动态检测Pro-BNP评估参附注射液对急性左心衰不同中医证型治疗效果
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摘要
目的:通过动态检测B型钠尿肽前体(Pro-BNP)水平评估参附注射液治疗不同证型急性左心衰患者的临床效果。方法:采用随机数字表法将160例急性左心衰患者随机分为治疗组和对照组,再将2组进行中医辨证分型,对照组给予常规药物治疗,治疗组则在对照组的基础上应用参附注射液治疗,通过对比2组患者急诊入院时、入院后24 h和72 h血浆Pro-BNP水平对治疗效果进行评估。结果:从总体来看,治疗组治疗有效率、Pro-BNP下降幅度与对照组相比,差异皆有统计学意义(P<0.05);从各个证型来看,参附注射液治疗阳虚喘脱型效果最佳,阳虚水泛型次之,而痰浊阻肺型最差;从BNP下降趋势来看,下降幅度由大到小依次为阳虚喘脱证>阳虚水泛证>痰浊壅肺证,尤其是在治疗72h后,阳虚喘脱型血浆Pro-BNP水平下降更明显,痰浊壅肺证患者2组无明显差异。结论:参附注射液治疗不同证型急性左心衰患者效果有差异,临床上应该辨证施治,效果会更确切。
Objective:To investigate the clinical effect of Shenfu injection in the treatment of patients with acute left heart failure with different syndromes by detecting the level of dynamic Pro-BNP. Methods:A total of 160 patients with acute left heart failure were divided into treatment group and control group by random number table method. Traditional Chinese Medicine syndrome differentiation was performed in the two groups. The control group was given conventional drug treatment, while the treatment group was applied Shenfu injection on the basis of the control group. The therapeutic effects were evaluated by comparing the plasma Pro-BNP levels at admission, 24 and 72 hours after hospitalization. Results:Overall, the effective treatment rate and Pro-BNP decreased in the treatment group compared with the control group, the difference was statistically significant(P<0.05). From the perspective of each syndrome type, compared with the control group, the effect of the Shenfu injection treatment of yang deficiency and asthmatic is the best, Yang deficiency water syndrome is the second, and phlegm obstruction of lung syndrome is the worst. The decline trend of plasma Pro-BNP level from high to low is Yang Asthenia Syndrome > Yang deficiency water syndrome > phlegm obstruction of lung syndrome, especially after 72 hours of treatment, the level of Pro-BNP in Yang Asthenia asthmatic type plasma was more obvious, but there was no significant difference between the two groups in phlegm obstruction of lung syndrome. Conclusion:The effect of Shenfu injection in the treatment of patients with acute left heart failure of different syndromes is different. Clinically, it should be treated with syndrome differentiation, and the effect will be more accurate and obvious.
Objective:To investigate the clinical effect of Shenfu injection in the treatment of patients with acute left heart failure with different syndromes by detecting the level of dynamic Pro-BNP. Methods:A total of 160 patients with acute left heart failure were divided into treatment group and control group by random number table method. Traditional Chinese Medicine syndrome differentiation was performed in the two groups. The control group was given conventional drug treatment, while the treatment group was applied Shenfu injection on the basis of the control group. The therapeutic effects were evaluated by comparing the plasma Pro-BNP levels at admission, 24 and 72 hours after hospitalization. Results:Overall, the effective treatment rate and Pro-BNP decreased in the treatment group compared with the control group, the difference was statistically significant(P<0.05). From the perspective of each syndrome type, compared with the control group, the effect of the Shenfu injection treatment of yang deficiency and asthmatic is the best, Yang deficiency water syndrome is the second, and phlegm obstruction of lung syndrome is the worst. The decline trend of plasma Pro-BNP level from high to low is Yang Asthenia Syndrome > Yang deficiency water syndrome > phlegm obstruction of lung syndrome, especially after 72 hours of treatment, the level of Pro-BNP in Yang Asthenia asthmatic type plasma was more obvious, but there was no significant difference between the two groups in phlegm obstruction of lung syndrome. Conclusion:The effect of Shenfu injection in the treatment of patients with acute left heart failure of different syndromes is different. Clinically, it should be treated with syndrome differentiation, and the effect will be more accurate and obvious.
引文
[1]中国医师协会急诊医师分会中国心胸血管麻醉学会急救与复苏分会.中国急性心力衰竭急诊临床实践指南(2017)[J].中华急诊医学杂志, 2017,26 (12):1347-1356.
[2]TANG Qi, WANG Yuanping, LI Kuangyi. Zhenwu Decoction for Chronic Heart Failure: Protocol for a Systematic Review and Meta-analysis[J].Medicine (Baltimore), 2018, 97(29): e11559.
[3]LI Xinli, ZHANG Jian, HUANG Jun et al. A Multicenter, Randomized, Double-blind, Parallel-group, Placebo-controlled study of the Effects of Qili Qiangxin Capsules in Patients with Chronic Heart Failure[J].J Am Coll Cardiol, 2013, 62(12): 1065-1072.
[4]TANG W H Wilson, HUANG Yanming. Cardiotonic Modulation in Heart Failure: Insights from Traditional Chinese Medicine[J]. J Am Coll Cardiol, 2013, 62(12): 1073-1074.
[5]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志,2014,42(2):98-122.
[6]葛均波,徐永健.内科学[M].北京:人民卫生出版社,2013;
[7]郑筱萸.中药新药临床研究指导原则[S].北京:中国医药科技出版社,2002:77.
[8]邓铁涛.中医诊断学[M].上海:上海科学技术出版社,2012.
[9]周文君,姚亚丽,邓爱云,等.血浆N-末端脑钠肽前体对射血分数正常心力衰竭患者诊断价值[J].中华实用诊断与治疗杂志,2012,26(3):254-259.
[10]苏华,陈琛,李宝亮.B-型钠尿肽和N-末端B-型钠尿肽前体在疾病诊断和预后判断中应用价值[J].中国老年学杂志,2016,36(22):5750-5753.
[11]何玲玲,余国龙,高琪乐,等.血浆B型利钠肽动态变化对急性左心衰患者短期预后及死亡风险预测价值[J].临床心血管病杂志,2009,25(3):216-218
[12]邱泽亮,刘建华,张宁,等.参附注射液对严重脓毒症患者肝肾功能的保护作用[J].中药药理与临床, 2013,31(10):155-157.
[13]叶烨,曾瑞峰,赖嘉华,等.温阳活血法治疗复苏后综合征的临床观察[J].中华中医药杂志,2017,32(3):1390-1392.
[14]杨萍,李华,章永南,等.参附注射液治疗舒张性心力衰竭的临床疗效[J].中国老年学杂志,2016,36(9):2103-2105.
[15]李文佳,郭迪,王迪.强心活力方对心肌梗死后慢性心衰大鼠心功能和氧化应激的作用研究[J].成都中医药大学学报, 2017, 40(3):17-19.
[16]严治涛,罗文利,黄金梅,等.不同剂量参附注射液治疗慢性心力衰竭的临床疗效观察[J].中华中医药杂志,2015,30(2):636-640.
[17]杜浩,戴小华.参附注射液治疗心力衰竭的Meta分析[J].中华中医药杂志,2014,29(11):3643-3646
[18]赵旺.参附注射液治疗慢性心力衰竭急性加重患者的临床观察[J].中华中医药杂志,2014,29(11):3667-3669.
[19]朱金墙,梁钰彬,华声瑜,等.参附注射液的成分及其对心血管系统的药理作用研究进展[J].中成药,2014,36(04):819-823.
[20]王俊辉,郝浩,韩宁,等.参附注射液对急性左心衰(心肾阳虚证)患者血流动力学指标的影响[J].中国中医急症,2017,26(04):693-695.
[21]侯雅竹,毛静远,王贤良,等.参附注射液治疗心力衰竭的系统评价[J].中国循证医学杂志.2011,11(3):292-299.
[22]陈景利,何明丰,李旷怡,等.参附注射液治疗急性左心衰的临床观察[J].中国中医急症,2015,24(8):1339-1341.
[23]常素平,程学军.参附注射液对急性心衰患者BNP及心功能影响的疗效研究[J].内蒙古医科大学学报.2015,337(2):185-186.
[2]TANG Qi, WANG Yuanping, LI Kuangyi. Zhenwu Decoction for Chronic Heart Failure: Protocol for a Systematic Review and Meta-analysis[J].Medicine (Baltimore), 2018, 97(29): e11559.
[3]LI Xinli, ZHANG Jian, HUANG Jun et al. A Multicenter, Randomized, Double-blind, Parallel-group, Placebo-controlled study of the Effects of Qili Qiangxin Capsules in Patients with Chronic Heart Failure[J].J Am Coll Cardiol, 2013, 62(12): 1065-1072.
[4]TANG W H Wilson, HUANG Yanming. Cardiotonic Modulation in Heart Failure: Insights from Traditional Chinese Medicine[J]. J Am Coll Cardiol, 2013, 62(12): 1073-1074.
[5]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志,2014,42(2):98-122.
[6]葛均波,徐永健.内科学[M].北京:人民卫生出版社,2013;
[7]郑筱萸.中药新药临床研究指导原则[S].北京:中国医药科技出版社,2002:77.
[8]邓铁涛.中医诊断学[M].上海:上海科学技术出版社,2012.
[9]周文君,姚亚丽,邓爱云,等.血浆N-末端脑钠肽前体对射血分数正常心力衰竭患者诊断价值[J].中华实用诊断与治疗杂志,2012,26(3):254-259.
[10]苏华,陈琛,李宝亮.B-型钠尿肽和N-末端B-型钠尿肽前体在疾病诊断和预后判断中应用价值[J].中国老年学杂志,2016,36(22):5750-5753.
[11]何玲玲,余国龙,高琪乐,等.血浆B型利钠肽动态变化对急性左心衰患者短期预后及死亡风险预测价值[J].临床心血管病杂志,2009,25(3):216-218
[12]邱泽亮,刘建华,张宁,等.参附注射液对严重脓毒症患者肝肾功能的保护作用[J].中药药理与临床, 2013,31(10):155-157.
[13]叶烨,曾瑞峰,赖嘉华,等.温阳活血法治疗复苏后综合征的临床观察[J].中华中医药杂志,2017,32(3):1390-1392.
[14]杨萍,李华,章永南,等.参附注射液治疗舒张性心力衰竭的临床疗效[J].中国老年学杂志,2016,36(9):2103-2105.
[15]李文佳,郭迪,王迪.强心活力方对心肌梗死后慢性心衰大鼠心功能和氧化应激的作用研究[J].成都中医药大学学报, 2017, 40(3):17-19.
[16]严治涛,罗文利,黄金梅,等.不同剂量参附注射液治疗慢性心力衰竭的临床疗效观察[J].中华中医药杂志,2015,30(2):636-640.
[17]杜浩,戴小华.参附注射液治疗心力衰竭的Meta分析[J].中华中医药杂志,2014,29(11):3643-3646
[18]赵旺.参附注射液治疗慢性心力衰竭急性加重患者的临床观察[J].中华中医药杂志,2014,29(11):3667-3669.
[19]朱金墙,梁钰彬,华声瑜,等.参附注射液的成分及其对心血管系统的药理作用研究进展[J].中成药,2014,36(04):819-823.
[20]王俊辉,郝浩,韩宁,等.参附注射液对急性左心衰(心肾阳虚证)患者血流动力学指标的影响[J].中国中医急症,2017,26(04):693-695.
[21]侯雅竹,毛静远,王贤良,等.参附注射液治疗心力衰竭的系统评价[J].中国循证医学杂志.2011,11(3):292-299.
[22]陈景利,何明丰,李旷怡,等.参附注射液治疗急性左心衰的临床观察[J].中国中医急症,2015,24(8):1339-1341.
[23]常素平,程学军.参附注射液对急性心衰患者BNP及心功能影响的疗效研究[J].内蒙古医科大学学报.2015,337(2):185-186.
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