真武汤合保元汤对2型心肾综合征阳气亏虚证兼血瘀证心肾功能的影响

张秀荣; 薛一涛

doi:10.13422/j.cnki.syfjx.20180936

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真武汤合保元汤对2型心肾综合征阳气亏虚证兼血瘀证心肾功能的影响

临床 | 更新时间：2024-01-04

- 真武汤合保元汤对2型心肾综合征阳气亏虚证兼血瘀证心肾功能的影响
- Effect of Zhenwutang Combined with Baoyuantang on Heart and Renal Function of Patients with Type 2 Cardiorenal Syndrome
- 中国实验方剂学杂志 2018年24卷第9期页码：202-207
- 作者机构：
- 作者简介：
- 基金信息：
  
  国家自然科学基金项目（81673246）
- DOI：10.13422/j.cnki.syfjx.20180936
  中图分类号： R259
- 纸质出版日期：2018
- 稿件说明：
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张秀荣, 薛一涛. 真武汤合保元汤对2型心肾综合征阳气亏虚证兼血瘀证心肾功能的影响[J]. 中国实验方剂学杂志, 2018,24(9):202-207.

ZHANG Xiu-rong, XUE Yi-tao. Effect of Zhenwutang Combined with Baoyuantang on Heart and Renal Function of Patients with Type 2 Cardiorenal Syndrome[J]. Chinese journal of experimental traditional medical formulae, 2018, 24(9): 202-207.
张秀荣, 薛一涛. 真武汤合保元汤对2型心肾综合征阳气亏虚证兼血瘀证心肾功能的影响[J]. 中国实验方剂学杂志, 2018,24(9):202-207. DOI： 10.13422/j.cnki.syfjx.20180936.

ZHANG Xiu-rong, XUE Yi-tao. Effect of Zhenwutang Combined with Baoyuantang on Heart and Renal Function of Patients with Type 2 Cardiorenal Syndrome[J]. Chinese journal of experimental traditional medical formulae, 2018, 24(9): 202-207. DOI： 10.13422/j.cnki.syfjx.20180936.

摘要

目的：探讨真武汤合保元汤加味治疗2型心肾综合征（CRS）的临床疗效及血清一氧化氮（NO），内皮素-1（ET-1），白细胞介素-1（IL-1），IL-6和肿瘤坏死因子-α（TNF-α）的影响。方法：将134例患者采用SPSS软件生成的区组，随机按数字表法分为对照组和观察组各67例。对照组服用厄贝沙坦片，0.15 g/次，1次/d；美托洛尔片，1.25 mg/次，2次/d；螺内酯片，20 mg/次，1次/d；氢氯噻嗪片25 mg/次，1次/d，地高辛片，0.125~0.25 mg ·d-1，必要时服用。观察组在对照组治疗的基础上给予真武汤合保元汤加味；两组疗程均为连续治疗3个月。记录治疗前后心功能指标心室射血分数（LVEF），每搏输出量（SV），N末端B型利钠肽原（NT-proBNP），6 min步行试验（6 MWT），和肾功能指标血肌酐（Scr），尿素氮（BUN），血胱抑素C（CysC），尿微量白蛋白（mALB），尿肾损伤分子-1（Kim-1），并计算肾小球滤过率（eGFR）和尿微量白蛋白/肌酐（UACR），进行治疗前后Lee氏心衰评分和中医证候评分。检测治疗前后NO，ET-1，IL-6，IL-1和TNF-α水平。结果：经Ridit分析，观察组患者临床综合疗效优于对照组（P<0.05）；观察组NYHA分级评分和NT-proBNP水平均低于对照组（P<0.01），6 MWT远于对照组（P<0.01），LVEF和SV均高于对照组（P<0.05）；观察组Scr，BUN，CysC，mALB，Kim-1和UACR水平均低于对照组（P<0.01）；观察组eGFR较治疗前升高，并高于对照组（P<0.01）；观察组患者Lee氏心衰评分和中医证候评分均低于对照组（P<0.01）；观察组患者血清ET-1，hs-CRP，IL-1，IL-6和TNF-α水平均低于对照组，NO水平高于对照组（P<0.01）。结论：在西医常规治疗的基础上，配合服用真武汤合保元汤加味治疗2型CRS患者，能改善患者的心肾功能，减轻临床症状，改善内皮功能障碍和慢性炎症状态，提高临床综合治疗效果。

Abstract

Objective: To discuss the clinical efficacy of Zhenwutang combined with Baoyuantang on type 2 cardio renal syndrome(CRS) and its effect on levels of serum nitric oxide (NO)

endothelin-1 (ET-1)

interleukin-1 (IL-1)

IL-6 and tumor necrosis factor-α (TNF-α). Method: Totally 134 patients were randomly divided into control group (67 cases) and observation group (67 cases) by random number table. Patients in control group got irbesartan

0.15 g/tmie

1 time/day. Metoprolol tablet

1.25 mg/time

2 times/days. Spironolactone tablets

20 mg/time

1 time/day. Hydrochlorothiazide 25 mg/time

1 time/day. digoxin tablets

0.125-0.25 mg/day

when necessary. In addition to the therapy for control group

patients in observation group were also given Zhenwutang combined with Baoyuantang. The course of treatment was 3 months. Before and after treatment

cardiac function indexes

such as ventricular ejection fraction (LVEF)

stroke volume (SV)

N-natriuretic peptide (NT-proBNP)

6-minute walking test (6 MWT) and renal function index such as serum creatinine (Scr)

urea nitrogen (BUN)

serum cystatin C (CysC)

urinary microscale albumin (mALB)

urinary kidney injury molecule-1 (Kim-1) were recorded

glomerular filtration rate(eGFR) and UACR were calculated

and Lee's heart failure and traditional Chinese medicine(TCM)syndromes were scored. And levels of NO

ET-1

IL-6

IL-1 and TNF-α were detected. Result: The clinical efficacy in observation group was superior to that in control group by Ridit (P<0.05). And NYHA score and levels of NT-proBNP

Scr

BUN

CysC

mALB

Kim-1 and UACR were lower than those in control group (P<0.01)

6 MWT in observation group was longer than that in control group (P<0.01)

and LVEF

SV and NO were higher than those in control group (P<0.05). Compared with before treatment

eGFR in observation group increased and was higher than that in control group(P<0.01). Scores of Lee's heart failure and TCM syndromes were lower than those in control group (P<0.01). And levels of ET-1

hs-CRP

IL-1

IL-6 and TNF-α were lower than those in control group (P<0.01). Conclusion: In addition to the routine western medicine therapy

Zhenwutang combined with Baoyuantang can improve heart function and renal function

relieve endothelial dysfunction and chronic inflammation

clinical symptoms

and improve the comprehensive treatment effect.

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