温阳活血解毒汤对男性阳气亏虚血瘀型慢性心力衰竭患者睾酮及心率变异性的影响

目的:观察温阳活血解毒汤对男性阳气亏虚血瘀型慢性心力衰竭患者睾酮及心率变异性(heart rate variability,HRV)的临床疗效,探讨温阳活血解毒汤对男性阳气亏虚血瘀型慢性心力衰竭患者睾酮及HRV的作用机制。方法:将110例男性慢性心力衰竭门诊或住院患者随机数字表分治疗组及对照组,各55例。对照组为规范化西药基础治疗加用参附汤,治疗组在西药基础治疗的基础上加用温阳活血解毒汤,两组疗程均为28 d。疗程结束后观察两组患者临床疗效,中医证候积分,6 min步行距离,明尼苏达生活质量评分,睾酮,左心室射血分数(LVEF),HRV等变化规律,同时记录治疗期间不良反应。结果:治疗组临床疗效总有效率(90.91%),优于对照组(84.45%)(P0.05),两组治疗后6 min步行距离,睾酮,LVEF,HRV较本组治疗前明显提高,明尼苏达生活质量评分,中医证候积分,N端前BNP(NT-pro BNP)明显下降,治疗后治疗组上述指标明显优于对照组(P0.05)。结论:男性阳气亏虚血瘀型慢性心力衰竭患者治疗前睾酮与HRV水平较低,温阳活血解毒汤使男性慢性心力衰竭患者阳气亏虚的程度得到纠正,心功能得到改善,生活质量提高,其作用机制可能与其抑制交感神经活性,提高血清睾酮水平、改善HRV有关,中药具有类激素样作用,具有整体治疗、多靶点干预等独特优势,可能正是中医药调节神经内分泌的特点和意义所在,值得进一步深入研究。

Effect of Wenyang Huoxue Jiedu Decoction on Testosterone and Heart Rate Variability in Male Patients with Chronic Heart Failure

Objective: To observe the clinical efficacy of Wenyang Huoxue Jiedu decoction on testosterone and heart rate variability (HRV) in male patients with chronic heart failure (CHD), in order to explore the mechanism of Wenyang Huoxue Jiedu decoction on testosterone and HRV in male patients of chronic heart failure with Yang deficiency. Method: A total of 110 outpatients or inpatients with chronic heart failure by the random number method were divided into treatment group and control group. The control group received standardized western medicine combined with Shenfu decoction, while the treatment group was also given Wenyang Huoxue Jiedu decoction in addition to basic therapy of western medicine. The course of treatment was 28 days. At the end of the course of treatment, the clinical efficacy of the two groups was observed, and the 6-minute walking distance, the Minnesota quality of life score, the testosterone, the left ventricular ejection fraction (LVEF), the HRV and the adverse reactions were recorded. Result: The total effective rate of treatment group (90.91%) was better than that of the control group (84.45%, P<0.05). After treatment, the walking distance, testosterone, LVEF and HRV were significantly higher than those before treatment, whereas the Minnesota quality of life score, NT-proBNP were significantly decreased (P<0.05). Conclusion: The levels of testosterone and HRV in patients with chronic heart failure (CHD) were significantly lower than those in the control group. Wenyang Huoxue Jiedu decoction relieved the degree of Yang deficiency, improved the heart function and the quality of life of male patients with chronic heart failure. Its mechanism may be related to the inhibition of sympathetic activity and the improvement of serum testosterone level and HRV. Traditional Chinese medicine(TCM) has a hormone-like effect and the advantages of overall treatment and multi-target intervention, which reflects the features and significance of TCM in regulating endocrine, and is worth further study.