苓桂养心汤对心气阳虚证扩张型心肌病患者心功能和抗心肌抗体的影响

沈丽娟; 陶然; 陆曙; 杨庆有; 朱红俊

doi:10.13422/j.cnki.syfjx.2017230152

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苓桂养心汤对心气阳虚证扩张型心肌病患者心功能和抗心肌抗体的影响

临床 | 更新时间：2024-01-04

- 苓桂养心汤对心气阳虚证扩张型心肌病患者心功能和抗心肌抗体的影响
- Effect of Linggui Yangxin Decoction on Heart Function and Anti-myocardial Antibodies of Patients with Dilated Cardiomyopathy with Syndrome of Heart Qi and Yang Deficiency
- 中国实验方剂学杂志 2017年23卷第23期页码：152-158
- 作者机构：
- 作者简介：
- 基金信息：
  
  无锡市医院管理中心科研项目（YGZXM14047）
- DOI：10.13422/j.cnki.syfjx.2017230152
  中图分类号： R259
- 纸质出版日期：2017
- 稿件说明：
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沈丽娟, 陶然, 陆曙, 等. 苓桂养心汤对心气阳虚证扩张型心肌病患者心功能和抗心肌抗体的影响[J]. 中国实验方剂学杂志, 2017,23(23):152-158.

SHEN Li-juan, TAO Ran, LU Shu, et al. Effect of Linggui Yangxin Decoction on Heart Function and Anti-myocardial Antibodies of Patients with Dilated Cardiomyopathy with Syndrome of Heart Qi and Yang Deficiency[J]. Chinese journal of experimental traditional medical formulae, 2017, 23(23): 152-158.
沈丽娟, 陶然, 陆曙, 等. 苓桂养心汤对心气阳虚证扩张型心肌病患者心功能和抗心肌抗体的影响[J]. 中国实验方剂学杂志, 2017,23(23):152-158. DOI： 10.13422/j.cnki.syfjx.2017230152.

SHEN Li-juan, TAO Ran, LU Shu, et al. Effect of Linggui Yangxin Decoction on Heart Function and Anti-myocardial Antibodies of Patients with Dilated Cardiomyopathy with Syndrome of Heart Qi and Yang Deficiency[J]. Chinese journal of experimental traditional medical formulae, 2017, 23(23): 152-158. DOI： 10.13422/j.cnki.syfjx.2017230152.

摘要

目的：观察苓桂养心汤对心气虚和（或）阳虚证素的扩张型心肌病（dilated cardiomyopathy，DCM）患者的临床疗效、心功能及抗心肌抗体的影响，为苓桂养心汤的临床应用提供理论依据。方法：抽取无锡地区2013年5月—2016年9月住院的DCM[心气虚和（或）阳虚证素]患者142例，随机分为对照组（西医常规治疗）70例，治疗组（西医常规治疗基础上，加用苓桂养心汤治疗）72例。并随机抽取40例非DCM心力衰竭患者（心衰组）以及34例健康体检者（正常组）。对入选病例进行血清抗心肌抗体测定，4周后观察DCM组患者的临床疗效及治疗前后心功能、抗心肌抗体变化。结果：临床疗效，治疗组患者中医证候疗效总有效率为89.6%，对照组为71.9%，治疗组高于对照组（P<0.05）。心功能，治疗组与对照组患者治疗后纽约心脏病学会（New York Heart Association，NYHA）分级疗效的总有效率分别为85.1%，81.2%，两组比较差异无统计学意义。治疗组治疗后N端前脑钠素（NT-ProBNP）水平低于对照组同期水平（P<0.05）。与治疗前比较，两组左心室射血分数（LVEF）明显升高；左心室舒张末期内径（LVEDd）明显下降（P<0.05）。治疗后与对照组比较，治疗组各指标值差异均无统计学意义。抗心肌抗体，DCM组与正常组比较，各抗心肌抗体明显升高（P<0.01）。DCM组与心衰组比较，抗心肌抗体抗β1肾上腺能受体自身抗体（ant-β1），抗肌球蛋白重链自身抗体（ant-MHC），抗毒蕈碱-2受体自身抗体（ant-M2），抗腺嘌呤核苷（ADP/ATP）转位酶自身抗体（ant-ANT）差异显著（P<0.01）；心衰组与正常组比较，4种抗心机抗体均无统计学差异。与治疗前比较，两组患者血清抗心肌抗体ant-β1，ant-MHC，ant-M2，ANT均显著降低（P<0.05）。治疗后与对照组比较，治疗组ant-β1，ANT水平降低（P<0.05）。治疗组低血压、心律失常及刺激性干咳发生率低于对照组（P<0.05）。两组肾功能不全发生率无统计学差异。结论：苓桂养心汤可改善心气虚和（或）阳虚证素DCM患者的症状、体征，提高中医证候疗效，改善心功能，减少不良事件的发生，其作用机制可能与改善抗心肌抗体水平有关。

Abstract

Objective: To observe the effect of Linggui Yangxin decoction on the cardiac function indexes of dilated cardiomyopathy (DCM) patients with the syndrome of heart Qi and Yang deficiency and anti-heart antibodies in DCM patients

in order to explore its possible mechanism. Method: The 142 DCM patients in Wuxi were randomly divided into 2 groups

traditional Chinese medicine(TCM) treatment group and control group. Among then

40 patients with heart failure that were not caused by DCM were included into the CHF group

while 34 health cases were included into normal group. The control group was treated with standard therapy

without TCM

for 4 weeks

whereas the TCM treatment group was also given Linggui Yangxin decoction in addition to the therapy of the control group for 4 weeks. At the beginning and the end of the experiment

serum levels of Nterminalpro brain natriuretic peptide (NT-ProBNP)

anti-β1 adrenergic receptor autoantibody

ant-β1(ant-β1)

anti-myosin heavy chain autoantibody (ant-MHC)

anti-muscarinic receptor-2 autoantibody (ant-M2)

anti-adenine nucleotide (ADP/ATP) translocaseautoantibody (ant-ANT) were measured. Left ventricular dimension at end-diastole (LEVDd) and left ventricle ejection fraction (LVEF) were measured with echocardiography. To observe the clinical curative effect

the cardiac functional compensation of the DCM patients was observed in pre and post treatment. Result: The total effective rate of syndrome in the TCM treatment group was 89.6%

while that of the control group was 71.9%

indicating a significant difference (P<0.05). There was no significant difference between the DCM group and the control group in NYHA classification and grading of cardiac function (85.1% for treatment group vs 81.2% for control group). NT-ProBNP had significant differences before and after treatment (P<0.05). LVEF and LEVDd were significant improved in the two groups. Levels of ant-β1

ant-MHC

ant-M2

ant-ANT were significantly increased in the DCM group than in the CHF group (P<0.01). Levels of ant-β1

ant-MHC

ant-M2

ant-ANT were significantly increased in DCM group than normal group (P<0.01). After treatment

ant-β1 and ant-M2 were significantly different between the TCM treatment group and the control group (P<0.05). The incidence rates of hypotension

arrhythmia and stimulating dry cough in the TCM treatment group were lower than those in control group

with significant differences (P<0.05). Conclusion: Linggui Yangxin decoction can improve the expression of anti-myocardial antibodies

reduce the levels of NT-ProBNP

improve the clinical curative effect and the cardiac functional compensation

and reduce the incidence of adverse events. Its mechanism may be related to the improvement of anti-myocardial antibodies levels.

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