Effects of Ziwu Liuzhu auricular points pressing beans on inflammatory cytokines and NT-proBNP levels in patients with chronic heart failure
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摘要:
目的 观察子午流注择时耳穴压豆对慢性心力衰竭(chronic heart failure,CHF)患者炎症细胞因子及末端脑钠肽(NT-proBNP)水平的影响。探讨子午流注择时耳穴压豆改善CHF患者中医症候、心功能与活动耐力的作用机制。 方法 选择2019年1月—2020年6月于黑龙江中医药大学附属第一医院门诊就诊的80例CHF患者,使用随机数字表法将80例CHF患者随机分为对照组和观察组,每组40例(对照组脱落2例,观察组脱落1例)。对照组给予常规基础治疗;观察组在对照组基础上采用子午流注择时耳穴压豆治疗。观察2组患者治疗前后左心室射血分数(LVEF)、6 min步行距离(6MWD)变化,血清IL-6、超敏C反应蛋白(hs-CRP)和NT-proBNP水平变化,比较2组患者临床疗效与中医症候疗效。 结果 治疗后,观察组LVEF与6MWD较治疗前明显提高(P<0.05),观察组优于对照组(P<0.05)。治疗后,观察组血清IL-6、hs-CRP和NT-proBNP水平较治疗前显著减低(P<0.05),观察组优于对照组(P<0.05)。观察组中医症候总有效率为92.3%(36/39),明显优于对照组的34.2%(13/38),差异有统计学意义(P<0.05)。观察组临床总有效率为71.8%(28/39),对照组为44.7%(17/38),差异有统计学意义(P<0.05)。 结论 子午流注择时耳穴压豆能明显提升CHF患者临床疗效,改善CHF患者中医症候、心功能与活动耐力,降低CHF患者血清IL-6、hs-CRP和NT-proBNP水平。 Abstract:Objective To observe the effect of time-controlled Ziwu Liuzhu auricular points pressing beans on inflammatory cytokines and N-terminal pro-Brain natriuretic peptide (NT-proBNP) levels in patients with chronic heart failure (CHF). To investigate the mechanism of Ziwu Liuzhu auricular points pressing beans and earlobes to improve TCM symptoms, heart function and exercise tolerance in patients with CHF. Methods A total of 80 patients with CHF who admitted in the Outpatient Clinic in the First Affiliated Hospital of Heilongjiang University of Chinese Medicine from January 2019 to June 2020 were selected and divided into a control group and an observation group by using the random number table method, with 40 cases in each group (2 cases dropped off in the control group and 1 case dropped off in the observation group). The control group received routine basic treatment, while the observation group was treated by Ziwu Liuzhu auricular points pressing beans on the basis of the control group. Changes in serum left ventricular ejection fraction (LVEF), 6-min walking distance (6MWD), IL-6, hypersensitive C-reactive protein (hs-CRP) and NT-proBNP in both groups were observed before and after treatment. The clinical efficacy and efficacy of TCM symptoms were compared between the two groups. Results After treatment, the LVEF and 6MWD in the observation group were significantly improved compared to before treatment (P < 0.05), and the observation group was superior to the control group (P < 0.05); The serum levels of IL-6, hs-CRP, and NT-proBNP in the observation group were significantly reduced compared to before treatment (P < 0.05), and the observation group was superior to the control group (P < 0.05). The total effective rate of active TCM symptoms in the observation group was 92.3% (36/39), which was significantly better than that in the control group [34.2% (13/38), P < 0.05]. The total clinical effective rate of the observation group was 71.8% (28/39), while the control group was 44.7% (17/38), with a statistically significant difference (P < 0.05). Conclusion Ziwu Liuzhu auricular points pressing beans may significantly improve the clinical efficacy of CHF patients, improve CHF patients ' TCM symptoms, cardiac function and activity endurance, and reduce serum IL-6, hs-CRP and NT-proBNP levels in CHF patients. -
Key words:
- Ziwu Liuzhu /
- Auricular points /
- Chronic heart failure /
- Natron method
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表 1 2组CHF患者临床疗效比较[例(%)]
Table 1. Comparison of clinical efficacy between two groups of CHF patients [cases(%)]
组别 例数 显效 有效 无效 总有效 观察组 39 11(28.2) 17(43.6) 11(28.2) 28(71.8) 对照组 38 5(13.1) 12(31.6) 21(55.3) 17(44.7) 注:2组总有效率比较,χ2=5.802,P=0.016。 表 2 2组CHF患者中医症候疗效比较[例(%)]
Table 2. Comparison of TCM syndromes and curative effects between 2 groups of CHF patients [cases (%)]
组别 例数 显效 有效 无效 总有效 观察组 39 5(12.8) 31(79.5) 3(7.7) 36(92.3) 对照组 38 0 13(34.2) 25(65.8) 13(34.2) 注:2组总有效率比较,χ2=28.073,P<0.001。 表 3 2组CHF患者治疗前后LVEF与6MWD比较(x±s)
Table 3. Comparison of LVEF and 6MWD in two groups of CHF patients before and after treatment(x±s)
组别 例数 LVEF(%) 6 min步行距离(m) 治疗前 治疗6周 治疗前 治疗6周 观察组 39 40.14±5.35 49.31±8.44a 298.45±63.66 367.72±81.22a 对照组 38 41.30±5.63 45.28±7.27a 294.36±61.51 327.40±75.65a t值 0.926 2.247 0.287 2.255 P值 0.357 0.028 0.775 0.027 注:与同组治疗前比较,aP<0.05。 表 4 2组CHF患者治疗前后炎症细胞因子和NT-proBNP水平比较(x±s)
Table 4. Comparison of inflammatory cytokines and NT-proBNP levels in two groups of CHF patients before and after treatment(x±s)
组别 例数 IL-6(mg/L) hs-CRP(mg/L) NT-proBNP(ng/L) 治疗前 治疗6周 治疗前 治疗6周 治疗前 治疗6周 观察组 39 18.01±2.33 10.27±2.12a 13.82±2.44 4.83±0.89a 4.26±1.06 1.61±0.41a 对照组 38 17.32±3.11 12.41±2.36a 13.61±2.71 7.01±1.33a 4.13±1.01 2.77±0.54a t值 1.100 4.182 0.357 8.430 0.551 10.600 P值 0.275 <0.001 0.722 <0.001 0.583 <0.001 注:与同组治疗前比较,aP<0.05。 -
[1] 中华医学会心血管病学分会心力衰竭学组, 中国医师协会心力衰竭专业委员会, 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2018[J]. 中华心血管病杂志, 2018, 46(10): 760-789. doi: 10.3760/cma.j.issn.0253-3758.2018.10.004The Heart Failure Group of the Cardiovascular Branch of the Chinese Medical Chamber, the Specialist Committee for Heart Failure of the Chinese Medical Chamber and the Editorial Committee of the Chinese Journal of Cardiovascular Diseases. Chinese Guidelines for the Diagnosis and Treatment of Heart Failure 2018[J]. Chinese Journal of Cardiology, 2018, 46(10): 760-789. doi: 10.3760/cma.j.issn.0253-3758.2018.10.004 [2] ROGER V L. Epidemiology of heart failure: a contemporary perspective[J]. Circ Res, 2021, 128(10): 1421-1434. doi: 10.1161/CIRCRESAHA.121.318172 [3] REY J R, CARO-CODÓN J, ROSILLO S O, et al. Failure in COVID-19 patients: prevalence, incidence and prognostic implications[J]. Eur J Heart Fail, 2020, 22(12): 2205-2215. doi: 10.1002/ejhf.1990 [4] RAO B R, DICKERT N W, MORRIS A A, et al. Heart failure and shared decision-making: patients open to medication-related cost discussions[J]. Circ Heart Fail, 2020, 13(11): e007094. DOI: 10.1161/CIRCHEARTFAILURE.120.007094. [5] 马丽媛, 吴亚哲, 陈伟伟. 《中国心血管病报告2018》要点介绍[J]. 中华高血压杂志, 2019, 27(8): 712-716. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGZ201908007.htmMA L Y, WU Y Z, CHEN W W. Key points of China cardiovascular disease report 2018[J]. Chinese Journal of Hypertension, 2019, 27(8): 712-716. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGZ201908007.htm [6] 王文, 郝敏. 慢性心力衰竭患者自我感受负担与自我效能的相关性[J]. 护理实践与研究, 2020, 17(14): 51-52. https://www.cnki.com.cn/Article/CJFDTOTAL-HLSJ202014023.htmWANG W, HAO M. Correlation between self-perceived burden and self-efficacy in patients with chronic heart failure[J]. Nursing Practice and Research, 2020, 17(14): 51-52. https://www.cnki.com.cn/Article/CJFDTOTAL-HLSJ202014023.htm [7] 王小平, 惠晓艳, 王建锋. 急诊治疗慢性充血性心力衰竭临床疗效评估[J]. 贵州医药, 2021, 45(12): 1887-1888. https://www.cnki.com.cn/Article/CJFDTOTAL-GZYI202112020.htmWANG X P, HUI X Y, WANG J F. Evaluation of clinical efficacy of emergency treatment for chronic congestive heart failure[J]. Guizhou Medical Journal, 2021, 45(12): 1887-1888. https://www.cnki.com.cn/Article/CJFDTOTAL-GZYI202112020.htm [8] 郭娟, 毕清泉. 老年慢性心力衰竭患者乐观应对和社会支持及营养评价与生命质量的关系分析[J]. 中华全科医学, 2020, 18(12): 2047-2050, 2135. doi: 10.16766/j.cnki.issn.1674-4152.001685GUO J, BI Q Q. Analysis of the relationship between optimistic coping style, social support, nutrition evaluation and quality of life in elderly patients with chronic heart failure[J]. Chinese Journal of General Practice, 2020, 18(12): 2047-2050, 2135. doi: 10.16766/j.cnki.issn.1674-4152.001685 [9] 贺卫, 朱慧英, 丁嘉怡, 等. 中药联合针刺治疗气虚血瘀证慢性心力衰竭(心功能分级Ⅱ级)的临床疗效[J]. 上海中医药大学学报, 2022, 36(S1): 76-79, 83. https://www.cnki.com.cn/Article/CJFDTOTAL-SHZD2022S1019.htmHE W, ZHU H Y, DING J Y, et al. Clinical efficacy of traditional Chinese medicine combined with acupuncture on chronic heart failure(cardiac function grade Ⅱ)with Qi deficiency and blood stasis syndrome[J]. Academic Journal of Shanghai University of Traditional Chinese Medicine, 2022, 36(S1): 76-79, 83. https://www.cnki.com.cn/Article/CJFDTOTAL-SHZD2022S1019.htm [10] 王云丽, 韩永斌, 田玉静, 等. 回阳复脉汤对慢性心衰急性加重合并低血压患者血压调控及心功能改善作用研究[J]. 吉林中医药, 2021, 41(12): 1605-1608. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJL202112018.htmWANG Y L, HAN Y B, TIAN Y J, et al. On the effect of Huiyang Fumai Decoction on the blood pressure regulation and cardiac function improvement in patients with an acute exacerbation of chronic heart failure complicated with a hypotension[J]. Jilin Journal of Chinese Medicine, 2021, 41(12): 1605-1608. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJL202112018.htm [11] 张健, 张宇辉. 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. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYW201910003.htmZHANG J, ZHANG Y H. Chinese heart failure diagnosis and treatment guidelines 2014[J]. Chinese Journal of Cardiology, 2014, 42(2): 98-122. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYW201910003.htm [12] 国家药品监督管理局. 中药新药临床研究指导原则(试行)[M]. 北京: 中国医药科技出版社, 2002: 77-85.State Drug Administration. Guiding principles for clinical research of new Chinese medicines (Trial)[M]. Beijing: China Medical Science and Technology Press, 2002: 77-85. [13] 马新豫. 黄芪联合多巴酚丁胺及酚妥拉明治疗慢性肺源性心脏病顽固性心力衰竭疗效观察[J]. 新乡医学院学报, 2021, 38(2): 133-136. https://www.cnki.com.cn/Article/CJFDTOTAL-XXYX202102008.htmMA X Y. Effect of astragalus membranaceus combined with dobutamine and phentolamine in the treatment of chronic pulmonary heart disease with refractory heart failure[J]. Journal of Xinxiang Medical University, 2021, 38(2): 133-136. https://www.cnki.com.cn/Article/CJFDTOTAL-XXYX202102008.htm [14] 徐迪华, 徐剑秋. 中医量化诊断[M]. 南京: 江苏科学技术出版社, 1997: 104-105.XU D H, XU J Q. Quantitative diagnosis of traditional Chinese medicine[M]. Nanjing: Jiangsu Science and Technology Press, 1997: 104-105. [15] 张亚君, 林楠, 陈茜茜, 等. 针刺对急性缺血性卒中继发脑心综合征患者心脏自主神经功能失衡和儿茶酚胺的影响[J]. 上海针灸杂志, 2020, 39(2): 131-136. https://www.cnki.com.cn/Article/CJFDTOTAL-SHZJ202002003.htmZHANG Y J, LIN N, CHEN Q Q, et al. Effect of Acupuncture on Cardiac Autonomic Imbalance and Catecholamine in Patients with Cerebrocardiac Syndrome Secondary to Acute Ischemic Stroke[J]. Shanghai Journal of Acupuncture and Moxibustion, 2020, 39(2): 131-136. https://www.cnki.com.cn/Article/CJFDTOTAL-SHZJ202002003.htm [16] 徐佳慧, 胡世莲. 慢性心力衰竭的流行病学与预防措施[J]. 中国临床保健杂志, 2021, 24(6): 721-725. https://www.cnki.com.cn/Article/CJFDTOTAL-LZBJ202106001.htmXU J H, HU S L. The epidemiology and prevention of chronic heart failure[J]. Chinese Journal of Clinical Healthcare, 2021, 24(6): 721-725. https://www.cnki.com.cn/Article/CJFDTOTAL-LZBJ202106001.htm [17] MA T, SU Y, SONG J, et al. Treatment of heart failurewith mid-range ejection fraction: a summary of current evidence[J]. Front Cardiovasc Med, 2021, 8: 653336. DOI: 10.3389/fcvm.2021.653336. [18] 迪拉热·太外库力, 芦颜美. 慢性心力衰竭患者心脏再同步化治疗左心室最佳起搏位点的选择机制与植入方案进展[J]. 中华心力衰竭和心肌病杂志, 2021, 5(2): 152-156.Dilare·Taiwaikuli, LU Y M. Selection of optimal left ventricular sites for cardiac resynchronization therapy in patients with chronic heart failure--mechanism and implantation progress[J]. Chinese Journal of Heart Failure and Cardiomyopathy, 2021, 5(2): 152-156. [19] 符慧玉, 陈求珠, 黄泽窈, 等. 耳穴贴压联合电针对疝气患儿术后疼痛及炎性细胞因子的影响[J]. 中国针灸, 2019, 39(6): 583-587, 603. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZE201906004.htmFU H Y, CHEN Q Z, HUANG Z Y, et al. Effect of auricular point pressing combined with electroacupuncture on postoperative pain and inflammatory cytokines in children with hernia[J]. Chinese Acupuncture & Moxibustion, 2019, 39(6): 583-587, 603. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZE201906004.htm [20] 龙竞伟, 李平. 肌钙蛋白T和CRP与NT-proBNP联合检测在慢性心力衰竭早期诊断的价值[J]. 中华全科医学, 2020, 18(3): 435-437. doi: 10.16766/j.cnki.issn.1674-4152.001266LONG J W, LI P. Value study of combined detection of cTnT, CRP and NT-proBNP in early diagnosis of chronic heart failure[J]. Chinese Journal of General Practice, 2020, 18(3): 435-437. doi: 10.16766/j.cnki.issn.1674-4152.001266 [21] HANNA A, FRANGOGIANNIS N G. Inflammatory cytokines and chemokines as therapeutic targets in heart failure[J]. Cardiovasc Drugs Ther, 2020, 34(6): 849-863. [22] 孙景巍, 彭万胜, 黄玉柱, 等. 小儿肺炎支原体肺炎合并全身炎症反应综合征时超敏CRP、PCT、WBC变化及临床意义研究[J]. 中华全科医学, 2019, 17(2): 245-247, 255. doi: 10.16766/j.cnki.issn.1674-4152.000651SUN J W, PENG W S, HUANG Y Z, et al. Changes and clinical significance of hypersensitive CRP, PCT and WBC in children with mycoplasma pneumoniae pneumonia complicated with systemic inflammatory response syndrome[J]. Chinese Journal of General Practice, 2019, 17(2): 245-247, 255. doi: 10.16766/j.cnki.issn.1674-4152.000651 [23] 张洪磊, 郝伟, 张婷. 养心益阳汤对慢性心力衰竭患者IL-6、IL-18、hs-CRP水平的影响[J]. 西部中医药, 2020, 33(8): 86-88. https://www.cnki.com.cn/Article/CJFDTOTAL-GSZY202008022.htmZHANG H L, HAO W, ZHANG T. Influence of Heart-nourishing Yang-invigorating Decoction on the Levels of IL-6, IL-18 and hs-CRP in CHF Patients[J]. Western Journal of Traditional Chinese Medicine, 2020, 33(8): 86-88. https://www.cnki.com.cn/Article/CJFDTOTAL-GSZY202008022.htm [24] 路轶晴, 段雯婷. 血清IL-1、IL-6、CA125、BNP及hs-CRP水平用于评估慢性心力衰竭的临床价值[J]. 贵州医科大学学报, 2021, 46(1): 115-119. https://www.cnki.com.cn/Article/CJFDTOTAL-GYYB202101021.htmLU Y Q, DUAN W T. Clinical values of serum levels of IL-1, IL-6, CA125, BNP, and hsCRP in evaluating chronic heart failure[J]. Journal of Guizhou Medical University, 2021, 46(1): 115-119. https://www.cnki.com.cn/Article/CJFDTOTAL-GYYB202101021.htm
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