养心汤加减辨治对肺心病缓解期心肺气虚证疾病的进展

目的:探讨养心汤加减辨治对缓解期肺心病(CPHD)心肺气虚证患者的控制效果及对免疫功能和炎症因子的影响。方法:128例患者按随机数字表法分为对照组和观察组各64例。对照组采用西医综合康复治疗,气流受限采用沙美特罗替卡松粉吸入剂,每次1吸,1~2次/d;咳嗽痰多口服盐酸氨溴索片,1~2片/次,3次/d,连用1~2周。观察组在对照组治疗的基础上,给予养心汤加减辨治内服,1剂/d,5 d/周。记录48周的观察期间的急性加重次数、感冒次数;记录治疗前后肺动脉收缩压(PASP),肺动脉平均压(MPAP),左室射血分数(LVEF),每搏输出量(SV)和心输出量(CO);进行治疗前后改良版英国医学研究委员会呼吸问卷(mMRC问卷)评分、明尼苏达心力衰竭生活质量量表(MLHFQ)评分、心肺气虚证评分和6 min步行试验(6 MWT);检测治疗前后N末端B型利钠肽原(NT-proBNP),肿瘤坏死因子-α(TNF-α),白细胞介素-6(IL-6),一氧化氮(NO)和内皮素-1(ET-1)和T淋巴细胞亚群(CD3^+,CD4^+,CD8^+,CD4^+/CD8^+)水平。结果:观察组临床疗效优于对照组(Z=2.108,P<0.05);在48周期间观察期间,观察组急性加重次数、感冒次数均少于对照组(P<0.01);观察组患者PASP,MPAP水平均低于对照组(P<0.01);观察组NT-proBNP水平低于对照组(P<0.01),LVEF,SV,CO均高于对照组(P<0.01);观察组患者mMRC问卷,MLHFQ,心肺气虚证评分均低于对照组(P<0.01),治疗后观察组6 MWT多于对照组(P<0.01);观察组CD3^+,CD4^+水平和CD4^+/CD8^+均高于对照组(P<0.05),CD8^+水平低于对照组(P<0.05);治疗后观察组TNF-α,IL-6,ET-1均低于对照组(P<0.01),NO高于对照组(P<0.01)。结论:在抗炎、平喘、止咳等综合康复治疗的基础上,采用养心汤加减辨证内服治疗缓解期CPHD心肺气虚证患者,可提高免疫功能,可减轻心、肺症状,提高心肺功能和生活质量,还能抑制炎症反应,改善血管内皮功能,降低肺动脉高压,改善了病情的进展,临床疗效优于单纯西医康复治疗。

Effect of Modified Yangxintang on Chronic Pulmonary Heart Disease with Syndrome of Deficiency of Heart and Lung Qi

Objective:To discuss the effect of modified Yangxintang on chronic pulmonary heart disease(CPHD)with syndrome of deficiency of heart and lung Qi and progress of disease.Method:One hundred and twenty-eight patients were randomly divided into control group 64 cases and observation group 64 cases by random number table.Patients in control group got comprehensive rehabilitation measures of western medicine.Those who had respiratory distress got Salmeterol ticasone powder inhaler,1-2 times/day,1 inhale/time.And those who had cough and phlegm got Ambroxol hydrochloride tablets for 1-2 week,1-2 tablet/time,3 times/day.In addition to the therapy of control group,patients in observation group was also added with modified Yangxintang,1 dose/day,5 days/week.Record the and times of acute aggravate and cold,pulmonary artery systolic pressure(PASP),mean pulmonary artery pressure(MPAP),left ventricular ejection fraction(LVEF),stroke volume(SV)and cardiac output(CO)were recorded during 48 weeks.Before and after treatment,scores of modified British medical research council respiratory questionnaire(mMRC questionnaire),Minnesota Heart Failure Quality of life scale(MLHFQ),syndrome of deficiency of heart and lung Qi and 6-minute walking test(6 MWT)were scored.And levels of N-terminal B-type natriuretic peptide(NT-proBNP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),nitric oxide(NO),endothelin(ET-1),CD3^+,CD4^+,CD8^+and CD4^+/CD8^+were detected.Result:The clinical efficacy in observation group was better than that in control group(Z=2.108,P<0.05).During 48 weeks of observation period,times of acute aggravate and cold in observation group were less than those in control group(P<0.01).Levels of PASP,MPAP and NT-proBNP were lower than those in control group(P<0.01).And levels of LVEF,SV,CO,6 MWT and NO were higher than those in control group(P<0.01),levels of CD3^+,CD4^+and CD4^+/CD8^+were higher than those in control group(P<0.05).And levels of mMRC,MLHFQ,score of syndrome of deficiency of heart and lung Qi,TNF-α,IL-6,ET-1,CD8^+and were all lower than those in control group(P<0.01,P<0.05).Conclusion:In addition to anti-inflammatory,anti-asthmatic and anti-tussive therapies,modified Yangxintang can improve the immune function,relieve the symptoms of heart and lung,improve the function of heart and lung and the quality of life,inhibit the inflammatory reaction,improve the function of vascular endothelium,reduce the pulmonary hypertension,control the progress of disease.