摘要
目的探讨参芪血府逐瘀汤加减治疗急性心肌梗死(AMI)的疗效及其部分作用机制。方法将150例AMI患者随机均分为对照组与观察组,各75例。对照组采取西医规范化治疗,观察组在对照组治疗的基础上采用参芪血府逐瘀汤加减治疗。比较2组的临床疗效,治疗前后测定心脏超声指标[左室射血分数(LVEF)、左室舒张末期内径(LVEDD)与左室收缩末期内径(LVESD)]、心功能指标[磷酸肌酸激酶-同功酶(CK-MB)、肌钙蛋白Ⅰ(cTnⅠ)、胱抑素C(CysC)和氨基末端B型利钠肽原(NT-proBNP)]、心肌纤维化指标[半乳凝素-3(Gal-3)、转化生长因子β_(1)(TGF-β_(1))、Ⅰ型前胶原羟基末端肽(PⅠCP)、Ⅲ型前胶原氨基末端肽(PⅢNP)、结缔组织生长因子(CTGF)]、炎症因子[超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)]和血管内皮因子[一氧化氮(NO)、内皮素-1(ET-1)],随访6个月统计短期心血管不良事件(ACE)的发生情况。结果治疗后,观察组总有效率明显高于对照组,观察组的LVEF高于对照组,LVEDD和LVESD低于对照组,且血清CK-MB、cTnⅠ、CysC和NT-proBNP均低于对照组(P<0.05)。治疗1、4周后,观察组的血清Gal-3、TGF-β_(1)、PⅠCP、PⅢNP、CTGF、hs-CRP、TNF-α、IL-6和ET-1水平均低于对照组,NO水平高于对照组(P<0.05)。随访6个月,观察组的ACE发生率为5.33%,低于对照组的22.67%;观察组的再入院率为1.33%,低于对照组的14.67%(P<0.05)。结论参芪血府逐瘀汤加减治疗AMI疗效确切,可改善心功能并抑制心肌纤维化进程,其机制可能与抗炎症损伤及保护血管内皮功能有关。
Objective To investigate the effect of Shenqi Xuefu Zhuyu Decoction in the treatment of patients with acute myocardial infarction(AMI)and its mechanism.Methods 150 patients with AMI were randomly divided into control group and observation group with 75 cases in each group.The control group received standardized Western medicine treatment,and the observation group received Shenqi Xuefu Zhuyu Decoction addition and subtraction treatment on this basis.The clinical efficacy of the 2 groups was compared.Cardiac ultrasound indexes[left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD)and left ventricular end-systolic diameter(LVESD)],cardiac function markers[creatine kinase-myocardial isoenzyme(CK-MB),troponinⅠ(cTnⅠ),cystatin C(CysC)and amino-terminal pro-B-type natriuretic peptide(NT-proBNP)],myocardial fibrosis indicators[galectin-3(Gal-3),transforming growth factorβ_(1)(TGF-β_(1)),procollagenⅠC-terminal peptide(PⅠCP),typeⅢprocollagen amino terminal peptide(PⅢNP),connective tissue growth factor(CTGF)],inflammation factors[high-sensitivity C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)]and vascular endothelial factor[nitric oxide(NO),endothelin-1(ET-1)]were detected before and after treatment.Followed up for 6 months,the occurrence of short-term adverse cardiovascular events(ACE)was counted.Results After treatment,the total effective rate of the observation group was higher than that of the control group(P<0.05).The LVEF of the observation group was higher than that of the control group,the LVEDD and LVESD were lower than the control group,and serum levels of CK-MB,cTnⅠ,CysC,NT-proBNP were lower than the control group(P<0.05).After 1 and 4 weeks of treatment,the serum levels of Gal-3,TGF-β_(1),PⅠCP,PⅢNP,CTGF,hs-CRP,TNF-α,IL-6 and ET-1 in the observation group were lower than those in the control group,and the NO level was higher than the control group(P<0.05).After 6 months of follow-up,the incidence of ACE in the observation group
作者
王兴荣
王飞寒
陆伟兰
宋广军
WANG Xingrong;WANG Feihan;LU Weilan;SONG Guangjun(Department of Cardiology,Shanghai Jinshan District Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai 201501,China;Department of Internal Medicine,Guangdong Dongguan People′s Hospital,Dongguan 523000,China;Department of Respiratory Medicine,Shanghai Jinshan District Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai 201501,China;Department of Traditional Chinese Medicine,Shanghai Jinshan District Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai 201501,China)
出处
《西北药学杂志》
CAS
2021年第3期479-484,共6页
Northwest Pharmaceutical Journal
基金
上海市金山区中西医结合医院课题(编号:2019-4/2018-5)。
关键词
参芪血府逐瘀汤
急性心肌梗死
心血管不良事件
心肌纤维化
Shenqi Xuefu Zhuyu Decoction
acute myocardial infarction
adverse cardiovascular events
myocardial fibrosis
