理气化痰祛瘀法对慢性心力衰竭伴血脂异常患者脂代谢的调节作用  

Effect of Method of Regulating Qi to Dissipate Blood Stasis and Phlegm on Blood Lipid Metabolism of Patients with Chronic Heart Failure and Dyslipidemia

作　　者：李培培[1] 刘婷[1] 马宏博[2] LI Pei-pei;LIU Ting;MA Hong-bo(Huaiyin People＇s Hospital of Ji＇nan City,Ji＇nan 250021,China;Shandong Provincial Hospital,Ji＇nan 250013,China)

机构地区：[1]济南市槐荫人民医院,济南250021 [2]山东省立医院,济南250013

出　　处：《中国实验方剂学杂志》2018年第21期199-204,共6页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：济南市卫生和计划生育委员会科技发展计划项目(2016-2-14)

摘　　要：目的：观察理气化痰祛瘀法对慢性心力衰竭（CHF）伴血脂异常血脂代谢的影响及调节血管内皮功能、炎症因子和氧化应激的作用。方法：将118例符合要求的患者,按随机数字表法分为对照组和观察组各58例。两组患者基础治疗均口服螺内酯片,20 mg/次,1次/d;盐酸贝那普利片,20 mg/次,1次/d;富马酸比索洛尔片,10 mg/次,1次/d。对照组加服阿托伐他汀钙片,10 mg/次,1次/d;观察组西药治疗同对照组,加用丹参饮合血府逐瘀汤加减,1剂/d。两组疗程均连续治疗2个月。检测治疗前后总胆固醇（TC）,甘油三酯（TG）,低密度脂蛋白胆固醇（LDL-C）,高密度脂蛋白胆固醇（HDL-C）,脂蛋白（a）（Lpa）水平;检测治疗前后一氧化氮（NO）,内皮素-1（ET-1）和血清血管性假血友病因子（v WF）,脂联素（APN）,瘦素（LP）,白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）,超氧化物歧化酶（SOD）和丙二醛（MDA）水平;进行治疗前后超声心动图检查,记录左心室收缩期内径（LVIDd）,左室射血分数（EF）,每搏输出量（SV）,心输出量（CO）和二尖瓣口舒张早期及舒张晚期流速峰值（E/A）。结果：经Ridit分析,观察组中医证候疗效优于对照组（P〈0.05）;观察组HDL-C水平高于对照组,LDL-C水平低于对照组（P〈0.05）,观察组患者Lp-a水平低于对照组（P〈0.05）,观察组LDL-C和HDL-C异常例数均少于对照组（P〈0.05）;观察组ET-1,v WF,MDA均低于对照组,NO和SOD水平均高于对照组（P〈0.01）;观察组血清IL-6,TNF-α和LP水平均低于对照组,APN水平高于对照组（P〈0.01）;治疗后观察组LVEF,SV,CO和E/A均高于对照组（P〈0.05）。结论：理气化痰祛瘀法治疗CHF伴血脂异常患者,可调节患者脂代谢,改善心功能症状,具有调节血管内皮功能及抗炎、抗氧化的功能,从而起到改善CHF预后的作用。Objective： To observe the effect of method of regulating Qi to dissipate blood stasis and phlegm on blood lipid metabolism of patients with chronic heart failure（ CHF） and dyslipidemia and investigate its effect on regulating vascular endothelial function,inflammatory factors and oxidative stress. Method： One hundred and eighteen eligible patients were randomly divided into control group（ 58 cases） and observation group（ 58 cases） by random number table. Both groups received spironolactone tablets,20 mg/time, qd. Benazepril hydrochloride tablets,20 mg/time,qd. Bisoprolol tumarate tablets,10 mg/time,qd. Patients in control group got atorvastatin,10 mg/time,qd. Based on the treatment in control group,patients in observation group additionally received add and subtract Danshen Tang and Xuefu Zhuyu Tang,1 dose/day. The treatment course was 2 months for both groups. Before and after treatment,levels of total cholesterol（ TC）,triglyceride（ TG）,low density lipoprotein（ LDL-C）,high density lipoprotein water（ HDL-C）,lipoprotein（ a）（ Lp-a）,nitric oxide（ NO）,endothelin-1（ ET-1）,von Willebrand factor（ v WF）,adiponectin（ APN）,leptin（ LP）,interleukins-6（ IL-6）,tumor necrosis factor-α（ TNF-α）,superoxide dismutase（ SOD） and malondialdehyde（ MDA） were detected.Echocardiography,left ventricular end diastolic diameter（ LVIDd）,left ventricular ejection fraction（ EF）,stroke volume（ SV）,cardiac output（ CO） and the ratio of the peak velocity of early stage and advanced stage of diastolic phase at the mitral orifice（ E/A） were recorded before and after treatment. Result： Ridit analysis showed that the clinical efficacy for traditional Chinese medicine syndrome in observation group was better than that in control group（ P〈 0. 05）. Level of HDL-C in observation group was higher than that in control group,and level of LDL-C was lower than that in control group（ P〈 0. 05）. Level of Lp-a was lower than that in control group（ P�

关 键 词：慢性心力衰竭 理气化痰祛瘀法 血脂 血管内皮功能 炎症因子 氧化应激 心功能 

分 类 号：R25[医药卫生—中医内科学] R256[医药卫生—中医学]