冠心宁片联合重组人脑利钠肽治疗腹膜透析合并急性失代偿性心力衰竭的疗效观察及其对免疫功能、炎症状态的影响  

Observation on Curative Effect of Guanxinning Tablet(冠心宁片)Combined with Recombinant Human Brain Natriuretic Peptide in Treatment of Peritoneal Dialysis Complicated with Acute Decompensated Heart Failure Patients and Effects on Immune Function and Inflammatory

作　　者：胡晓燕 黄益麒 沈伟钢[1] HU Xiaoyan;HUANG Yiqi;SHEN Weigang(Shaoxing Second Hospital,Shaoxing,Zhejiang 312000)

机构地区：[1]绍兴第二医院,浙江绍兴312000

出　　处：《中国中医药科技》2025年第1期15-19,共5页Chinese Journal of Traditional Medical Science and Technology

基　　金：浙江省医学会临床医学科研专项资金项目(2022ZYC-A218);浙江省医药卫生科技计划项目(2023XY059)。

摘　　要：目的:观察冠心宁片联合重组人脑利钠肽(rhBNP)治疗腹膜透析(PD)合并急性失代偿性心力衰竭(ADHF)的临床疗效及其对免疫功能和炎症状态的调节作用。方法:将78例PD合并ADHF患者随机分成观察组和对照组,各39例,对照组给予rhBNP微泵注射,治疗72 h后停药;观察组在对照组基础上给予冠心宁片,2组患者均治疗4周。比较2组临床疗效及治疗前后症状评分、心功能指标、炎性细胞因子水平、CD_(4)^(+)T淋巴细胞亚群及不良反应和预后等。结果:观察组临床总有效率(94.87%)高于对照组(79.48%)(P<0.05);治疗后两组患者胸闷胸痛、心悸不安、气短乏力、气喘不得卧等症状评分均较治疗前降低(均P<0.05),且观察组低于对照组(P<0.05);治疗后两组患者左室射血分数(LVEF)、左心室短轴缩短率(LVFS)、心脏指数(CI)、白细胞介素-10(IL-10)和2型辅助性T细胞(Th2)、调节性T细胞(Treg)水平较治疗前升高(均P<0.05),且观察组高于对照组(P<0.05);治疗后两组患者左心室舒张末期内径(LVEDd)、干扰素-γ(INF-γ)、IL-17、Th1、Th17、Th1/Th2和Th17/Treg较治疗前降低(均P<0.05),且观察组低于对照组(P<0.05);观察组不良反应发生率和出院30 d内ADHF再入院率均降低。结论:冠心宁片联合能rhBNP明显改善PD合并ADHF患者的临床症状和心功能水平,有效调节免疫功能及缓解炎症状态,临床疗效确切。Objective:To explore the clinical effect of Guanxinning Tablet combined with recombinant human brain natriuretic peptide(rhBNP)on acute decompensated heart failure(ADHF)caused by peritoneal dialysis(PD)and effects on immune function and inflammatory state.Methods:78 patients with Qi-deficiency and blood-stasis type PD combined with ADHF were randomly divided into observation group and control group,39 cases in each group.The control group was given rhBNP by micropump injection for 72 h,Observation group was given Guanxinning Tablet on the basis of control group,and both groups were treated for 4 weeks.The clinical efficacy,TCM symptoms scores,cardiac function indexes,inflammatory cytokines,CD_(4)^(+)T lymphocyte subsets,adverse reactions and prognosis were compared between the two groups before and after treatment.Re-sults:The total effective rate of observation group(94.87%)was higher than that of control group(79.48%)(P<0.05).After treatment,the scores of TCM symptoms such as chest tightness,chest pain,palpitation,short-ness of breath and asthma were lower than those before treatment,and the scores of observation group were lower than those of the control group(P<0.05).After treatment,the levels of LVEF,LVFS,CI,IL-10,Th2 and Treg in two groups were raised,and those in observation group were higher than those in control group(P<0.05).After treatment,LVEDd,INF-γ,IL-17,Th1,Th17,Th1/Th2 and Th17/Treg in both groups were lowered,and those in the observation group were lower than those in the control group(P<0.05).The inci-dence of adverse events and the rate of readmission for heart failure within 30 days after discharge were both re-duced in the observation group.Conclusion:Guanxinning Tablet combined with rhBNP can significantly improve the clinical symptoms and cardiac function level of patients with Qi-deficiency and blood-stasis type PD com-bined with ADHF,effectively regulate immune function and relieve inflammation,and the clinical effect is accu-rate.

关 键 词：冠心宁片 重组人脑利钠肽 腹膜透析 急性失代偿性心力衰竭 心功能 CD_(4)^(+)T淋巴细胞亚群 炎性因子 

分 类 号：R54[医药卫生—心血管疾病]