丹芪心脉散对气虚血瘀型冠心病慢性心衰患者心室重构的干预效果及机制探讨  

Discussion on the Mechanism and Intervention Effects of Danqi Xinmai Powder on Ventricular Remodeling in Patients with Coronary Heart Disease and Chronic Heart Failure of Qi Deficiency and Blood Stasis Pattern

作　　者：许禄华 黄小靖 宋银枝 曾志聪 包秀珍 陈珊珊 XU Luhua;HUANG Xiaojing;SONG Yinzhi;ZENG Zhicong;BAO Xiuzhen;CHEN Shanshan(Baoan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine/Shenzhen Bao'an Traditional Chinese Medicine Hospital(Group),Shenzhen 518133,China)

机构地区：[1]广州中医药大学附属宝安中医院/深圳市宝安中医院(集团),广东深圳518133

出　　处：《西部中医药》2021年第8期1-5,共5页Western Journal of Traditional Chinese Medicine

基　　金：国家中医药管理局项目(2019GZY-FJS-2019-004);深圳市科技计划项目(JCYJ20170306152620264)。

摘　　要：目的:观察丹芪心脉散对气虚血瘀型冠心病慢性心力衰竭患者的临床疗效及对心室重构的干预效果与可能机制。方法:选择冠心病慢性心衰患者120例,随机分为观察组和对照组,每组60例。对照组给予常规西药治疗,观察组在此基础上给予丹芪心脉散治疗。治疗3个月后,比较两组临床疗效、证候积分、心力衰竭积分、生活质量评分、心功能相关指标[(six minutes walking distance,6MWD)、(N-terminal pro brain natriuretic peptide,NT-proBNP)、(ejection fraction,EF)]、心室重构指标[左心室舒张末期内径(left ventricular end diastolic dimension,LVEDD)、左室收缩末期内径(left ventricular endsystolic diameter,LVESD)],酶联免疫吸附法检测基质金属蛋白酶1(matrix metalloproteinase-1,MMP-1)、基质金属蛋白酶抑制因子1(tissue inhibitor of metalloproteinase 1,TIMP-1)]及不良反应发生率。结果:观察组总有效率[93.3%(56/60)]显著高于对照组[76.7%(46/60)](P<0.05);治疗后证候积分、心力衰竭积分和生活质量评分观察组低于对照组(P<0.05);治疗后6MWD、NT-proBNP和EF等心功能指标观察组较对照组改善更明显(P<0.05);治疗后LVEDD、LVESD和MMP-1/TIMP-1等心室重构相关指标观察组低于对照组(P<0.05);两组不良反应发生率比较差异无统计学意义(P>0.05)。结论:丹芪心脉散治疗冠心病慢性心力衰竭疗效明确,能改善患者心功能,提高运动耐量及生活质量,可能与其通过调节MMP-1/TIMP-1平衡,拮抗心室重构有关。Objective:To observe clinical effects of Danqi Xinmai powder in the treatment for the patients with CHD and CHF of Qi deficiency and blood stasis pattern,its intervention effects and the potential mechanism on ventricular remodeling.Methods:All 120 patients were chosen and randomized into the observation group and the control group,60 cases in each group.The control group accepted conventional Western medicine,and the observation group was treated by Danqi Xinmai powder based on the therapy the control group accepted.To compare clinical effects,TCM syndrome integrals,heart failure score,quality of life scores,the related indexes of heart function(6MWD,NT-proBNP,EF),the indexes of ventricular remodeling(LVEDD and LVESD),ELISA method was used to detect the levels of MMP-1,TIMP-1 and the incidence of adverse reaction.Results:Total effective rate of the observation group was 93.3%(56/60),notably higher than 76.7%(46/60)of the control group(P<0.05);the observation group was lower than the control group in TCM syndrome integrals,heart failure scores and quality of life scores after treating(P<0.05);the improvements of heart function indexes including 6MWD,NT-proBNP,EF and others were more notable than these of the control group(P<0.05);the observation group was lower than the control group in the related indexes of ventricular remodeling such as LVEDD,LVESD,MMP-1/TIMP-1 and others(P<0.05);the difference had no statistical meaning in the incidence of adverse reaction between both groups(P>0.05).Conclusion:Danqi Xinmai powder could gain definite effects in treating CHD CHF,it could improve heart function,lift exercise tolerance and quality of life,which might be related to regulating MMP-1/TIMP-1 balance and antagonizing ventricular remodeling.

关 键 词：心力衰竭 慢性 丹芪心脉散 心功能 心室重构 基质金属蛋白酶1 基质金属蛋白酶抑制因子1 

分 类 号：R541.4[医药卫生—心血管疾病]