鹿红颗粒干预心肌梗死后心功能不全的临床研究

薛金贵，赵斐然，顾嘉霖，叶康，高俊杰，戎靖枫，沈智杰，周华，王肖龙

摘要：目的观察鹿红颗粒对心肌梗死(MI)后阳虚血瘀证心功能不全患者的心功能及心室重构的影响。方法60例确诊为MI后心功能不全且中医辨证为阳虚血瘀证的患者随机分为对照组与干预组，各30例。对照组给予标准西药治疗，干预组在对照组治疗基础上加用鹿红颗粒，观察周期3个月。观察用药前后两组患者的中医临床症状，检测指标：血浆B型脑钠肽(BNP)、血浆血管紧张素Ⅱ(AngⅡ)、血浆去甲肾上腺素(NE)、左室舒张末内径(LVEDD)、左室收缩末内径(LVESD)、左室射血分数(LVEF)、室间隔厚度(IVST)、左室后壁厚度(LVPWT)。结果两组用药前后NE和BNP有统计学意义(P<0.01)；两组用药前后BNP差值比较有统计学意义(P<0.01)，两组治疗前后AngⅡ无统计学意义(P>0.05)。干预组治疗前后LVESD有统计学意义(P<0.05)；两组用药前后LVESD差值比较有统计学意义(P<0.05)，其他指标均无统计学意义(P>0.05)。干预组用药后中医临床症状有效率优于对照组(P<0.01)。结论在标准西药治疗基础上加载鹿红颗粒治疗能够改善MI后心功能不全患者BNP、LVEF、LVESD及中医临床症状，疗效优于单纯标准西药治疗。

关键词：心肌梗死；心室重构；心功能不全；鹿红颗粒

中图分类号：R542R289

基金项目：国家“863”项目“综合性中医院信息系统研发与示范”(2012AA02A610)；吴阶平基金会临床科研专项资助基金(No.320.6750.12183)；上海市科委科技支撑项目(No.12401903400)；上海市卫生局科研项目(No.20124069)

通讯作者：周华、王肖龙，E-mail：zhouhuam@medmail.com.cn

收稿日期：(2015-03-08)

Clinical Observation on Luhong Granules in Intervening Heart Dysfunction after Myocardial Infarction

Xue Jingui，Zhao Feiran， Gu Jialin， Ye Kang， Gao Junjie， Rong Jingfeng， Shen Zhijie，Zhou Hua，Wang Xiaolong

Shuguang Hospital，Shanghai University of Traditional Chinese Medicine，Shanghai 201203，China

Corresponding Author：Zhou Hua，Wang Xiaolong

Abstract：ObjectiveTo investigate the effects of Luhong granules(LHG) on heart function and ventricular remodeling in patients with heart dysfunction after myocardial infarction and yang deficiency and blood stasis syndrome.MethodsSixty patients with heart dysfunction after myocardial infarction and yang deficiency and blood stasis syndrome were randomly divided into two groups：The control group(n=30) treated with routine treatment and the treatment group(n=30)treated with LHG on the basis of routine treatment for 3 months.Before and after treatment，the symptoms of traditional Chinese medicine， B-type natriuretic peptide(BNP)，angiotensin Ⅱ(AngⅡ)， norepinephrine(NE)，left ventricular(LV)end diastolic dimension (LVEDD)，LV end-systolic dimension(LVESD)，LV ejection fraction (LVEF)， inter-ventricular septal thickness (IVST)，LV posterior wall thickness (LVPWT) were observed.ResultsAfter treatment，NE and BNP levels in two groups had very more significant improvement(P<0.01).BNP level in treatment group was higher than that in the control group (P<0.01).There were no difference in AngⅡ between two groups before and after treatment(P>0.05).LVESD had significant improvement in the treatment group after treatment (P<0.05)； Difference value of LVESD in treatment group was more improved than in the control group (P<0.05).The effective rate of the symptoms of traditional Chinese medicine were 93.4% in treatment group， 13.3% in control group (P<0.05). Conciusion LHG plus routine treatment can improve the BNP，LVEF，LVESD and clinical symptoms in patients with heart dysfunction after myocardial infarction and yang deficiency and blood stasis syndrome.

Key words：myocardial infarction；ventricular remodeling；heart failure；Luhong granules

心功能不全是心肌梗死(MI)后的主要并发症之一，而心室重构是目前研究发生心功能不全的主要原因[1]，交感神经系统(SNS)兴奋性的增强和肾素血管紧张素醛固酮系统(RAAS)的激活是MI后心室重构的两个主要因素[2]。鹿红颗粒全方共奏温养调和心肾之阳气，调全身之气血之效。本研究探讨鹿红颗粒对于MI后心功能不全及心室重构的临床疗效。……