益气活血利水方联合螺内酯治疗老年射血分数保留心力衰竭的效果

摘要
图/表
参考文献(23)
相关文章 (10)

全文: PDF (566 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探讨益气活血利水方联合醛固酮受体拮抗剂治疗老年射血分数保留心力衰竭（HFpEF）的临床效果。方法采用前瞻性、开放、空白对照的临床研究方法，收集2017年12月～2018年12月湖北省中医院门诊及住院HFpEF患者120例，按照随机数字表法将其分为中药组、螺内酯组、联合组及对照组，每组各30例。对照组采用西药基础治疗，中药组予益气活血利水方，螺内酯组予螺内酯20 mg/片/d，联合组同时予与中药组及螺内酯组相同的治疗干预，各组均连续治疗2周。记录并比较各组治疗前后患者氨基末端脑钠肽前体（NT-proBNP）水平、中医证候积分及6 min步行试验结果。结果研究过程中脱落5例，实际完成研究115例。其中对照组30例、中药组28例，螺内酯组29例、联合组28例。四组患者治疗前NT-proBNP水平比较，差异无统计学意义（P ＞ 0.05）。联合组、中药组、螺内酯组治疗后NT-proBNP水平均低于治疗前，差异均有统计学意义（均P ＜ 0.05）。与对照组治疗后比较，联合组、螺内酯组和中药组NT-proBNP水平降低，且联合组低于螺内酯组，差异均有统计学意义（均P ＜ 0.05）。四组患者治疗前中医证候积分比较，差异无统计学意义（P ＞ 0.05）。各组治疗后中医证候积分均低于治疗前，差异有统计学意义（P ＜ 0.05）。与对照组治疗后比较，联合组、中药组、螺内酯组中医证候积分均降低，其中联合组和中药组中医证候积分均低于螺内酯组，差异均有统计学意义（均P ＜ 0.05）。联合组与中药组中医证候积分比较，差异无统计学意义（P ＞ 0.05）。四组患者治疗前6 min步行距离比较，差异无统计学意义（P ＞ 0.05）。各组患者治疗后6 min步行距离均大于治疗前，差异均有统计学意义（均P ＜ 0.05）。联合组治疗后6 min步行距离大于螺内酯组及对照组，差异均有统计学意义（均P ＜ 0.05）。联合组与中药组6 min步行距离比较，差异无统计学意义（P > 0.05）。结论益气活血利水方的优势在于改善中医证候和提高活动耐力，螺内酯的优势在于降低NT-proBNP水平，两者联用是治疗HFpEF的有效方法。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	彭朗1
	2 鲁晓斌1
	3 梅应兵1
	2 刘进进1
	2 倪维1
	4

关键词 ：益气活血利水, 醛固酮受体拮抗剂, 射血分数保留心力衰竭, 临床观察

Abstract：Objective To investigate the clinical effect of treating heart failure and preserved ejection fraction (HFpEF) in elderly patients with Yiqi Huoxue Lishui Prescription combined with aldosterone receptor antagonist. Methods A prospective, open and blank controlled clinical study was conducted to collect 120 cases of HFpEF patients in the outpatient and in-patient department of Hubei Provincial Hospital of Traditional Chinese Medicine from December 2017 to December 2018. According to the random number table method, they were divided into the traditional Chinese medicine group, the Spironolactone group, the combined group and the control group, each group with 30 cases. The control group was treated with western medicine basic treatment, the traditional Chinese medicine group was treated with Yiqi Huoxue Lishui Prescription, the Spironolactone group was treated with Spironolactone 20 mg/tablet/day, and the combined group received the same therapeutic intervention as the traditional Chinese medicine group and spironolactone group at the same time. Each group was treated continuously for 2 weeks. The results of N terminal pro B type natriuretic peptide (NT-proBNP) level, traditional Chinese medicine syndrome score and 6 min walking test were recorded and compared before and after treatment. Results Five cases were shed during the study, and 115 cases were actually completed. There were 30 cases in the control group, 28 cases in the traditional Chinese medicine group, 29 cases in the Spirolactone group and 28 cases in the combined group. There was no statistically significant difference in the level of NT-proBNP between the four groups before treatment (P ＞ 0.05). The level of NT-proBNP after treatment in the combined group, the traditional Chinese medicine group and the Spironolactone group was lower than that before treatment, and the differences were statistically significant (all P ＜ 0.05). Compared with the control group after treatment, the level of NT-proBNP in the combined group, the Spironolactone group and the traditional Chinese medicine group decreased, and the combined group was lower than the Spironolactone group, the differences were statistically significant (all P ＜ 0.05). There was no significant difference in traditional Chinese medicine syndrome score among the four groups before treatment (P ＞ 0.05). The traditional Chinese medicine syndrome scores of each group were lower after treatment than before treatment, and the differences were statistically significant (P ＜ 0.05). Compared with the control group after treatment, the traditional Chinese medicine syndrome scores of the combined group, the traditional Chinese medicine group and the Spironolactone group all decreased, and the traditional Chinese medicine syndrome scores of the combined group and the traditional Chinese medicine group were all lower than those of the Spironolactone group, with statistically significant differences (all P ＜ 0.05). There was no significant difference in traditional Chinese medicine syndrome scores between the combined group and the traditional Chinese medicine group (P ＞ 0.05). There was no statistically significant difference in 6 min walking distance among the four groups before treatment (P ＞ 0.05). The 6 min walking distance of each group after treatment was greater than that before treatment, and the differences were statistically significant (all P ＜ 0.05). After treatment, the 6 min walking distance of the combined group was greater than that of the Spirolactone group and the control group, and the differences were statistically significant (all P ＜ 0.05). There was no significant difference in 6 min walking distance between the combined group and the traditional Chinese medicine group (P > 0.05). Conclusion The advantage of the Yiqi Huoxue Lishui Prescription lies in the improvement of traditional Chinese medicine syndrome and activity endurance, and the advantage of Spironolactone lies in the reduction of NT-proBNP level. The combination of the two is an effective method for the treatment of HFpEF.

Key words： Yiqi Huoxue Lishui Prescription Aldosterone receptor antagonist Heart failure and preserved ejection fraction Clinical observation

基金资助:中国中医科学院中医基础理论研究所“院所协同创新科研专项基金”资助项目（YZ-1753）；
湖北省卫生健康委员会科研项目（WJ2019F164）。

通讯作者: 倪维（1981.10-），男，硕士；研究方向：临床检验诊断。

作者简介: 彭朗（1986.6-），女，硕士；研究方向：中西医结合防治心血管疾病。

引用本文:

彭朗1,2 鲁晓斌1,3 梅应兵1,2 刘进进1,2 倪维1,4. 益气活血利水方联合螺内酯治疗老年射血分数保留心力衰竭的效果[J]. 中国医药导报, 2020, 17(17): 57-61.
PENG Lang1,2 LU Xiaobin1,3 MEI Yingbing1,2 LIU Jinjin1,2 NI Wei1,4. Effect of Yiqi Huoxue Lishui Prescription combined with Spironolactone in the treatment of heart failure and preserved ejection fraction in the elderly. 中国医药导报, 2020, 17(17): 57-61.

链接本文:

http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2020/V17/I17/57

[1] Miller RJH，Howlett JG. Evolving role for mineralocorticoid receptor antagonists in heart failure with preserved ejection fraction [J]. Curr Opin Cardiol，2015，30（2）：168-172.
[2] Dickstein K，Cohen-Solal A，Filippatos G，et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008：the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology [J]. Eur J Heart Fail，2008， 10（10）：933-989.
[3] Eldeman F，Wachter R，Schmidt AG，et al. Effect of spironolactone on diastolic function and exercise capacity in patients with heart failure with preserved ejection fraction：the Aldo-DHF randomized controlled trial [J]. JAMA，2013， 309（8）：781-791.
[4] Capuano A，Scavone C，Vitale C，et al. Mineralocorticoid receptor antagonists in heart failure with preserved ejection fraction（HFpEF）[J]. Int J Cardiol，2015，200：15-19.
[5] Pitt B，Pfeffer MA，Assmann SF，et al. Spironolactone for heart failure with preserved ejection fraction [J]. N Engl J Med，2014，370（15）：1383-1392.
[6] 罗良涛，赵慧辉，郭淑贞，等.中国17家中医医院冠心病慢性心力衰竭住院患者临床特征及治疗情况调查[J].中西医结合心脑血管病杂志，2013，11（9）：1030-1033.
[7] 中华医学会心血管病学分会，中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志，2014，42（2）：98-122.
[8] WRITING COMMITTEE MEMBERS，Yancy CW，Jessup M，et al. 2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure: An Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America [J]. Circulation，2016，134（13）：e282-e293.
[9] 郑筱萸.中药新药临床研究指导原则[M].北京：中国医药科技出版社，2002：77-85.
[10] 荆志成.六分钟步行距离试验的临床应用[J].中华心血管病杂志，2006，34（4）：381-384.
[11] Yamamto K，Origasa H，Hori M，et al. Effects of carvedilol on the heart failure with preserved ejection fraction：the Japaneses diastiolic heart failure study（J-DHF）[J]. Eur J Heart Fail，2013，15（1）：110-118.
[12] Xanthakis V，Vasan RS. Aldosterone and the risk of hypertension [J]. Curr Hypertens Rep，2013，15（2）：102-107.
[13] Briet M，Schiffrin EL. Vascular actions of aldosterone [J]. J Vasc Res，2013，50（2）：89-99.
[14] Anand IS，Rector TS，Cleland JG，et al. Prognostic value of baseline plasma amino-terminal pro-brain natriuretic peptide and its interactions with irbesartan treatment effects in patients with heart failure and preserved ejection fraction：findings from the I-PRESERVE trial [J]. Circ Heart Fail，2011，4（5），569-577.
[15] Xiang Y，Shi W，Li Z，et al. Efficacy and safety of spironolactone in the heart failure with mid-rangeejection fraction and heart failure with preserved ejection fraction：A meta-analysis of randomized clinical trials [J]. Medicine （Baltimore），2019，98（13）：e14967.
[16] Pandey A，Garg S，Matulevicius SA，et al. Effect of Mineralocorticoid Receptor Antagonists on Cardiac Structure and Function in Patients With Diastolic Dysfunction and Heart Failure With Preserved Ejection Fraction：A Meta-Analysis and Systematic Review [J]. J Am Heart Assoc，2015，4（10）：e002137.
[17] 李崇耀，张曼，赵鸿斌，等.收缩性心力衰竭患者降钙素原、氨基末端脑钠肽前体水平及超声心动图变化分析[J].疑难病杂志，2019，18（12）：1208-1211，1217.
[18] 中华医学会心血管病学分会心力衰竭学组，中国医师协会心力衰竭专业委员会，中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2018[J].中华心血管病杂志，2018，46（10）：760-789.
[19] 程冕，严金华，翟茂才，等.盐酸曲美他嗪对老年慢性心力衰竭患者疗效及血清BNP和IL-6水平的影响[J].疑难病杂志，2018，17（9）：865-868.
[20] 戴雁彦，张立山.水饮与心衰[J].北京中医药大学学报：中医临床版，2007，14（5）：31-32.
[21] 关继华，郝桂芳.益气活血温阳利水法治疗心衰的文献分析[J].陕西中医，1995，16（3）：98-99.
[22] 省格丽，赵勇.郭维琴教授证治心衰的经验[J].新疆中医药，2015，33（4）：51-52.
[23] 李立志.陈可冀治疗充血性心力衰竭经验[J].中西医结合心脑血管病杂志，2006，4（2）：136-138.