摘要
目的观察加味五苓散联合西药治疗高血压性心力衰竭阳虚水泛证患者的临床疗效及对炎性因子的影响。方法选择2022年6月30日至2024年5月30日江西中医药大学附属医院收治的152例高血压性心力衰竭阳虚水泛证患者,按随机数字表法分为对照组与观察组各76例。对照组给予常规西药治疗,观察组给予加味五苓散联合西药治疗,2组均治疗12周。观察两组患者治疗前后血清基质金属蛋白酶2(MMP-2)、转化生长因子β1(TGF-β1)、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)、脑钠肽(BNP)、白细胞介素6(IL-6)、同型半胱氨酸(Hcy)、内皮素1(ET-1)、白细胞介素10(IL-10)水平及中医证候积分、6 min步行试验距离(6MWD)、左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左心室后壁厚度(LVPW)和血压改善情况,并评估两组患者的临床疗效及不良反应发生情况。结果(1)观察组患者的总有效率为93.42%(71/76),高于对照组的81.58%(62/76),差异有统计学意义(P<0.05)。(2)治疗后,两组患者的中医证候积分及LVEDD、LVPW、收缩压(SBP)、舒张压(DBP)水平均较治疗前降低(P<0.05),6MWD增加(P<0.05),LVEF水平升高(P<0.05);与对照组比较,观察组治疗后患者的中医证候积分及LVEDD、LVPW、SBP、DBP水平明显降低(P<0.05),6MWD明显增加(P<0.05),LVEF水平升高(P<0.05)。(3)治疗后,两组患者血清MMP-2、ET-1、TGF-β1、ALD、AngⅡ、BNP、IL-6、Hcy水平明显较治疗前降低(P<0.05),IL-10水平升高(P<0.05);与对照组比较,观察组治疗后患者的血清MMP-2、ET-1、TGF-β1、ALD、AngⅡ、BNP、IL-6、Hcy水平明显降低(P<0.05),IL-10水平升高(P<0.05)。(4)两组均未发生不良反应。结论加味五苓散联合西药治疗能够提高高血压性心力衰竭阳虚水泛证患者的临床疗效,减轻患者炎症反应,促进心功能恢复,降低血压与预防心室重构,安全性较高。
Objective To evaluate the clinical efficacy of Modified Wuling San combined with western medicine in treating hypertensive heart failure(HHF)patients with yang deficiency and water diffusion syndrome and its effects on inflammatory factors.Methods A total of 152 HHF patients with yang deficiency and water diffusion syndrome admitted to Affiliated Hospital of Jiangxi University of Chinese Medicine from June 30,2022 to May 30,2024 were randomly divided into control group(n=76,conventional western medicine)and observation group(n=76,Modified Wuling San plus western medicine).Both groups received 12-week treatment.Serum levels of matrix metalloproteinase-2(MMP-2),transforming growth factor-β1(TGF-β1),angiotensin Ⅱ(AngⅡ),aldosterone(ALD),brain natriuretic peptide(BNP),interleukin-6(IL-6),homocysteine(Hcy),endothelin-1(ET-1),interleukin-10(IL-10),traditional Chinese medicine(TCM)syndrome scores,6-minute walking distance(6MWD),left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),left ventricular posterior wall thickness(LVPW),and blood pressure were observed before and after treatment.Clinical efficacy and adverse reactions were evaluated.Results(1)The total effective rate was significantly higher in observation group(93.42%,71/76)than control group(81.58%,62/76),the difference being statistically significant(P<0.05).(2)After treatment,both groups showed decreased TCM syndrome scores,LVEDD,LVPW,systolic blood pressure(SBP),diastolic blood pressure(DBP)(P<0.05),increased 6MWD(P<0.05),and improved LVEF(P<0.05).Compared with control group,observation group demonstrated significantly greater improvements in all parameters(P<0.05).(3)Serum MMP-2,ET-1,TGF-β1,ALD,AngⅡ,BNP,IL-6,and Hcy levels decreased(P<0.05),while IL-10 increased(P<0.05)in both groups after treatment.Compared with the control group,the observation group showed significantly decreased serum levels of MMP-2,ET1,TGF-β1,ALD,AngⅡ,BNP,IL-6,and Hcy after treatment(P<0.05),while the level of IL-10 was increased(P<0.05).(4)No adverse reactions occurred in either group.Conclusion Modified Wuling San combined with western medicine significantly improves clinical efficacy in HHF patients with yang deficiency and water diffusion syndrome by reducing inflammation,promoting cardiac function recovery,lowering blood pressure,preventing ventricular remodeling,with good safety profile.
作者
黄卫清
廖为民
杜婷婷
田鑫
HUANG Weiqing;LIAO Weimin;DU Tingting;TIAN Xin(Affiliated Hospital of Jiangxi University of Chinese Medicine,Nanchang 330006 Jiangxi,China)
出处
《中药新药与临床药理》
北大核心
2025年第10期1757-1762,共6页
Traditional Chinese Drug Research and Clinical Pharmacology
基金
江西省中医药管理局科技计划项目(2021B693,2024B0793)。
关键词
加味五苓散
高血压性心力衰竭
阳虚水泛证
心室重构
炎性因子
Modified Wuling San
hypertensive heart failure
yang deficiency and water diffusion syndrome
ventricular remodeling
inflammatory factors
