益气强心汤对慢性心衰患者心肌能量消耗的影响

目的:探讨加服益气强心汤治疗慢性心力衰竭(CHF)的疗效及对心肌能量消耗(MEE)和心型脂肪酸结合蛋白(H-FABP)的影响。方法:80例CHF患者采用随机按数字表法分为西药组和观察组各40例。西药组采用盐酸贝那普利片,10 mg/次,1次/d;美托洛尔片,50 mg/次,1次/d;螺内酯片,20 mg/次,1次/d;地高辛,0.125 mg/次,1次/d。观察组在西药组治疗的基础上加服益气强心汤,1剂/d。两组疗程均为4个月。进行治疗前后纽约心脏病协会(NYHA)心功能分级、6 min步行实验(6 MWT)及Lee氏心衰积分评价记录,采用超声心动图测定左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、左室射血分数(LVEF),并计算MEE;进行治疗前后血浆N-末端脑钠肽前体(NT-proBNP)和心型脂肪酸结合蛋白(H-FABP)水平检测。结果:采用有序资料卡方检验进行分析,观察组NYHA心功能分级均明显优于西药组(P<0.05);治疗后两组Lee氏心衰积分比治疗前明显降低,6 MWT步行比治疗前有明显增加;治疗后观察组Lee氏心衰积分明显低于西药组,6 MWT步行与西药组比较有显著性差异(P<0.01);治疗后两组LVEDV,LVESV和MEE均比治疗前明显下降,LVEF比治疗前有所改善(P<0.01);治疗后观察组LVEDV,LVESV和MEE各项心功能指标均比西药组有所改善,LVEF与西药组比较有显著性差异(P<0.01);治疗后观察组NT-proBNP和H-FABP水平明显低于西药组(P<0.01)。结论:加服益气强心汤能调节CHF患者心肌能量代谢,阻断或逆转心肌重塑,从而减轻临床症状,改善患者心功能。

Influence of Yiqi Qiangxin Decoction on Myocardial Energy Expenditure in Patients with Chronic Heart Failure

Objective: To discuss the curative efficacy of Yiqi Qiangxin decoction and influence on myocardial energy expenditure (MEE) and heart type fatty acid binding protein (H-FABP) in treating patients with chronic heart failure (CHF). Method: Eighty patients with CHF were randomly divided into western medicine group (40 cases) and observation group (40 cases) by random number table. Patients in western medicine group received 10 mg benazepril hydrochloride, 50 mg metoprolol tablets, 20 mg spironolactone tablets and 0.125 mg digoxin once daily. Based on the treatment of western medicine group, patients in observation group added 1 dose Yiqi Qiangxin decoction once daily. The patients in both groups received two 4 month periods of treatment. The New York Heart Association(NYHA) cardiac function class, 6 minute walk test (6 MWT) and Lee's heart failure were observed. The left ventricular end-diastolic volume(LVEDV), left ventricular end-systolic volume(LVESV) and left ventricular ejection fraction (LVEF) were detected using echocardiogram, and the MEE was calculated. Levels of serous N-terminal pro-brain natriuretic peptide (NT-proBNP) and heart type fatty acid binding protein (H-FABP) were detected before and after treatment. Data was analyzed by chi-square test of ordered data. Result: The score of NYHA cardiac function class in observation group was superior to that in western medicine group (P<0.05). After treatment, the score of Lee's heart failure in observation group was lower than that in western medicine group, and score of 6 MWT was obviously higher than that in western medicine group (P<0.01). The LVEDV, LVESV and MEE in observation group were obviously lower than those in western medicine group, while LVEF was significantly higher than that in western medicine group (P<0.01). Levels of NT-proBNP and H-FABP in observation group were lower than those in western medicine group (P<0.01). Conclusion: Yiqi Qiangxin decoction could alleviate the clinical symptoms and ameliorate cardiac function in patients with CHF, which may be chieved by regulating their MEE, blocking or reversing the myocardial remodeling.