【摘要】：目的:探討溫腎活血湯對(duì)老年慢性心衰陽(yáng)虛血瘀證患者活動(dòng)耐量的改善作用,及對(duì)N末端B型利鈉肽原(NT-proBNP),和肽素,心肌肌鈣蛋白T(CTnT)和血漿糖類抗原125(CA125)水平的影響。方法:將158例患者隨機(jī)分為對(duì)照組和觀察組。對(duì)照組在調(diào)整生活方式的基礎(chǔ)上口服復(fù)方卡托普利片,2片/次,3次/d;阿替洛爾片,12.5 mg/次,2次/d;螺內(nèi)酯片,10 mg/次,1次/d;地高辛片,0.125 mg/次,必要時(shí)服用。觀察組在對(duì)照組治療的基礎(chǔ)上加服溫腎活血湯,1劑/d。兩組療程均為16周�；顒�(dòng)耐量采用6 min步行試驗(yàn)(6 MWT),于治療前、治療后8周和16周各評(píng)價(jià)1次;生活質(zhì)量采用明尼蘇達(dá)心衰生活質(zhì)量調(diào)查表(MLHFQ)和簡(jiǎn)明健康問(wèn)卷(SF-36),治療前后各評(píng)價(jià)1次;進(jìn)行治療前后Lee氏心衰評(píng)分,NYHA心功能分級(jí)和中醫(yī)證候評(píng)分;采用超聲心動(dòng)圖記錄治療前后左室射血分?jǐn)?shù)(LVEF),心輸出量(CO),左室收縮末內(nèi)徑(LVESD)和舒張?jiān)缙谘鞣逯?E)和舒張晚期血流峰值(A)之比(E/A),檢測(cè)治療前后NT-proBNP,和肽素,CTn T和CA125水平。結(jié)果:觀察組心功能療效總有效率為88.73%,高于對(duì)照組的71.43%(χ~2=6.631,P0.05);觀察組心衰療效總有效率為85.92%,高于對(duì)照組的67.14%(χ~2=6.929,P0.01);觀察組在治療后8周和16周,6 min步行距離均多于對(duì)照組(P0.01);觀察組SF-36量表各維度評(píng)分均較對(duì)照組高(P0.01);治療后觀察組Lee氏心衰,MLHFQ,陽(yáng)虛血瘀證和NYHA心功能分級(jí)評(píng)分均低于對(duì)照組(P0.01);治療后觀察組LVEF,CO和E/A均高于對(duì)照組(P0.05,P0.01);治療后觀察組NT-proBNP,CTnT,CA125和和肽素水平低于對(duì)照組(P0.01)。結(jié)論:溫腎活血湯治療老年CHF陽(yáng)虛血瘀證患者,能減輕心衰癥狀,改善心功能,并能調(diào)節(jié)NT-proBNP,CTnT,CA125和和肽素水平,起到提高患者活動(dòng)耐量和生活質(zhì)量的作用。
[Abstract]:Objective: to investigate the effect of Wenshen Huoxue decoction (WXD) on the activity tolerance of elderly patients with chronic heart failure with yang deficiency and blood stasis syndrome, and to study the effect of warming kidney and activating blood decoction on N-terminal B-type natriuretic peptide (NT-proBNP) and peptide. Effects of cardiac troponin T (CTnT) and plasma carbohydrate antigen 125 (CA125) levels. Methods: 158 patients were randomly divided into control group and observation group. The control group was treated with compound captopril tablets (2 tablets, 3 times per day), atenolol tablets (12. 5 mg/, 2 times per day), spironolactone tablets (10 mg/, 1 time per day), while the control group took compound captopril tablets once a day on the basis of lifestyle adjustment. Digoxin tablets, 0.125 mg/, if necessary. The observation group was treated with Wenshen Huoxue decoction, 1 dose per day. The course of treatment in both groups was 16 weeks. The activity tolerance was measured by 6 min walking test (6 MWT), before treatment, 8 weeks and 16 weeks after treatment respectively). The quality of life (QOL) was evaluated once before and after treatment by Minnesota Heart failure questionnaire (MLHFQ) and brief Health questionnaire (SF-36). Lee's heart failure score, NYHA cardiac function grading and TCM syndromes score were performed before and after treatment. Left ventricular ejection fraction (LVEF),) cardiac output (CO), left ventricular end-systolic diameter (LVESD), early diastolic peak value (E) and late diastolic peak value (A) ratio (E / A) were recorded by echocardiography before and after treatment. The levels of NT-proBNP, CTn T and CA125 were measured before and after treatment. Results: the total effective rate of cardiac function in the observation group was 88.73, which was higher than that in the control group (71.43%) (蠂 ~ 2, 6.631, P 0.05). The total effective rate of heart failure in the observation group was 85.92, which was higher than that in the control group (67.14%), and the walking distance in the observation group at 8 and 16 weeks after treatment was higher than that in the control group (P0.01). The scores of each dimension of SF-36 scale in the observation group were higher than those in the control group (P0.01), the scores of Lee's heart failure, MLHFQ, yang deficiency and blood stasis syndrome and NYHA cardiac function grading in the observation group were lower than those in the control group after treatment (P0.01). After treatment, the levels of LVEF,CO and EPA in the observation group were higher than those in the control group (P 0.05 P 0.01), and the levels of NT-proBNP,CTnT,CA125 and peptide in the observation group were lower than those in the control group (P 0.01). Conclusion: Wenshen Huoxue decoction can relieve the symptoms of heart failure, improve cardiac function, regulate the levels of NT-proBNP,CTnT,CA125 and peptide, and improve the activity tolerance and quality of life in the elderly patients with CHF syndrome of yang deficiency and blood stasis.
【作者單位】： 重慶市中醫(yī)院;
【基金】：重慶市科技計(jì)劃項(xiàng)目(cste2016jcyjAX0010)
【分類號(hào)】：R259

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