patients were divided into western medicine treatment group （western group） and integrated traditional Chinese and western medicine treatment group （combined group）, 31 cases in each group. The western group was given routine treatments, while the combined group, besides the routine therapy, additionally Zhongjing＇s warming yang recipe was given （ingredients of the recipe： processed sliced radix aconiti lateralis 20 g, cassia twig 20 g, astragalus membranaceus 30 g, codonopsis pilosula 15 g, glycyrrhiza 10 g, poria cocos 20 g, atractylodes 15 g, the root of red-rooted salvia 20 g, radix paeoniae alba 15 g, radix ophiopogonis 15 g, ginger 10 g, jujube 10 g, decocted in water）, one dose each day, the two groups were treated for 8 weeks. The changes of cardiac functional grading of New York Heart Association （NYHA）, TCM syndrome scores, Minnesota living heart failure quality questionnaire （MLHFQ） scores and echocardiography were recorded respectively for each patient before and after the treatments in both groups; N-terminal pro-hormone of brain natriuretic peptide （NT-proBNP）, hypersensitive C-reactive protein （hs-CRP）, angiotensin （Ang 1~） and aldosteron （ALD） were detected by immunofluorescence, as well as the security indicators （blood, urine and excrement, liver and kidney functions）, and incidence of adverse events were recorded. Results The total effective rate of the combined group was higher than that of the western group [87.10% （27/31） vs. 64.52% （20/31）, P 〈 0.05]. After treatment, the TCM syndrome scores, MLHFQ scores, the levels of plasma NT-proBNP, Ang H, ALD and hs-CRP were significantly lower than those before treatment in both groups; on the contrary, the levels of left ventricular ejection fraction （LVEF）, stroke volume （SV） and cardiac output （CO） were higher than those before treatment, and in addition, the improvement degrees of TCM syndrome scores, MLHFQ scores, the levels of LVEF, SV, ALD and hs-CRP in the combined group were significantly better compared to the western group [TCM syndrome scores： 9.16 ± 2.66 vs. 10.97 ± 3.30, MLHFQ scores： 38.00 ± 8.45 vs. 43.16 ± 8.26, LVEF： 0.57 ±0.07 vs. 0.53 ± 0.09, SV （L/min）： 58.29 ± 6.93 vs. 54.16 ±7.78, ALD （ng/L）： 86.26±28.00 vs. 102.74±35.41, hs-CRP （mg/L）： 6.71 ＋3.59 vs. 8.58±3.59, all P 〈 0.05]; besides, there were no statistical significant differences among the levels of CO, plasma NT-proBNP and Ang Ⅱ after treatment in both groups（all P 〉 0.05）. Meanwhile, there was no statistical significant difference in the incidence of adverse events between the two groups [6.67% （2/31） vs. 3.23% （1/31）, P 〉 0.05]. Conclusion Zhongjing＇s warming yang method was effective in improving the patients＇ heart function, clinical symptoms and the quality of life, the mechanism might be related to the two key pathways, blockade of renin-angiotensin-aldosterone system （RAAS） and alleviation of inflammatory response in the body, playing a role for treatment of CHF.
作者
陈婷
祝小芬
常征利
胡建华
Chen Ting;Zhu Xiaofen;Chang Zhengli;Hu Jianhua(Department of Cardiology,Quzhou City Kecheng Hospital,Quzhou 324000,Zhejiang,China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2018年第5期476-479,共4页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
浙江省衢州市指导性科技计划项目（2016134）
关键词
温阳法
慢性心力衰竭
辨证论治
Warming yang
Chronic heart failure
Treatment according to syndrome differentiation
