目的 观察参元益气活血汤治疗冠心病心力衰竭的临床疗效及对凝血酶、血浆转化生子因子β1（transforming growth factor-β1，TGF-β1）、N末端脑钠肽前体（N-terminal brain natriuretic propeptide，NT-proBNP）和血清Ⅰ型胶原（collagen Ⅰ，Col-Ⅰ）、Ⅲ型胶原（collagen Ⅲ，Col-Ⅲ）水平的影响。方法 将84例冠心病心力衰竭患者随机分为治疗组和对照组，每组42例。对照组给予常规西药治疗，治疗组在常规西药治疗基础上予参元益气活血汤煎剂，两组疗程均为4周。观察两组治疗前后中医症状及证候积分变化，评价临床疗效，测定血浆凝血酶、TGF-β1、NT-proBNP，血清Col-Ⅰ、Col-Ⅲ水平，采用超声心动图检测左心室舒张末内径（left ventricular end-diastolic diameter，LVEDD）、左心室收缩末内径（left ventricular end-systolic diameter，LVESD）和左心室射血分数（left ventricular ejection fraction， LVEF）。结果 与对照组比较，治疗组治疗后中医症状及证候积分均明显改善（P<0.05），治疗组临床疗效优于对照组（P<0.05）；治疗组治疗后血浆凝血酶、TGF-β1，血清Col-Ⅰ和Col-Ⅲ水平均较对照组明显降低（P<0.05），LVEDD、LVESD、NT-proBNP均明显降低（P<0.05），LVEF明显升高（P<0.05）。结论 参元益气活血方能够改善冠心病心力衰竭患者中医症状及证候，提高心功能，降低凝血酶及心肌纤维化水平。
Objective To investigate the clinical effect of Shenyuan Yiqi Huoxue Decoction in the treatment of heart failure caused by coronary heart disease and its influence on the levels of thrombin, transforming growth factor-β1 (TGF-β1), N-terminal pro-brain natriuretic peptide (NT-proBNP), type Ⅰ collagen (Col-Ⅰ), and type Ⅲ collagen (Col-Ⅲ). Methods A total of 84 patients with heart failure caused by coronary heart disease were randomly divided into treatment group and control group, with 42 patients in each group. The patients in the control group were given routine Western medicine treatment, and those in the treatment group were given Shenyuan Yiqi Huoxue Decoction in addition to the routine Western medicine treatment in the control group; the course of treatment was 4 weeks for both groups. The changes in traditional Chinese medicine (TCM) symptoms and syndrome score after treatment were observed to evaluate clinical outcome; the plasma levels of thrombin, TGF-β1, and NT-proBNP and the serum levels of Col-Ⅰ and Col-Ⅲ were measured; echocardiography was performed to measure left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), and left ventricular ejection fraction (LVEF). Results Compared with the control group, the treatment group had significant improvements in TCM symptoms and syndrome score after treatment (P<0.05). Compared with the control group after treatment, the treatment group had significant reductions in the plasma levels of thrombin and TGF-β1 and the serum levels of Col-Ⅰ and Col-Ⅲ (P<0.05), as well as significant reductions in LVEDD, LVESD, and NT-proBNP (P<0.05) and a significant increase in LVEF (P<0.05). Conclusion For patients with heart failure caused by coronary heart disease, Shenyuan Yiqi Huoxue Decoction can improve TCM symptoms, TCM syndrome, and cardiac function and reduce the level of thrombin and the degree of myocardial fibrosis.
褚福永,刘 巍,尚菊菊,谢 皛,李宏艳,刘红旭.参元益气活血汤治疗冠心病心力衰竭患者临床疗效及对凝血酶、TGF-β1、Col-Ⅰ、Col-Ⅲ水平的影响[J].安徽中医药大学学报,2020,39(3):18-22复制