解毒消痈方干预急性心肌梗死后心力衰竭的临床研究  

Clinical Study of Jiedu Xiaoyong Formula Intervening Heart Failure after AMI

作　　者：石锐[1] 于克英 田腾辉 陈浩 姜悦 邓悦[1] SHI Rui;YU Keying;TIAN Tenghui;CHEN Hao;JIANG Yue;DENG Yue(Changchun University of Chinese Medicine, Branch of National Clinical Research Center for Chinese Medicine Cardiology, Changchun 130021, China)

机构地区：[1]长春中医药大学国家中医心血管病临床医学研究中心分中心,吉林长春130021

出　　处：《中医药学报》2022年第6期63-67,共5页Acta Chinese Medicine and Pharmacology

基　　金：国家自然科学基金项目(82174350);吉林省教育厅科学技术研究项目(JJKH20210985KJ);吉林省科技发展计划资助项目(20190303166SF);吉林省中医药管理局科技项目(2021032)。

摘　　要：目的:观察解毒消痈方对急性心肌梗死(AMI)后心力衰竭的治疗效果。方法:将84例急性心肌梗死后心力衰竭患者通过随机数字表分为观察组与对照组,每组42例。两组患者均给予西医常规治疗,观察组在常规治疗基础上联用解毒消痈方口服,两组疗程均为28d。检测治疗前后肌钙蛋白I(cTnI)、心脏型脂肪酸结合蛋白(H-FABP)、肌酸激酶同工酶(CK-MB)、脑钠肽(BNP)、超敏C反应蛋白(hs-CRP)、胱抑素C(CysC)及白细胞介素-6(IL-6);左室射血分数(LVEF)、左心室后壁厚度(LVWP)、室间隔厚度(IVS)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)及左心室质量指数(LVMI);6min步行距离、中医证候积分、Lee氏心衰计分、明尼苏达心衰生活质量调查表(MLHFQ)评分、生命质量测定量表(QLQ-C30)评分以及主要不良心血管事件(MACE)发生情况。结果:经治疗2周及4周之后,观察组的cTnI、H-FABP、CK-MB、BNP、hs-CRP、CysC、IL-6指标水平均低于同时期的对照组各指标水平,差异有统计学意义(P<0.05);经治疗后观察组LVEF水平高于对照组(P<0.05);LVWP、IVS水平与对照组相比无明显差异;观察组LVEDV、LVESV、LVMI水平低于对照组(P<0.01,P<0.05);经治疗后观察组6min步行距离、QLQ-C30总分均高于对照组(P<0.01),中医证候积分、Lee氏心衰计分、MLHFQ计分均低于对照组,差异有统计学意义(P<0.05)。结论:在常规西医治疗基础上联用解毒消痈方治疗AMI后心力衰竭,可以有效改善缺血、改善心衰症状,提高运动耐力,改善生存生活质量,调节免疫功能、降低炎症反应,改善不良预后。Objective:To observe the therapeutic effect of Jiedu Xiaoyong Formula in the treatment of heart failure after acute myocardial infarction(AMI).Methods:84 patients with heart failure after AMI were randomly divided into the observation group and the control group,with 42 cases in each group.Both groups were treated with conventional western medication;on which basis,the observation group was also treated with Jiedu Xiaoyong Formula.The course of the treatment was 28 days in both groups.cTnI,H-FABP,CK-MB,BNP,hs-CRP,CysC and IL-6 were detected before and after the treatment in the two groups.LVEF,LVWP,IVS,LVEDV,LVESV,LVMI,6min walking distance,TCM syndrome score,Lee's heart failure score,MLHFQ score,QLQ-C30 score,as well as the occurrence of major adverse cardiovascular events were observed in the two groups.Results:After 2 and 4 weeks of treatment,the levels of cTnI,H-FABP,CK-MB,BNP,hs-CRP,CysC and IL-6 were lower in the observation group than those in the control group during the same period(P<0.05).LVEF level was higher in the observation group than that in the control group after the treatment(P<0.05).There were no statistical differences in the levels of LVWP and IVS between the two groups after the treatment.The levels of LVEDV,LVESV and LVMI were lower in the observation group than those in the control group(P<0.05,P<0.01).6-min walking distance and QLQ-C30 total score were higher(P<0.01),whereas the scores of TCM syndrome,Lee’s heart failure score and MLHFQ score were lower in the observation group than those in the control group after the treatment(P<0.05).Conclusion:The combination of Jiedu Xiaoyong Formula and conventional western medication can effectively improve ischemia,improve heart failure symptoms,increase exercise endurance,improve quality of life,regulate immune function,reduce inflammation and improve adverse prognosis in the treatment of heart failure after AMI.

关 键 词：急性心肌梗死 心力衰竭 解毒消痈方 内痈理论 生存质量 心功能水平 

分 类 号：R256.2[医药卫生—中医内科学]