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成都大学 附属医院,成都 610081
* 陈其军,主治医师,从事心血管疾病的临床诊疗工作,E-mail:5891255@qq.com
收稿日期:2020-05-27,
网络出版日期:2020-06-18,
纸质出版日期:2020-12-20
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陈其军,张春伟,周阳.心通口服液对急性心肌梗死后心力衰竭(气虚痰瘀互阻证)心功能的改善作用[J].中国实验方剂学杂志,2020,26(24):128-133.
CHEN Qi-jun,ZHANG Chun-wei,ZHOU Yang.Effect of Xintong Oral Liquid in Improving Cardiac Function of Patients with Heart Failure and Syndrome of Qi Deficiency and Phlegm and Blood Stasis Caused by Acute Myocardial Infarction[J].Chinese Journal of Experimental Traditional Medical Formulae,2020,26(24):128-133.
陈其军,张春伟,周阳.心通口服液对急性心肌梗死后心力衰竭(气虚痰瘀互阻证)心功能的改善作用[J].中国实验方剂学杂志,2020,26(24):128-133. DOI: 10.13422/j.cnki.syfjx.20200932.
CHEN Qi-jun,ZHANG Chun-wei,ZHOU Yang.Effect of Xintong Oral Liquid in Improving Cardiac Function of Patients with Heart Failure and Syndrome of Qi Deficiency and Phlegm and Blood Stasis Caused by Acute Myocardial Infarction[J].Chinese Journal of Experimental Traditional Medical Formulae,2020,26(24):128-133. DOI: 10.13422/j.cnki.syfjx.20200932.
目的
2
评价心通口服液治疗急性心肌梗死后(AMI)心力衰竭(气虚痰瘀互阻证)的临床疗效及对炎症因子的影响。
方法
2
将100例患者采用随机按数字表法分为对照组和观察组各50例。两组给予西医综合治疗。对照组口服心通液模拟药,20 mL/次,3次/d。观察组口服心通口服液,20 mL/次,3次/d。两组疗程均为治疗4周。检测治疗前、治疗后2周,4周心脏肌钙蛋白 I(cTnI),肌钙蛋白T(cTnT),心脏型脂肪酸结合蛋白(H-FABP)水平;测量治疗前后左心室射血分数(LVEF),心输出量(CO),每搏心输出量(SV)和左室舒张末期内径(LVEDd);检测治疗前后N末端B型利钠肽原(NT-proBNP),脂蛋白磷脂酶A
2
(Lp-PLA
2
),超敏C反应蛋白(hs-CRP),白细胞介素-6(IL-6),肿瘤坏死因子-
α
(TNF-
α
)水平;进行6 min步行试验,记录6 min步行距离和6 min 步行距离占预计值;进行治疗前后中医证候评分、明尼苏达心力衰竭生活质量调查表(MLHFQ)评分和心功能Killip 分级;随访2个月,记录主要不良心血管事件(MACE);进行安全性评价。
结果
2
治疗后2周,4周,观察组cTnI,cTnT和H-FABP水平均低于同期对照组(
P
<
0.01);观察组LVEF,CO和SV均高于对照组(
P
<
0.05,
P
<
0.01),NT-proBNP低于对照组(
P
<
0.01);观察组6 min步行距离和6 min 步行距离占预计值百分数均高于对照组(
P
<
0.01),中医证候积分和MLHFQ评分低于对照组(
P
<
0.01); 观察组Killip心功能分级低于对照组(
P
<
0.05);观察组MACE累积发生率为12.0%(6/50),低于对照组的28.0%(14/50)(
<math id="M1"><msup><mrow><mi>χ</mi></mrow><mrow><mn mathvariant="normal">2</mn></mrow></msup></math>
http://html.publish.founderss.cn/rc-pub/api/common/picture?pictureId=6941457&type=
http://html.publish.founderss.cn/rc-pub/api/common/picture?pictureId=6941454&type=
2.96333337
3.13266659
=4.251,
P
<
0.05);观察组Lp-PLA
2
,hs-CRP,IL-6和TNF-
α
水平均低于对照组(
P
<
0.01);未发现与服用心通口服液相关不良反应。
结论
2
在西医综合治疗的基础上,心通口服液治疗AMI后心衰(气虚痰瘀互阻证)患者,能减轻心肌损伤程度,保护心肌,提高心功能,减轻炎症反应,降低MACE发生,有效控制了临床症状,提高了运动耐量和生活质量。
Objective
2
To discuss the clinical efficacy of Xintong oral liquid on heart failure with syndrome of Qi deficiency, phlegm and blood stasis caused by acute myocardial infarction (AMI) and the effect on inflammatory factors.
Method
2
One hundred patients were randomly divided into observation group (50 cases) and control group (50 cases) by random number table. Both groups got comprehensive treatment of western medicine. Patients in control group got simulated medicine of Xintong oral liquid, 20 mL/time, 3 times/day. Patients in observation group got Xintong oral liquid, 20 mL/time, 3 times/day. The treatment lasted for 4 weeks. Before the treatment, and at the second week and forth week after treatment, levels of cardiac troponin I (cTnI), cardiac troponin T (cTnT), heart type fatty acid binding protein (H-FABP), left ventricular ejection fraction (LVEF), cardiac output (CO), cardiac output per stroke (SV) and left ventricular end diastolic diameter (LVEDd), N-terminal B-type natriuretic peptide (NT-proBNP), lipoprotein phospholipase A
2
(Lp-PLA
2
), high sensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6) and tumor necrosis factor-
α
(TNF-
α
) were detected. The 6-minute walking test was performed to record the 6-minute walking distance and the ratio of 6 min walking distance to estimated value. Scores of traditional Chinese medicine (TCM) syndromes, minnesota Heart Failure quality of life questionnaire (MLHFQ) and Killip classification of cardiac function were recorded. During the 2 months' follow-up, adverse cardiovascular events (MACE) were recorded, and the safety was evaluated.
Result
2
At the second and fourth week, levels of cTnI, cTnT, H-FABP, NT-proBNP, Lp-PLA
2
, hs-CRP, IL-6 and TNF-
α
were lower than those in control group (
P
<
0.01), and levels of LVEF, CO and SV were higher than those in control group (
P
<
0.05,
P
<
0.01). NT-proBNP was lower than control group (
P
<
0.01). The 6-minute walking distance and the ratio of 6-minute walking distance to estimated value were all more than those in control group (
P
<
0.01). Scores of TCM syndrome integral, MLHFQ, Killip heart function grading were lower than those in control group (
P
<
0.05,
P
<
0.01). Cumulative incidence of MACE was 12.0% (6/50), which was lower than 28.0% (14/50) in control group (
<math id="M2"><msup><mrow><mi>χ</mi></mrow><mrow><mn mathvariant="normal">2</mn></mrow></msup></math>
http://html.publish.founderss.cn/rc-pub/api/common/picture?pictureId=6941465&type=
http://html.publish.founderss.cn/rc-pub/api/common/picture?pictureId=6941460&type=
3.30199981
3.64066648
=4.251,
P
<
0.05). Levels of Lp-PLA
2
, hs-CRP, IL-6 and TNF-
α
in observation group were lower those in control group (
P
<
0.01).And there was no adverse reactions related to Xintong oral liquid.
Conclusion
2
Based on the comprehensive treatment of Western medicine, Xintong oral liquid can reduce the degree of myocardial injury, protect myocardium, improve cardiac function, reduce inflammatory reaction, reduce the occurrence of mace, effectively control clinical symptoms, and improve exercise tolerance and quality of life.
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