金匮肾气丸合桃红四物汤联合西药治疗慢性心力衰竭疗效及对患者心率变异性、左室重构和肾功能的影响

目的:探究金匮肾气丸合桃红四物汤加减联合西医用药血管紧张素受体脑啡肽酶抑制剂(ARNI)治疗慢性心力衰竭(CHF)的疗效及对心率变异性、左室重构和肾功能的影响。方法:72例气虚血瘀、阳虚水泛型CHF患者纳入研究,计算机随机数列生成分组法将其分为两组。对照组在一般治疗基础上服用沙库巴曲缬沙坦; 研究组在对照组基础上服用金匮肾气丸合桃红四物汤加减。评估两组治疗12周后的临床效果,观察两组中医证候积分(TCMSI)和心功能、心率变异性、左室重构、血清学、肾功能指标变化情况。结果:与对照组治疗后比较,研究组总体临床疗效更优(P<0.05); TCMSI明显下降,心功能指标左室射血分数(LVEF)、每搏心血输出量(SV)、6 min步行试验(6MWT)明显增大(P<0.05); 心率变异性指标正常窦性心搏间期标准差(SDNN)、正常相邻窦性心搏间期差值的均方根(RMSSD)、相邻窦性心搏间期差值>50 ms心搏数百分比(PNN50)、高频功率(HF)明显增大(P<0.05); 左室重构指标左室舒张末期内径(LVEDD)、平均室壁应力(MWS)、左房容积指数(LAVI)、左心室质量指数(LVMI)明显缩小,左心室短轴缩短率(PS)明显增大(P<0.05); 血清辅助性T 细胞17(Th₁₇)、血清白细胞介素-17(IL-17)、B型脑钠肽(BNP)、基质金属蛋白酶-9(MMP-9)、胱抑素C(Cys-C)水平明显下降,肾小球滤过率(eGFR)明显增大(P<0.05)。结论:金匮肾气丸合桃红四物汤加减联合ARNI治疗CHF疗效确切,能有效改善患者中医证候,增加心率变异性,促进其心脏结构、功能恢复,抑制机体免疫炎症反应,改善其心肾功能。

Efficacy of Jingui Shenqi pill and Taohong Siwu decoction combined with western medicine on heart rate variability,left ventricular remodeling and renal function in patients with chronic heart failure

Objective:To explore the effects of Jingui Shenqi pills and Taohong Siwu decoction combined with angiotensin receptor enkephalinase inhibitor(ARNI)in the treatment of chronic heart failure(CHF)and on heart rate variability,left ventricular remodeling and renal function influence.Methods:72 patients with general CHF with Qi deficiency,blood stasis and Yang deficiency and water were enrolled in the study,and were divided into two groups by computer random number sequence generation.The control group was treated by sacubitril and valsartan on the basis of general treatment; the study group was treated by Jingui Shenqi pill and Taohong Siwu decoction on the basis of the control group.The clinical effects were evaluated in the two groups after 12 weeks of treatment,and the changes in the scores of TCM syndromes,heart function,heart rate variability,left ventricular remodeling,serology,and renal function indicators were observed in the two groups.Results:Compared with the control group,the overall clinical curative effect of the study group was better(P<0.05); TCMSI was significantly reduced,and the left ventricular ejection fraction(LVEF),cardiac output per stroke(SV),6-min walk test(6MWT)significantly increased(P<0.05); the standard deviation of heart rate variability index of normal sinus beat interval(SDNN),the root mean square of the difference between normal adjacent sinus beats(RMSSD),the difference between adjacent sinus beats >50 ms heart rate percentage(PNN50),high frequency power(HF)increased significantly(P<0.05); left ventricular remodeling indicators left ventricular end diastolic diameter(LVEDD),mean wall stress(MWS),left atrial volume index(LAVI),left ventricular mass index(LVMI)were significantly reduced,and the left ventricular short axis shortening rate(PS)was significantly reduced increase(P<0.05).The level of helper T cell 17(Th₁₇),interleukin-17(IL-17),B-type brain natriuretic peptide(BNP),matrix metalloproteinase-9(MMP-9),cystatin C(Cys-C)decreased,and the glomerular filtration rate(eGFR)increased significantly(P<0.05).Conclusion:Jingui Shenqi pills and Taohong Siwu decoction combined with ARNI have a definite effect in the treatment of CHF,which can effectively improve the TCM syndromes of patients,increase heart rate variability,promote the recovery of cardiac structure and function,inhibit the body's immune inflammation,and improve their heart and kidney functions.