芪参益气滴丸对心肌梗死后气虚血瘀证患者 心室重构及心功能的影响

目的:观察芪参益气滴丸对心肌梗死后气虚血瘀证患者心室结构及心功能的影响。方法:选取符合标准的患者,按随机数字表法分为对照组和治疗组。其中对照组接受常规治疗。治疗组在常规治疗的基础上加用芪参益气滴丸。2组均以1年作为观察期。研究期间观察2组患者用药前后中医症状积分的变化,比较中医症状积分疗效;观察2组患者用药前后超声心动图的心脏结构及功能检测变化情况;ELISA法检测2组患者治疗前后血浆N末端前体脑钠肽(NT-proBNP)水平;并观察药物的安全性、不良反应。结果:2组患者治疗后中医症状积分均较治疗前降低,治疗组治疗后中医症状积分总有效率优于对照组。对照组和治疗组左心室收缩末期内径(LVDs)、左心室舒张末期内径(LVDd)均有改善,治疗组左心室舒张末期容积(LVEDV)较治疗前降低,与对照组比较有较显著差异,提示反映心室肥厚程度的心室内径有减小的趋势,心室容积有较显著减小;治疗组治疗后每搏量(SV)、有效心输出量(CO)、心脏指数(CI)、左心室射血(LVEF)分数明显增加提示心脏的收缩功能改善,心排血量增加。与对照组疗效比较有显著性差异。治疗组NT-proBNP的水平治疗后与对照组相比也明显下降,与超声心动图提示心室肥厚的程度减轻一致,且更敏感。结论:芪参益气滴丸对心肌梗死后气虚血瘀证患者心室重构及心功能具有一定的改善作用。

Effect of Qishenyiqi Pills on Ventricular Remodeling and Cardiac Function of Patient with Qi Deficiency and Blood Stasis Syndrome after Myocardial Infarction

Objective: To investigate the effect of Qishenyiqi pills on ventricular structure and cardiac functions of patients with blood-stasis syndrome after myocardial infarction (MI). Method: Seventy-eight cases meeting the diagnostic criteria for MI and matched criteria were chosen and divided randomly into two groups: a treatment group and a control group. Animals in the control group were treated with routine medicine and those in the treatment group were treated additionally by Qishenyiqi pills. Effects in both groups were observed for 1 year. Changes of scores for evaluating symptoms by traditional Chinese medicine (TCM) and changes of heart structure and its functions shown by echocardiography were observed before and after the treatment in both groups. Plasma levels of N-terminal pro-brain natriuretic peptide in the two groups were measured by ELISA before and after the treatment, and adverse reactions were also observed. Result: Symptom scores of the two groups decreased after treatment and the scores in the treatment group were significantly lowered than those in the control group (P<0.05). After treatment, the total effective rate of symptom scores evaluated by TCM was 89.5% in the treatment group, and that in the control group was 75%, showing the efficiency in the treatment group was superior to that in the control group. The left ventricular internal diameter at end-systole (VESD) in the treatment group and control group were both improved, indicating the internal diameter and the volume of ventricle reflecting the thickness of the ventricle structure decreased. After the treatment, the left ventricle end-diastolic volume was significantly lowered in the treatment group, compared with that in the control group (P<0.05), suggesting the volume of ventricle reflecting the thickness of the ventricle significantly decreased. The stroke volume, effective cardiac output, cardiac index and left ventricular ejection fraction in the treatment group were significantly developed after the treatment, indicating obvious improvement of cardiac contraction function and increase in cardiac output with a significant difference, compared with those in the control group (P<0.05). After the treatment, the level of plasma brain natriuretic peptide(NT-proBNP), the marker of left ventricular thickness in the treatment group was significantly lowered than that in the control group, which was in accord with the decreasing trend shown by ultrasonic cardiograph, and the marker was more sensitive. Conclusion: Qishenyiqi pills can improve ventricular remodeling and cardiac functions of patients with Qi deficiency and blood stasis syndrome after MI.