Clinical study on the adjuvant treatment of chronic heart failure with Wenjing Tongluo Yunyu and Xunxi Formula
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摘要:目的
探讨温经通络运瘀熏洗方辅助治疗对慢性心力衰竭患者心肺功能、微炎症状态的影响。
方法选择慢性心力衰竭患者100例,根据随机数字表法分为常规西医组50例(给予西医规范治疗)和中西医结合组50例(在西医规范治疗基础上给予温经通络运瘀熏洗方辅助治疗)。治疗前后观察2组患者巨噬细胞炎症蛋白-1α(MIP-1α)、白细胞介素-18(IL-18)、可溶性尿激酶型纤溶酶原激活物受体(suPAR)水平,检测患者外周阻力、每搏输出量、加速指数、心排指数,检测患者射血分数(LVEF)、左心室质量指数(LVMI)、最大呼气中段流量(MMF)、第1秒用力呼气容积(FEV1)水平,通过心肺运动试验(CPET)检测每分钟通气量与每分钟二氧化碳产生量比值(VE/VCO2)斜率(VE/VCO2 slope)、峰值心率、峰值摄氧量(VO2 peak)。采用中医证候评分、6 min步行距离(6MWT)测试及明尼苏达心衰生活质量量表(MLHFQ)对患者进行评价,比较常规西医组、中西医结合组临床疗效及不良反应发生情况。
结果中西医结合组患者的MIP-1α、IL-18、suPAR水平及外周阻力较常规西医组低,每搏输出量、加速指数、心排指数较常规西医组高,差异有统计学意义(P < 0.05); 中西医结合组LVEF、MMF、FEV1较常规西医组高, LVMI较常规西医组低,差异有统计学意义(P < 0.05)。中西医结合组患者VE/VCO2 slope较常规西医组低,峰值心率、VO2 peak较常规西医组高,差异有统计学意义(P < 0.05)。中西医结合组心悸、气短或喘息、乏力、脘腹或肢体寒冷、冷汗、怕冷或喜温、口唇或面色紫暗、MLHFQ评分较常规西医组低, 6MWT较常规西医组长,差异有统计学意义(P < 0.05)。中西医结合组患者总有效率为98.00%, 高于常规西医组的86.00%, 差异有统计学意义(P < 0.05)。治疗期间, 2组患者均未出现明显不良反应。
结论温经通络运瘀熏洗方辅助治疗可抑制慢性心力衰竭患者机体微炎症状态,改善血流动力学指标,提升心肺功能,缓解患者临床症状,提升临床疗效及生活质量。
Abstract:ObjectiveTo explore the effects of Wenjing Tongluo Huayu and Xunxi Prescription on cardiopulmonary function and microinflammation in patients with chronic heart failure.
MethodsA total of 100 patients with chronic heart failure were selected, and were divided into conventional western medicine group (n=50, receiving standardized western medicine treatment) and integrated Chinese and western medicine group (n=50, given adjuvant treatment by Wenjing Tongluo Huayu and Xunxi Prescription on the basis of standardized western medicine treatment). The levels of macrophage inflammatory protein-1α (MIP-1α), interleukin-18 (IL-18) and soluble urokinase-type plasminogen activator receptor (suPAR) were examined before and after treatment, and peripheral resistance, stroke output, acceleration index and cardiac output index were detected. The ejection fraction (LVEF), ventricular myocardial mass index (LVMI), maximum mid-expiratory flow (MMF), and forced expiratory volume in one second (FEV1) were measured. The slope of the relationship between the minute ventilation and carbon dioxide production(VE/VCO2 slope), peak heart rate, and peak oxygen uptake(VO2 peak)were detected by cardiopulmonary exercise test (CPET). TCM syndrome score, 6 min walking distance (6MWT) test, and Minnesota Heart Failure Quality of Life Scale (MLHFQ) were evaluated for patients. The clinical efficacy and adverse reactions of conventional western medicine group and integrated Chinese and western medicine group were compared.
ResultsThe contents of MIP-1α, IL-18 and suPAR in integrated Chinese and western medicine group were significantly lower, and the stroke output, acceleration index and cardiac output index were significantly higher than those in the conventional western medicine group (P < 0.05). LVEF, MMF and FEV1 in the integrated Chinese and western medicine group were higher, while LVMI was lower than those in the conventional western medicine group (P < 0.05). VE/VCO2 slope in integrated Chinese and western medicine group was significantly lower, and peak heart rate and VO2 peak in integrated Chinese and western medicine group were higher than those in conventional western medicine group (P < 0.05). Palpitation, shortness of breath or wheezing, fatigue, coldness in abdomen or body, cold sweat, aversion to cold or preference of warmth, dark lips or face and MLHFQ score in the integrated Chinese and western medicine group were lower, and 6MWT was longer than that in the conventional western medicine group (P < 0.05). The total effective rate of the integrated Chinese and western medicine group was significantly higher than that of the conventional western medicine group (98.00% versus 86.00%, P < 0.05), and there were no obvious adverse reactions between the two groups during treatment.
ConclusionThe adjuvant treatment for patients with chronic heart failure with Wenjing Tongluo Yunyu and Xunxi Formula can inhibit the micro-inflammatory state of the body, improve the hemodynamic index and the cardiopulmonary function, relieve the clinical symptoms, and improve the clinical efficacy and quality of life.
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表 1 2组患者MIP-1α、IL-18、suPAR水平比较(x±s)
组别 n MIP-1α/(pg/mL) IL-18/(pg/mL) suPAR/(ng/mL) 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 常规西医组 50 35.45±6.52 27.56±4.13* 41.23±4.55 35.51±3.64* 2.86±0.72 1.93±0.52* 中西医结合组 50 35.12±6.01 21.63±2.85*# 41.06±4.41 30.06±2.75*# 2.79±0.75 1.41±0.37*# MIP-1α: 巨噬细胞炎症蛋白-1α; IL-18: 白细胞介素-18; suPAR: 可溶性尿激酶型纤溶酶原激活物受体。
与治疗前比较, *P < 0.05; 与常规西医组比较, #P < 0.05。表 2 2组外周阻力、每搏输出量、加速指数、心排指数比较(x±s)
组别 外周阻力/[(Kpa·s)/L] 每搏输出量/mL 加速指数/[1/(100·m2)] 心排指数/[L/(min·m2)] 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 常规西医组 3 086.53±142.65 2 051.06±135.15* 58.24±1.77 62.33±2.16* 59.74±3.12 65.37±3.56* 2.12±0.15 2.33±0.17* 中西医结合组 3 075.18±137.21 1 832.48±102.09*# 58.12±1.72 65.71±2.54*# 59.19±3.05 73.18±4.24*# 2.15±0.16 2.61±0.23*# 与治疗前比较, *P < 0.05; 与常规西医组比较, #P < 0.05。 表 3 2组患者LVEF、LVMI、MMF、FEV1比较(x±s)
组别 LVMI/(mg/g) LVEF/% FEV1/L MMF/(L/s) 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 常规西医组 2.61±0.30 2.30±0.25* 33.09±5.32 40.54±5.61* 1.22±0.35 2.05±0.49* 0.81±0.21 1.16±0.33* 中西医结合组 2.63±0.32 2.12±0.22*# 33.25±5.40 48.81±6.45*# 1.17±0.33 2.44±0.71*# 0.78±0.19 1.86±0.54*# LVMI: 左心室质量指数; LVEF: 射血分数; FEV1: 第1秒用力呼气容积; MMF: 最大呼气中段流量。
与治疗前比较, *P < 0.05; 与常规西医组比较, #P < 0.05。表 4 2组VE/VCO2 slope、峰值心率、VO2 peak比较(x±s)
组别 VE/VCO2 slope 峰值心率/(次/min) VO2 peak/[mL/(min·kg)] 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 常规西医组 32.65±2.19 28.31±1.92* 106.52±7.08 113.04±8.75* 15.24±0.86 17.32±1.09* 中西医结合组 32.51±2.31 25.10±1.64*# 106.19±6.62 124.02±10.62*# 15.09±0.81 19.11±1.48*# VE/VCO2 slope: 每分钟通气量与每分钟二氧化碳产生量比值斜率; VO2 peak: 峰值摄氧量。
与治疗前比较, *P < 0.05; 与常规西医组比较, #P < 0.05。表 5 2组患者中医证候评分比较(x±s)
分 证候 时点 常规西医组 中西医结合组 心悸 治疗前 4.75±1.12 4.68±1.08 治疗后 1.51±0.36* 0.95±0.23*# 气短或喘息 治疗前 4.55±1.11 4.67±1.13 治疗后 1.49±0.37* 0.93±0.25*# 乏力 治疗前 1.43±0.36 1.40±0.33 治疗后 0.82±0.20* 0.57±0.13*# 脘腹或肢体寒冷 治疗前 1.85±0.43 1.82±0.40 治疗后 1.01±0.25* 0.62±0.15*# 冷汗 治疗前 1.76±0.45 1.72±0.47 治疗后 1.02±0.25* 0.62±0.14*# 怕冷或喜温 治疗前 1.77±0.50 1.81±0.53 治疗后 1.07±0.23* 0.67±0.18*# 口唇或面色紫暗 治疗前 1.69±0.41 1.73±0.43 治疗后 1.05±0.27* 0.65±0.16*# 与治疗前比较, *P < 0.05; 与常规西医组比较, #P < 0.05。 表 6 2组患者6MWT、MLHFQ评分比较(x±s)
组别 6MWT/m MLHFQ/分 治疗前 治疗后 治疗前 治疗后 常规西医组 192.42±20.33 315.41±40.45* 73.04±15.45 63.73±12.76* 中西医结合组 191.05±21.51 421.16±52.76*# 72.55±15.13 52.43±8.63*# 6MWT: 6 min步行距离; MLHFQ: 明尼苏达心力衰竭生活质量量表。与治疗前比较, *P < 0.05; 与常规西医组比较, #P < 0.05。 -
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