康心导引术联合苓桂术甘汤加味治疗慢性心力衰竭心肾阳虚证患者的临床研究

目的观察康心导引术联合苓桂术甘汤加味对慢性心力衰竭心肾阳虚证患者心功能和运动耐力及对血清N端前体脑钠肽(N-terminal pro-brain natriuretic peptide,NT-proBNP)、血管紧张素II(angiotensinⅡ,AngⅡ)、血管紧张素(1-7)angiotensin(1-7),Ang(1-7)]、基质金属蛋白酶-9(matrix metallo proteinase-9,MMP-9)的影响。方法将180例慢性心力衰竭患者分为对照组、观察A组、观察B组,每组60例。对照组予西医常规治疗;观察A组在西医常规治疗的基础上予以苓桂术甘汤加味治疗;观察B组在西医常规治疗的基础上予以苓桂术甘汤加味和导引术联合治疗。2周为1个疗程,连续治疗4个疗程。比较3组患者治疗前后心功能左室射血分数(left ventricular ejection fraction,LVEF)、6 min步行实验(6 minute walking distance,6MWD)]、运动耐力无氧阈值(anaerobic threshold,AT)、峰值摄氧量(maximal oxygen consumption,VO₂ Max)、氧脉比]以及血清NT-proBNP、AngⅡ、Ang(1-7)、MMP-9等实验室指标的变化情况,并评价3组的临床疗效及安全性。结果(1)3组治疗总有效率比较,观察B组优于对照组(P<0.05)。(2)治疗后,3组LVEF、6MWD均较治疗前改善(P<0.05),且观察B组6MWD改善作用效果优于对照组和观察A组(P<0.05)。(3)治疗后,观察B组的AT、VO2 Max、氧脉比水平均较治疗前提高(P<0.05),且观察B组效果优于对照组和观察A组(P<0.05)。(4)治疗后,3组NT-proBNP、AngⅡ和MMP-9较治疗前降低(P<0.05),且观察B组AngⅡ水平低于观察A组、对照组(P<0.05);观察A组、观察B组Ang(1-7)较治疗前升高(P<0.05),且观察B组高于观察A组(P<0.05)。(5)治疗过程中,3组均无明显不良反应病例出现。结论康心导引术联合苓桂术甘汤加味可以改善慢性心力衰竭心功能和运动耐力,并降低NT-proBNP、AngII、MMP-9水平,增加Ang(1-7)水平。

Clinical Study of Kangxin Daoyin Combined with Linggui Zhugan Decoction in the Treatment of Chronic Heart Failure Patients with Heart-kidney Yang Deficiency Syndrome

Objective To observe the effects of Lingui Zhugan Decoction combined with Kangxin Daoyin on cardiac function,exercise tolerance and serum N-terminal pro-brain natriuretic peptide(NT-proBNP),angiotensinⅡ(AngⅡ),angiotensin(1-7)Ang(1-7)]and matrix metalloproteinase-9(MMP-9)on chronic heart failure patients with heart-kidney Yang deficiency syndrome.Methods 180 patients with chronic heart failure were divided into control group,observation group A and observation group B,60 cases in each group.The control group was treated with conventional western medicine;observation group A was treated with Lingui Zhugan Decoction on the basis of conventional western medicine;observation group B was treated with Lingui Zhugan Decoction and Kangxin Daoyin on the basis of conventional western medicine.Two weeks period is a course of treatment,continuous treatment for 4 courses.Cardiac function,including left ventricular ejection fraction(LVEF)and 6-minute walking test(6MWD),exercise tolerance,including anaerobic threshold(AT)and maximum oxygen consumption(VO₂ max),oxygen pulse ratio and serum NT-proBNP,AngⅡ,Ang(1-7),and MMP-9 levels and other laboratory indicators were compared among the three groups before and after treatment.The clinical efficacy and safety of the three groups were evaluated.Results(1)Comparison of the total effective rate of the three groups showed that observation group B was better than the control group(P<0.05).(2)After treatment,LVEF and 6MWD were improved in three groups(P<0.05),and the improvement effect of 6MWD in observation group B was better than that in control group and observation group A(P<0.05).(3)After treatment,the levels of AT,VO₂ max,and oxygen pulse ratio in observation group B were higher than those before treatment(P<0.05),and the effect of observation group B was better than that of control group and observation group A(P<0.05).(4)After treatment,the levels of NT proBNP,AngⅡ,and MMP-9 in three groups were lower than those before treatment(P<0.05),and the level of AngⅡin observation group B was lower than that in observation group A and control group(P<0.05).The levels of Ang(1-7)in observation group A and observation group B were higher than those before treatment(P<0.05),and those in observation group B were higher than those in observation group A(P<0.05).(5)During the treatment,there were no obvious adverse reactions in the three groups.Conclusion Kangxin Daoyin combined with Linggui Zhugan Decoction can improve cardiac function and exercise endurance of chronic heart failure,reduce NT-proBNP,AngⅡ,MMP-9 levels,and increase Ang(1-7)level.