【摘要】 目的:观察加味真武汤对心肾阳虚型慢性心力衰竭患者心肌纤维化、氧化应激、血管内皮功能及心肌能量代谢的影响。方法:将120例心肾阳虚型慢性心力衰竭患者按照就诊顺序及随机数字表法,分为治疗组(60例)和对照组(60例)。对照组患者采用常规慢性心力衰竭药物治疗,口服利尿剂、血管紧张素转换酶抑制剂(ACEI)、β受体阻滞剂,必要时加服强心药地高辛,连续用药12周。治疗组患者在对照组基础上加用加味真武汤进行治疗,4周为1个疗程,连续服用3个疗程。以患者治疗前后中医证候评分、心肌纤维化指标(CTGF、TGF-β1)、氧化应激指标(SOD、MDA、GSH-Px)、血管内皮功能指标(NO、ET-1)及心肌能量代谢指标(FFA)评价临床疗效。结果:治疗组总有效率为93.33%(56/60),对照组总有效率为78.33%(47/60),治疗组总有效率高于对照组(P<0.05);两组患者治疗后中医证候评分均低于治疗前,且治疗组患者治疗后中医证候评分低于对照组(P<0.05);两组患者治疗后CTGF、TGF-β1水平均低于治疗前(P<0.05),且治疗组患者治疗后CTGF、TGF-β1水平均低于对照组(P<0.05);两组患者治疗后MDA水平低于治疗前(P<0.05),SOD、GSH-Px水平均高于治疗前(P<0.05),且治疗组患者治疗后MDA水平低于对照组,而SOD、GSH-Px水平高于对照组(P<0.05);两组患者治疗后NO、ET-1水平均低于治疗前,且治疗组患者治疗后NO、ET-1水平低于对照组(P<0.05);两组患者治疗后FFA水平均低于治疗前,且治疗组患者治疗后FFA水平低于对照组(P<0.05)。结论:加味真武汤可以有效改善心肾阳虚型慢性心力衰竭患者心肌纤维化和氧化应激指标,提升血管内皮功能,改善心肌能量代谢,同时还可有效缓解心悸、胸闷胸痛和四肢肿胀等临床症状,降低中医证候评分,提升临床疗效。更多还原

【Abstract】 Objective: To observe the effect of Jiawei Zhenwu Decoction on myocardial fibrosis, oxidative stress, vascular endothelial function and myocardial energy metabolism in patients with chronic heart failure of heart and kidney Yang deficiency syndrome. Methods: Totally 120 patients were selected and divided intotreatment group(60 cases) and control group(60 cases) according to the order of treatment and random number table method. Patients in control group were treated with conventional drugs for chronic heart failure, oral diuretics,angiotensin-converting enzyme inhibitors(ACEI), beta blockers and digoxin when necessary, for 12 weeks. Patients in treatment group were treated with Jiawei Zhenwu Decoction on the basis of the control group, four weeks as a c ourse of treatment, taking three courses continuously. Before and after treatment, TCM syndrome score,myocardial fibrosis index(CTGF and TGF-β1), oxidative stress index(SOD, MDA and GSH-PX), vascular endothelial function index(NO and ET-1) and heart muscle energy metabolism index [serum free fatty acid(FFA)] were used to evaluate the clinical effect. Results: The total effective rate was 93.33%(56/60) in treatment and 78.33%(47/60) in control group, and treatment group showed higher total effective rate than control group(P<0.05). After treatment, patients showed lower TCM syndrome score than before treatment in two groups(P<0.05), and treatment group showed lower TCM syndrome score than control group(P<0.05). After treatment, patients showed lower CTGF and TGF-β1 levels than before treatment in two groups(P <0.05), and treatment group showed lower CTGF and TGF-β1 levels than control group(P <0.05). After treatment, patients showed lower MDA level(P<0.05) while higher SOD and GSH PX levels than before treatment in two groups, and treatment group showed lower MDA level while higher SOD and GSH PX levels than control group(P<0.05). After treatment,patients showed lower NO and ET-1 levels than before treatment in two groups(P<0.05), and treatment group showed lower NO and ET-1 levels than control group(P<0.05). After treatment, patients showed lower FFA level than before treatment in two groups(P<0.05), and treatment group showed lower FFA level than control group(P <0.05). Conclusion: Jiawei Zhenwu Decoction can effectively improve the indexes of myocardial fibrosis and oxidative stress in patients with chronic heart failure of heart and kidney Yang deficiency syndrome, enhance vascular endothelial function, improve myocardial energy metabolism, effectively relieve palpitation, chest pain,limb swelling and other clinical symptoms, reduce TCM syndrome score and increase clinical efficacy.更多还原