【摘要】：目的:觀察黃芪顆粒劑對心氣虛和(或)陽虛證素的擴(kuò)張型心肌病(dilated cardiomyopathy,DCM)患者干預(yù)作用及對抗心肌抗體的影響,為黃芪的臨床應(yīng)用提供理論依據(jù)。方法:選擇無錫市中醫(yī)醫(yī)院和無錫市人民醫(yī)院2013年5月至2016年1月期間住院的DCM心氣虛和(或)陽虛證素患者134例為DCM組,隨機(jī)分為常規(guī)組(采用西醫(yī)常規(guī)治療)67例,中藥組(在常規(guī)組治療基礎(chǔ)上+黃芪60 g)67例。并隨機(jī)抽取30例健康體檢者作為正常組。在治療第1,28天觀察N終端腦鈉肽(NT-pro BNP),左室射血分?jǐn)?shù)(LVEF),左室舒張期末內(nèi)徑(LVEDD),抗心肌抗體抗β1腎上腺能受體自身抗體(ant-β1),抗肌球蛋白重鏈自身抗體(ant-MHC),抗毒蕈堿-2受體自身抗體(ant-M2),抗腺嘌呤核苷(ADP/ATP)轉(zhuǎn)位酶自身抗體(ant-ANT)水平,臨床癥狀、體征、紐約心臟病協(xié)會(huì)(NYHA)心功能分級(jí)等的變化。結(jié)果:臨床療效,中藥組患者中醫(yī)證候療效總有效率為91.9%,常規(guī)組患者中醫(yī)證候療效總有效率為71.0%,中藥組高于常規(guī)組(P0.05)。心功能,中藥組與常規(guī)組患者治療后NYHA分級(jí)的療效總有效率分別為82.3%,83.9%,兩組比較差異無統(tǒng)計(jì)學(xué)意義。中藥組治療后NT-pro BNP水平低于常規(guī)組同期水平(P0.05)。治療后兩組LVEF明顯升高(P0.05);LVEDD明顯下降(P0.05)。兩組治療后各指標(biāo)差異無統(tǒng)計(jì)學(xué)意義�？剐募】贵w,與正常組比較,DCM組各抗心肌抗體明顯升高(P0.05)。治療后兩組患者血清抗心肌抗體ant-β1,ant-MHC,ant-M2水平明顯降低(P0.05),中藥組治療后ant-ANT水平較治療前顯著降低(P0.05)。中藥組治療后ANT水平低于常規(guī)組同期水平(P0.05)。中藥組低血壓及心律失常發(fā)生率低于常規(guī)組(P0.05)。兩組腎功能不全及刺激性干咳發(fā)生率無統(tǒng)計(jì)學(xué)差異。結(jié)論:黃芪能調(diào)節(jié)心氣虛和(或)陽虛證素的DCM患者抗心肌抗體水平,降低血清NT-pro BNP水平,提高中醫(yī)證候療效,減輕患者癥狀,改善心功能,減少不良事件的發(fā)生。
[Abstract]:Objective: to observe the intervention effect of Huangqi granule on dilated cardiomyopathy (dilated cardiomyopathy,DCM) patients with deficiency of heart qi and / or yang deficiency syndrome and the effect of anti-myocardial antibody, so as to provide theoretical basis for clinical application of Astragalus membranaceus. Methods: from May 2013 to January 2016, 134 patients with DCM heart qi deficiency and / or yang deficiency syndrome hospitalized in Wuxi traditional Chinese Medicine Hospital and Wuxi people's Hospital were randomly divided into routine group (67 cases treated with routine western medicine) and traditional Chinese medicine group (60 g astragalus membranaceus 60 g on the basis of routine treatment). The patients with heart qi deficiency and / or yang deficiency syndrome were randomly divided into routine group (67 cases) and traditional Chinese medicine group (60 g astragalus membranaceus group). 30 healthy subjects were randomly selected as normal group. On the 1st and 28th day of treatment, the levels of N terminal brain natriuretic peptide (NT-pro BNP), left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD), anti-myocardial antibody anti-尾 1 suprarenal adenoreceptor autoantibody (ant- 尾 1), anti myosin heavy chain autoantibody (ant-MHC), anti muscarinic 2 receptor autoantibody (ant-M2), anti adenine nucleosides (ADP/ATP) translocation enzyme autoantibody (ant-ANT) were observed on the 1st and 28th day of treatment. Signs, changes in (NYHA) cardiac function classification of the New York Heart Association. Results: the total effective rate of TCM syndrome in traditional Chinese medicine group was 91.9%, and that in routine group was 71.0%. The total effective rate of TCM syndrome in traditional Chinese medicine group was higher than that in routine group (P 0.05). The total effective rate of NYHA grading in traditional Chinese medicine group and routine group was 82.3% and 83.9%, respectively. there was no significant difference between the two groups. After treatment, the level of NT-pro BNP in the traditional Chinese medicine group was lower than that in the routine group (P 0.05). After treatment, LVEF in the two groups increased significantly (P 0.05,); LVEDD decreased significantly (P 0.05). There was no significant difference in the indexes between the two groups after treatment. Compared with the normal group, the anti-myocardial antibodies in DCM group were significantly higher than those in the normal group (P 0.05). After treatment, the levels of serum anti-myocardial antibody ant- 尾 1 and ant-MHC,ant-M2 in the two groups were significantly lower than those before treatment (P 0.05), and the levels of ant-ANT in the traditional Chinese medicine group were significantly lower than those before treatment (P 0.05). After treatment, the level of ANT in the traditional Chinese medicine group was lower than that in the routine group (P 0.05). The incidence of hypotension and arrhythmia in the traditional Chinese medicine group was lower than that in the routine group (P 0.05). There was no significant difference in the incidence of renal insufficiency and irritating dry cough between the two groups. Conclusion: Astragalus membranaceus can regulate the level of anti-myocardial antibody in DCM patients with heart-qi deficiency and / or yang deficiency syndrome, reduce the level of serum NT-pro BNP, improve the curative effect of TCM syndrome, alleviate the symptoms of patients, improve cardiac function and reduce the occurrence of adverse events.
【作者單位】： 南京中醫(yī)藥大學(xué)無錫附屬醫(yī)院;無錫市惠山區(qū)中醫(yī)院;
【基金】：無錫市醫(yī)院管理中心科研項(xiàng)目(YGZXM14047)
【分類號(hào)】：R259

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