Effects of Shexiang Baoxin Pills on cardiac function, ventricular remodeling and vascular endothelial factor in elderly patients with chronic heart failure
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摘要:
目的 分析麝香保心丸对老年慢性心力衰竭(CHF)患者心功能、心室重构及血管内皮因子的影响，以期为临床CHF的治疗提供参考。 方法 选取2018年1月—2019年12月杭州师范大学附属医院老年CHF患者100例，采用随机数字表法分为对照组和观察组，每组50例。对照组采用常规西药治疗，观察组采用西药联合麝香保心丸治疗。比较2组患者的心功能、心室重构情况、血流动力学、内皮功能及不良反应发生情况。 结果 治疗后，2组左心室射血分数、6分钟步行试验、心脏指数明显高于治疗前(均P < 0.05)，且观察组明显高于对照组[(52.16±3.39)% vs.(44.24±4.73)%，(453.46±23.20)m vs. (417.25±22.52)m，(3.34±0.38)L/(min·m2) vs. (2.88±0.46)L/(min·m2), t=9.624、7.919、5.452，均P < 0.05]。治疗后，2组左心室舒张末期内径、左心室后壁厚度、室间隔收缩末期厚度、左心室质量指数、肺动脉楔压、总外周阻力、血管紧张素Ⅱ、醛固酮、内皮素-1水平明显低于治疗前(均P < 0.05)，且观察组明显低于对照组(t=7.440、7.083、3.733、6.272、12.507、11.399、9.234、7.876、10.218，均P < 0.05)。2组不良反应发生率比较差异无统计学意义(χ2=0.444，P>0.05)。 结论 麝香保心丸治疗可有效改善老年CHF患者内皮功能、心功能及血流动力学，延缓心室重构，且安全性良好。 Abstract:Objective To analyze the effect of Shexiang Baoxin Pills on cardiac function, ventricular remodeling and vascular endothelial factor in elderly patients with chronic heart failure (CHF), so as to provide reference for clinical treatment of CHF. Methods A total of 100 elderly patients with CHF in the Affiliated Hospital of Hangzhou Normal University from January 2018 to December 2019 were selected and divided into control group and observation group by random digital table method, 50 cases in each group. The control group was treated with conventional western medicine, and the observation group was treated with western medicine combined with Shexiang Baoxin Pills. The cardiac function, ventricular remodeling, hemodynamics, endothelial cell function and adverse reactions were compared between the two groups. Results After treatment, the levels of left ventricular ejection fraction, 6 min walking test, cardiac index in the two groups were significantly higher than those before treatment (all P < 0.05), and those in the observation group were significantly higher than those in the control group [(52.16±3.39) % vs. (44.24±4.73) %, (453.46±23.20) m vs. (417.25±22.52) m, (3.34±0.38) L/(min·m2) vs. (2.88±0.46) L/(min·m2), t=9.624, 7.919, 5.452, all P < 0.05]. After treatment, the levels of the left ventricular end diastolic diameter, left ventricular posterior wall thickness, interventricular septal end systolic thickness, left ventricular mass index, pulmonary artery wedge pressure, total peripheral resistance, angiotensin Ⅱ, aldosterone, endothelin-1 in the two groups were significantly lower than those before treatment (all P < 0.05), and the observation group were significantly lower than the control group (t=7.440, 7.083, 3.733, 6.272, 12.507, 11.399, 9.234, 7.876, 10.218, all P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (χ2=0.444, P>0.05). Conclusion Shexiang Baoxin Pills can effectively improve endothelial function, cardiac function and hemodynamics in elderly patients with CHF, delay ventricular remodeling, and has good safety. -
表 1 2组老年慢性心力衰竭患者心功能比较(x±s)
组别 例数 LVEF(%) 6MWT(m) LVEDD(mm) 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 对照组 50 35.67±4.72 44.24±4.73a 335.15±43.96 417.25±22.52a 59.68±5.16 52.17±4.12a 观察组 50 35.34±5.08 52.16±3.39a 341.57±35.22 453.46±23.20a 60.12±4.84 46.23±3.86a t值 0.337 9.624 0.806 7.919 0.440 7.440 P值 0.737 ＜0.001 0.422 ＜0.001 0.661 ＜0.001 注：与同组治疗前比较，aP < 0.05。 
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表 2 2组老年慢性心力衰竭患者心室重构指标比较(x±s)
组别 例数 LVPWT(mm) IVSS(mm) LVMI(g/m2) 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 对照组 50 13.08±1.68 10.94±1.06a 12.45±1.26 11.45±1.17a 139.52±18.16 123.28±9.76a 观察组 50 13.28±2.02 9.56±0.88a 12.37±1.18 10.62±1.05a 135.75±16.53 112.34±7.54a t值 0.538 7.083 0.328 3.733 1.086 6.272 P值 0.592 ＜0.001 0.744 ＜0.001 0.280 ＜0.001 注：与同组治疗前比较，aP < 0.05。
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表 3 2组老年慢性心力衰竭患者血流动力学指标比较(x±s)
组别 例数 PAWP(mm Hg) TPR[dyn/(s·cm5)] CI[L/(min·m2)] 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 对照组 50 23.95±2.66 16.84±1.52a 1 824.94±116.39 1 537.58±97.69a 2.22±0.34 2.88±0.46a 观察组 50 24.53±2.35 13.49±1.13a 1 852.62±105.88 1 342.62±71.30a 2.29±0.41 3.34±0.38a t值 1.155 12.507 1.244 11.399 0.929 5.452 P值 0.251 ＜0.001 0.216 ＜0.001 0.355 ＜0.001 注：与同组治疗前比较，aP < 0.05。1 mm Hg=0.133 kPa。
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表 4 2组老年慢性心力衰竭患者血管内皮因子水平比较(x±s，pg/mL)
组别 例数 Ang Ⅱ 醛固酮 ET-1 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 对照组 50 115.87±18.09 68.71±7.52a 127.42±20.38 85.28±9.31a 68.46±8.40 43.18±5.86a 观察组 50 113.39±15.72 55.61±6.64a 124.57±17.92 71.20±8.55a 67.85±7.94 32.45±4.56a t值 0.732 9.234 0.743 7.876 0.373 10.218 P值 0.466 ＜0.001 0.460 ＜0.001 0.710 ＜0.001 注：与同组治疗前比较，aP < 0.05。
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表 5 2组老年慢性心力衰竭患者不良反应发生情况比较[例(%)]
组别 例数 恶心呕吐 疲劳头晕 唇舌麻木 合计 对照组 50 2(4.00) 2(4.00) 0 4(8.00) 观察组 50 3(6.00) 2(4.00) 1(2.00) 6(12.00) 注：2组不良反应发生率比较，χ2=0.444，P=0.505。
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