丹葛五苓散对老年慢性心力衰竭患者左室重塑进展及预后的影响  

Influence of Dange Wuling Powder on Left Ventricle Remodel and Prognosis of Elderly Patients with Chronic Heart Failure

作　　者：黄金龙[1] 黄修解[2] 康善平[1] 蒙定水[1] HUANG Jin-long;HUANG Xiu-jie;KANG Shan-ping;MENG Ding-shui(Department of Geriatrics,Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine,Nanning Guangxi 530000;Department of Cardiology,Ruikang Hospital Affiliated to Guangi University of Chinese Medicine,Nanning Guangxi 530000)

机构地区：[1]广西中医药大学附属瑞康医院老年病科,广西南宁530000 [2]广西中医药大学附属瑞康医院心内科2区,广西南宁530000

出　　处：《世界中西医结合杂志》2021年第12期2298-2303,2307,共7页World Journal of Integrated Traditional and Western Medicine

基　　金：广西中医药中医老年医学重点学科建设项目(GZXK-Z-20-36);蒙定水全国名老中医传承工作室建设项目[桂卫中医发(2016)11号]。

摘　　要：目的探讨丹葛五苓散对老年慢性心力衰竭(Chronic heart failure,CHF)患者左室重塑(Left ventricle remodel,LVR)进展及临床预后的影响。方法选取2019年1月—2020年6月期间广西中医药大学附属瑞康医院收治的老年CHF患者94例,按随机数字表法均分为观察组与对照组两组。对照组47例患者给予常规西药治疗,观察组47例患者在常规西药治疗基础上给予丹葛五苓散治疗。治疗3个月后,评估并比较两组患者近期预后,随访6个月评价疾病进展情况。治疗前及治疗3个月后,评价Lee氏心衰评分、中医证候(TCM)评分、明尼苏达心衰生活质量调查表(Minnesota living with heart failure questionnaire,MLHFQ)、6 min步行试验(6MWT),测量左室射血分数(Left Ventricular Ejection Fractions,LVEF)、左室舒张末期内径(Left ventricular end diastolic diameter,LVEDd)、左室收缩末直径(Left ventricular end systolic dimension,LVESd)及左室质量指数(Left ventricular mass index,LVMI),检测外周血N末端B型脑钠肽前体(N-terminal B-type pro-brain natriuretic peptide,NT-proBNP)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、白介素-6(Interleukin-6,IL-6)、内皮素-1(Endothelin-1,ET-1)和一氧化氮(Nitric oxide,NO)水平。结果观察组的TCM疗效、心功能疗效的总有效率均高于对照组,差异有统计学意义(P<0.05)。治疗后观察组TCM评分、Lee氏心衰评分和MLHFQ评分均低于对照组,而6MWT高于对照组,差异有统计学意义(P<0.05)。治疗后观察组的LVEF及血清NO水平均高于对照组,而LVEDd、LVESd、LVMI、血浆NT-proBNP及血清TNF-α、IL-6、ET-1均低于对照组,差异有统计学意义(P<0.05)。随访6个月,观察组的心衰症状加重、NYHA分级恶化、疾病进展率均低于对照组,差异有统计学意义(P<0.05),但两组患者再住院率及病死率比较,差异无统计学意义(P>0.05)。结论丹葛五苓散治疗老年CHF能够缓解临床症状,改善心功能,抑制LVR进程,有助于控Objective To investigate the effect of Dange Wuling Powder on the progression of left ventricular remodeling(LVR)and clinical prognosis in elderly patients with chronic heart failure(CHF).Methods 94 elderly CHF patients who were admitted to Ruikang Hospital of Guangxi University of Traditional Chinese Medicine from January 2019 to June 2020 were randomly divided into observation group and control group according to the random number table method.47 patients in the control group were treated with conventional western medicine,and 47 patients in the observation group were treated with Dange Wuling powder on the basis of conventional western medicine,the course of treatment was 3 months.The short-term prognosis of the two groups was evaluated and compared,and the disease progression was evaluated for a 6-month follow-up.Before treatment and 3 months after treatment,the Lee′s heart failure score,traditional Chinese medical syndrome(TCM)score,Minnesota heart failure quality of life questionnaire(MLHFQ),6-min walk test(6 MWT)were evaluated,the left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDd),left ventricular end systolic dimension(LVESd)and left ventricular mass index(LVMI)were measured,the N-terminal B-type pro-brain natriuretic peptide(NT-proBNP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),endothelin-1(ET-1)and Nitric oxide(NO)levels were detected.Results The total effective rate of TCM curative effect and cardiac function curative effect of the observation group was higher than that of the control group(P<0.05).After 3 months of treatment,the TCM score,Lee′s heart failure score and MLHFQ score of the observation group were lower than those of the control group,while 6 MWT was higher than that of the control group(P<0.05).After treatment,LVEF and serum level of NO in the observation group were higher than those in the control group,while LVEDd,LVESd,LVMI,plasma NT-proBNP and serum levelsof TNF-α,IL-6 and ET-1 were lower than those in the control group(P<0.05).Follo

关 键 词：慢性心力衰竭 丹葛五苓散 左室重塑 

分 类 号：R541.6[医药卫生—心血管疾病]