金匮肾气丸联合沙库巴曲缬沙坦对慢性心力衰竭患者的影响

张晨曦; 梁雪梅; 张秀芹; 李霞; 陈春亮; 李运田

doi:10.12125/j.chj.202212073

金匮肾气丸联合沙库巴曲缬沙坦对慢性心力衰竭患者的影响

Effect of Jinkui Shenqi Pill and sacubitril-valsartan on TCM syndrome, mean ventricular wall stress and serum myostatin level in patients with chronic heart failure

摘要

摘要:
目的探究金匮肾气丸联合沙库巴曲缬沙坦对慢性心力衰竭（CHF）患者中医证候（TCMSI）、平均室壁应力（MWS）及血清肌肉生长抑制素（MSTN）水平的影响。
方法选取解放军第305医院于2021年3月～2022年4月收治的100例慢性心力衰竭患者为研究对象，随机分为对照组（n=50）和观察组（n=50），其中对照组给予沙库巴曲缬沙坦治疗，观察组给予金匮肾气丸联合沙库巴曲缬沙坦治疗。比较两组中医证候（TCMSI）积分、平均室壁应力（MWS）及血清MSTN水平。
结果观察组总有效率显著高于对照组（P<0.05）；与治疗前比较，治疗后两组TCMSI积分显著降低，且观察组显著低于对照组（均P<0.01）；治疗后两组每搏心血输出量（SV）、左室射血分数（LVEF）与6 min步行试验（6 min walking test，6MWT）数值显著增大，且观察组显著大于对照组（均P<0.01）；与治疗前比较，治疗后两组平均室壁应力（MWS）显著降低、左心室收缩末期直径（LVESD）显著降低、左心室舒张末期直径（LVEDD）显著升高、左心室舒张末期容积（LVEDV）显著升高，左心室收缩末期容积（LVESV）显著降低，且观察组与对照组差异显著（均P<0.01）；与治疗前比较，治疗后两组窦性心搏间期标准差（SDNN）、正常相邻窦性心搏间期差的均方根（RMSDD）、相邻窦性心搏间期差>50 ms心搏数百分比（PNN50）及高频率赫兹（HF）均显著升高，且观察组显著高于对照组（均P<0.01）；与治疗前比较，治疗后两组血清MSTN水平显著降低，且观察组显著低于于对照组（均P<0.01）。
结论金匮肾气丸联合沙库巴曲缬沙坦治疗CHF可有效改善患者的临床症状，降低TCMSI积分、MWS、血清MSTN水平，改善心功能，效果显著。

Abstract:
AIM To investigate the influences of Jinkui Shenqi Pill combined with sacubitril-valsartan on TCM syndrome integral (TCMSI), mean ventricular wall stress (MWS) and serum myostatin (MSTN) levels in patients with chronic heart failure (CHF).
METHODS A total of 100 CHF patients admitted in our hospital from March 2021 to April 2022 were selected as the research subjects and they were randomly grouped into the control group (50 cases) and the observation group (50 cases). The control group was treated with sacubitril-valsartan and theobservation group was treated with Jinkui Shenqi Pill and sacubitril-valsartan. TCMSI score, MWS and serum MSTN level were compared between the two groups.
RESULTS The total effective rate of the observation group was significantly higher than that of the control group (P<0.05); Compared with before treatment, the TCMSI scores of the two groups significantly decreased after treatment, and the observation group was significantly lower than the control group (both P<0.01); After treatment, the stroke volume (SV), left ventricular ejection fraction (LVEF), and 6-minute walking test (6MWT) distance values (LVEF and 6MWT) of the two groups significantly increased, and the observation group was significantly higher than the control group (all P<0.01); Compared with before treatment, the average wall stress (MWS) and left ventricular end systolic diameter (LVESD) were decreased, left ventricular end diastolic diameter (LVEDD) and left ventricular end diastolic volume (LVEDV) were increased, and left ventricular end systolic volume (LVESV) was significantly decreased in both groups after treatment, and the difference between observation group and control group was significant (all P<0.01); Compared with before treatment, after treatment, the standard deviation between sinus beats (SDNN), root mean square (RMSDD) of normal adjacent sinus beat interval difference, percentage of adjacent sinus beat interval difference>50 ms (PNN50), and high-frequency Hertz (HF) were significantly increased in both groups, and the observation group was significantly higher than the control group (all P<0.01); Compared with before treatment, the serum MSTN levels in the two groups significantly decreased after treatment, and the observation group was significantly lower than the control group (both P<0.01).
CONCLUSION Jinkui Shenqi Pill combined with sacubitril-valsartan effectively improve the clinical symptoms of CHF patients, reduce their TCMSI scores, MWS and serum MSTN levels and improve cardiac functions and the effect is remarkable.

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