补肾活血方治疗慢性心力衰竭利尿剂抵抗的疗效观察

Therapeutic Effect of Bushen Huoxue Prescription on Diuretic Resistance in Chronic Heart Failure

摘要:

目的 探讨补肾活血方对慢性心力衰竭利尿剂抵抗患者心脏功能、炎性反应及生活质量的影响。方法 选取符合纳入标准的患者78例随机分为观察组、对照组，各39例，两组患者均依据指南进行心力衰竭利尿剂抵抗规范化治疗，观察组在此基础上加用中药补肾活血方，对比两组治疗前后心脏功能指标、症状疗效总有效率、运动耐力、尿量、体质量、生活质量、炎症因子水平。结果 治疗前两组患者在24 h尿量、体质量、6 min步行试验（6MWT）、明尼苏达心力衰竭生活质量量表（MLHFQ）、N-末端B型脑钠肽前体（NT-proBNP）、左室射血分数（LVEF）、每搏输出量（SV）、血清白细胞介素-6（IL-6）、血清白细胞介素-4（IL-4）、肿瘤坏死因子-α（TNF-α）方面对比差异无统计学意义。治疗后与对照组比较，观察组患者在中医证候有效率、美国纽约心脏病协会（NYHA）心功能分级治疗有效率更优（P<0.05）。与本组治疗前比较，治疗后两组患者体质量、MLHFQ、IL-6、TNF-α、NT-proBNP水平均明显降低（P<0.05，P<0.01），观察组相较于对照组改善更明显（P<0.05，P<0.01）。与本组治疗前比较，两组患者治疗后24 h尿量、6MWT、LVEF、SV、IL-4 均明显升高（P<0.05，P<0.01）；治疗后与对照组比较，观察组患者治疗后改善更明显（P<0.05，P<0.01）。结论 补肾活血方联合规范化治疗能改善慢性心力衰竭利尿剂抵抗患者的临床症状，改善利尿剂抵抗及心脏功能，且安全性良好。

Abstract:

Objective To investigate the effects of Bushen Huoxue prescription on the cardiac function， inflammation， and quality of life of the patients with chronic heart failure resistant to diuretics.Method A total of 78 patients who met the inclusion criteria were randomized into observation and control groups （39 cases）. Both groups received standardized treatment for diuretic resistance in accordance with the guidelines. In addition， the observation group received Bushen Huoxue prescription. The cardiac function indicators， total response rate regarding symptom alleviation， exercise endurance， urine volume， body mass， quality of life， and levels of inflammatory cytokines were compared between the two groups before and after treatment.Result Before treatment， the two groups of patients showed no significant differences in terms of 24 h urine volume， body mass， 6 minute walk test （6MWT）， Minnesota Living with Heart Failure Questionnaire （MLHFQ） score， N-terminal pro-B-type natriuretic peptide （NT-proBNP） level， left ventricular ejection fraction （LVEF）， stroke volume （SV）， and serum levels of interleukin-6 （IL-6）， interleukin-4 （IL-4）， and tumor necrosis factor-alpha （TNF-α）. After treatment， the observation group outperformed the control group in terms of the response rates regarding traditional Chinese medicine symptom scores and New York Heart Association （NYHA） grading of cardiac function （P<0.05）. After treatment， the body mass， MLHFQ score， and IL-6， TNF-α， and NT-proBNP levels decreased in both groups （P<0.05， P<0.01）， and the observation group showed more significant decreases than the control group （P<0.05， P<0.01）. Both groups showed increases in 24-h urine volume， 6MWT， LVEF， SV， and IL-4 after treatment （P<0.05， P<0.01）， and the observation group showed more significant increases than the control group （P<0.05， P<0.01）.Conclusion The combination of Bushen Huoxue prescription with standardized treatment is effective in ameliorating the clinical symptoms of the patients with chronic heart failure resistant to diuretics. Moreover， it alleviates diuretic resistance and improves the cardiac function without causing obvious adverse reactions.