本文選題：復(fù)方真武沖劑 + 慢性心力衰竭��； 參考：《安徽中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的:本課題以復(fù)方真武沖劑與常規(guī)西藥相結(jié)合治療心腎陽(yáng)虛型慢性心力衰竭(CHF)患者,通過(guò)觀(guān)察患者血清中IL-6、NT-pro BNP和hs-CRP變化以及治療前后患者心功能(NYHA)、心衰積分、中醫(yī)證候積分、MLHFQ評(píng)分及LVEF的變化,判定復(fù)方真武沖劑的臨床療效并探討其作用機(jī)制。方法:1.遵循慢性心力衰竭診斷標(biāo)準(zhǔn)、NYHA心功能分級(jí)標(biāo)準(zhǔn)以及中醫(yī)診斷標(biāo)準(zhǔn),收集符合病例納入標(biāo)準(zhǔn)中的中醫(yī)及西醫(yī)診斷的患者共52例,隨機(jī)分為研究組及對(duì)照組,每組各26例。2.研究組均予以復(fù)方真武沖劑聯(lián)合常規(guī)西藥治療,對(duì)照組則僅予常規(guī)西藥治療。以8周為一療程。3.對(duì)比治療前后的心功能(NYHA)、心衰積分、中醫(yī)證候積分、MLHFQ評(píng)分及LVEF變化;于治療前后提取患者血清進(jìn)行IL-6、NT-pro BNP及hs-CRP的實(shí)驗(yàn)室檢測(cè)并記錄相關(guān)數(shù)據(jù)。4.收集全部相關(guān)數(shù)據(jù)并制作成病例資料表格。用SPSS17.0對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析并以“—xE±s”表示數(shù)據(jù),用配對(duì)資料t檢驗(yàn)進(jìn)行組間治療前后的對(duì)比,用獨(dú)立樣本t檢驗(yàn)進(jìn)行治療前后兩組之間的對(duì)比,當(dāng)p0.05時(shí)差異具有統(tǒng)計(jì)學(xué)意義,若p0.01則差異具有顯著統(tǒng)計(jì)學(xué)意義。結(jié)果:1.研究組治療前與治療后對(duì)比:治療后患者心功能(NYHA)、心衰積分、中醫(yī)證候積分、MLHFQ評(píng)分及LVEF均較前改善;血清IL-6、NT-pro BNP及hs-CRP數(shù)值較前下降明顯,具統(tǒng)計(jì)學(xué)意義(P0.01)。2.對(duì)照組治療前與治療后對(duì)比:治療后患者心功能(NYHA)、心衰積分、中醫(yī)證候積分、MLHFQ評(píng)分及LVEF均較前改善;血清IL-6、NT-pro BNP及hs-CRP數(shù)值下降明顯,具有統(tǒng)計(jì)學(xué)意義(P0.01)。3.研究組、對(duì)照組治療后數(shù)值對(duì)比:NYHA心功能分級(jí)研究組優(yōu)于對(duì)照組(P0.05);心衰積分兩組均有所改善,以研究組更顯著(P0.05);中醫(yī)證候積分兩組均有所改善,以研究組更顯著(P0.01);MLHFQ評(píng)分兩組均較前改善,以研究組更顯著(P0.05);LVEF數(shù)值兩組均有改善,以研究組療效更優(yōu)(P0.05);NT-pro BNP兩組均有改善,研究組療效更優(yōu)(P0.05);治療后兩組血清IL-6及hs-CRP平均下降,以研究組下降更為明顯(P0.01);兩組均未發(fā)生現(xiàn)嚴(yán)重不良反應(yīng)。結(jié)論:復(fù)方真武沖劑與常規(guī)西藥相結(jié)合治療心腎陽(yáng)虛型心衰,療效優(yōu)于單純西藥,對(duì)患者心功能及生活質(zhì)量有明顯改善作用,其機(jī)制可能為:1.通過(guò)調(diào)控炎性細(xì)胞因子的異常表達(dá),抑制免疫炎癥反應(yīng),從而減少心肌細(xì)胞損傷,改善心功能;2.通過(guò)抑制膠原降解和基質(zhì)重構(gòu)延緩心肌重塑;3.通過(guò)對(duì)RAAS系統(tǒng)的作用減少鈉水潴留,減輕心臟負(fù)荷,改善心功能;4.通過(guò)調(diào)整自主神經(jīng)功能,興奮迷走神經(jīng),抑制交感神經(jīng)活性,減輕心肌缺血缺氧,改善心功能。
[Abstract]:Objective: to observe the changes of IL-6 NT-pro BNP and hs-CRP in the serum of patients with heart and kidney yang deficiency chronic heart failure (CHF) treated with compound Zhenwu granule combined with routine western medicine, and to observe the cardiac function of patients before and after treatment.The changes of MLHFQ score and LVEF in TCM syndromes were used to evaluate the clinical efficacy of compound Zhenwu granule and to explore its mechanism.Method 1: 1.According to NYHA criteria and TCM diagnostic criteria, 52 patients were randomly divided into study group and control group (n = 26, n = 26, n = 26, n = 26, n = 26, n = 26, n = 26, n = 26, n = 26, n = 26, n = 26, n = 26, n = 26, n = 26).The study group were treated with compound Zhenwu granules combined with conventional western medicine, while the control group were only treated with conventional western medicine.Take 8 weeks as a course of treatment.The changes of cardiac function, heart failure score, TCM syndrome score and LVEF were compared before and after treatment, and the serum samples were collected before and after treatment for IL-6 NT-pro BNP and hs-CRP in laboratory and recorded the relevant data. 4.Collect all relevant data and make case data form.The data were statistically analyzed by SPSS17.0 and represented by "-xE 鹵s". The data were compared before and after treatment with paired data t test, and the comparison between two groups before and after treatment with independent sample t test.When p0.05, the difference was statistically significant, if p0.01, the difference was statistically significant.The result is 1: 1.The study group before and after treatment: after treatment, the heart function of patients with NYHA, heart failure score, TCM syndrome score and MLHFQ score and LVEF were improved, serum IL-6 NT-pro BNP and hs-CRP values were significantly lower than before, with statistical significance.The comparison between the control group and the control group before and after treatment: after treatment, the cardiac function, heart failure score, TCM syndrome score and MLHFQ score and LVEF were improved, and the serum IL-6 NT-pro BNP and hs-CRP decreased significantly (P 0.01 路3).In the study group, the value of the control group was compared with that of the control group after treatment. The heart failure score in the study group was better than that in the control group (P 0.05); the score of heart failure was improved in both groups, especially in the study group; the score of TCM syndromes was improved in both groups.The score of MLHFQ in the study group was significantly improved than that in the previous group, and the value of P0.05 / L LVEF in the study group was significantly improved. The better effect of the study group was improved in both groups (P 0.05 / NT-pro BNP), and the curative effect in the study group was better than that in the control group (P 0.05), and the serum IL-6 and hs-CRP in the two groups decreased on average after treatment.In the study group, the decrease was more obvious than that in the study group, and there was no serious adverse reaction in both groups.Conclusion: the combination of compound Zhenwu granule and routine western medicine in the treatment of heart failure with deficiency of heart and kidney yang is better than that of western medicine alone. It can obviously improve the heart function and quality of life of the patients, and its mechanism may be 1: 1.By regulating the abnormal expression of inflammatory cytokines, inhibiting the immune inflammatory response, thereby reducing myocardial cell injury, improving cardiac function.Myocardial remodeling was delayed by inhibiting collagen degradation and matrix remodeling.Through the effect of RAAS system to reduce sodium and water retention, reduce cardiac load, improve cardiac function. 4.By regulating autonomic nervous function, stimulating vagus nerve, inhibiting sympathetic nerve activity, alleviating myocardial ischemia and hypoxia, improving cardiac function.
【學(xué)位授予單位】：安徽中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R259

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