加味真武汤辨治慢性心力衰竭阳气亏虚证心肌纤维化的临床观察

王健; 李芳; 周晓露; 曾庆宁

doi:10.13422/j.cnki.syfjx.20181134

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加味真武汤辨治慢性心力衰竭阳气亏虚证心肌纤维化的临床观察

临床 | 更新时间：2024-01-04

- 加味真武汤辨治慢性心力衰竭阳气亏虚证心肌纤维化的临床观察
- Clinical Observation of Modified Zhenwutang in Treatment of Chronic Heart Failure Patients with Yang Deficiency Syndrome
- 中国实验方剂学杂志 2018年24卷第11期页码：173-178
- 作者机构：
- 作者简介：
- 基金信息：
  
  海南省医药卫生科研项目（1404000320A2004）
- DOI：10.13422/j.cnki.syfjx.20181134
  中图分类号： R259
- 纸质出版日期：2018
- 稿件说明：
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王健, 李芳, 周晓露, 等. 加味真武汤辨治慢性心力衰竭阳气亏虚证心肌纤维化的临床观察[J]. 中国实验方剂学杂志, 2018,24(11):173-178.

WANG Jian, LI Fang, ZHOU Xiao-lu, et al. Clinical Observation of Modified Zhenwutang in Treatment of Chronic Heart Failure Patients with Yang Deficiency Syndrome[J]. Chinese journal of experimental traditional medical formulae, 2018, 24(11): 173-178.
王健, 李芳, 周晓露, 等. 加味真武汤辨治慢性心力衰竭阳气亏虚证心肌纤维化的临床观察[J]. 中国实验方剂学杂志, 2018,24(11):173-178. DOI： 10.13422/j.cnki.syfjx.20181134.

WANG Jian, LI Fang, ZHOU Xiao-lu, et al. Clinical Observation of Modified Zhenwutang in Treatment of Chronic Heart Failure Patients with Yang Deficiency Syndrome[J]. Chinese journal of experimental traditional medical formulae, 2018, 24(11): 173-178. DOI： 10.13422/j.cnki.syfjx.20181134.

摘要

目的：探讨加味真武汤辨治慢性心力衰竭（CHF）阳气亏虚证患者疾病进展和血清转化生长因子-β1（TGF-β1），结缔组织生长因子（CTGF），白细胞介素-1β（IL-1β），肿瘤坏死因子-α（TNF-α）的影响。方法：采用区组分层随机法，将120例患者按入组先后顺序分为对照组和观察组各60例。对照组服用贝那普利片，10 mg/次，1次/d；比索洛尔片，12.5 mg/次，2次/d；螺内酯片，20 mg/次，1次/d；地高辛片，0.125~0.25 mg·d-1。观察组在对照组治疗的基础上给予加味真武汤辨证治疗，1剂/d。两组疗程均为连续治疗3个月，并进行3个月的随访。进行治疗前后纽约心脏病协会（NYHA）心功能评估，6 min步行试验（6 MWT），记录心室射血分数（LVEF），每搏输出量（SV），心输出量（CO）和E/A；进行治疗前、治疗后和随访期Lee氏心衰评分、中医证候评分；检测治疗前后N末端B型利钠肽原（NT-proBNP），TGF-β1，CTGF，TNF-α和IL-1β水平；评估治疗后和随访期6个月内NYHA分级加重、心衰加重需要增加剂量或加用新药物、导致住院的情况。结果：两组患者经Ridit分析，观察组心功能改善情况和中医证候疗效均优于对照组（P<0.05）；观察组患者LVEF，CO，SV和E/A均高于对照组（P<0.05）；治疗后和随访期，观察组Lee氏心衰评分和气亏虚证评分均低于对照组，6 min步行距离长于对照组（P<0.01）；观察组治疗和随访期间（共6个月）疾病进展的累积发生率为19.3%，少于对照组的42.86%，（χ2=7.333，P<0.01）；观察组患者血清NT-proBNP，TGF-β1，CTGF，TNF-α和IL-1β水平均低于对照组（P<0.01）。结论：加味真武汤治疗阳气亏虚型CHF患者，能改善心功能，减轻心衰程度，增加活动能力，提高了临床疗效；并能减轻心肌纤维化（MF），防止和延缓心肌重构，延缓疾病进展，稳定病情。

Abstract

Objective: To discuss the efficacy of modified Zhenwutang in treating chronic cardiac failure (CHF) with deficiency of Yang Qi

and its effect on levels of transforming growth factor-β1 (TGF-β1)

connective tissue growth factor (CTGF)

interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α). Method: One hundred and twenty CHF patients were randomly divided into control group 60 cases and combination group 60 cases by random number table. Patients in control group took enalapril tablets

10 mg/time

1 time/day. Metoprolol tablets

12.5 mg/time

2 times/days. Spironolactone tablets

20 mg/time

1 time/day

and Digoxin tablets

0.125-0.25 mg/days when necessary. In addition to the therapy of control group

patients in observation group were also given modified Zhenwutang

1 dose/day. The course of treatment was 3 months. And a three-month follow-up period was set. Before and after treatment

cardiac function based on New York heart disease association (NYHA) and 6-minute walk test were evaluated

and left ventricular ejection fraction (LVEF)

stroke volume (SV)

cardiac output (CO) and E/A were recorded by echocardiogram. Lee congestive heart failure

traditional Chinese medicine (TCM) symptoms were scored. Levels of NT-proBNP

TGF-β1

CTGF

TNF-α and IL-1β were detected. And addition of dose or new medicine or hospitalization caused by exacerbation of NYHA fractionation and heart failure were evaluated after treatment and during the follow-up period. Result: By Ridit

the total effective rates of cardiac function and TCM symptoms in observation group were better than those in control group (P<0.05). And LVEF

SV and E/A were higher than those in control group (P<0.05). After treatment and during the follow-up period

scores of Lee congestive heart failure and symptom of deficiency of Yang Qi were all lower than those in control group (P<0.01). The distance of 6-minute walk was longer than that in control group (P<0.01). And during treatment and follow-up period

the cumulative incidence of disease progress in control group was 42.86%

which was higher than 19.3% in observation group (χ2=7.333

P<0.01). And levels of NT-proBNP

TGF-β1

CTGF

TNF-α and IL-1β were lower than those in control group (P<0.01). Conclusion: Modified Zhenwutang on CHF with deficiency of Yang Qi can relieve symptoms

degree of heart failure and MF

increase the activity ability

and inhibit or delay myocardial remodeling

so as to stabilize the disease.

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