摘要
目的 探讨复脉益心方辅助治疗风湿性心脏瓣膜病患者的疗效及对其心功能、血清基质金属蛋白酶-9(Matrix metalloprotein-9,MMP-9)水平、N 末端前体脑利钠肽(N-terminal precursor brain natriuretic pep-tide,NT-pro BNP)水平的影响.方法 选取2021年2月-2022年2月期间湖南中医药大学第一附属医院收治的风湿性心脏瓣膜病患者88例作为研究对象.采用随机数字表法将患者分为对照组和观察组,每组各44例.两组患者均接受二尖瓣置换术治疗,术后根据病情给予西医常规治疗,观察组术后在常规西医治疗基础上联合复脉益心方治疗.治疗4周后,观察比较两组患者临床疗效、安全性,治疗前后中医证候积分,MMP-9、NT-pro BNP水平、心功能指标(每分钟心输出量、每搏输出量、心脏指数、左心室射血分数)、生活质量评分(社会限制、体力限制、症状、情绪)变化情况.结果 治疗后两组患者心悸、疲乏、气短、盗汗或自汗、心烦、失眠多梦评分均较治疗前降低,差异有统计学意义(P＜0.05);且观察组心悸、疲乏、气短、盗汗或自汗、心烦、失眠多梦评分均明显低于对照组,差异有统计学意义(P＜0.05).治疗后两组患者血清MMP-9和NT-pro BNP水平均较治疗前明显降低,差异有统计学意义(P＜0.05);且观察组血清MMP-9和NT-pro BNP水平均明显低于对照组,差异有统计学意义(P＜0.05).治疗后两组患者每分钟心输出量、每搏输出量、心脏指数及左心室射血分数指标均较治疗前明显升高,差异有统计学意义(P＜0.05);且观察组每分钟心输出量、每搏输出量、心脏指数及左心室射血分数指标均高于对照组,差异有统计学意义(P＜0.05).治疗后两组患者社会限制、体力限制、症状及情绪评分均较治疗前明显降低,差异有统计学意义(P＜0.05);且观察组社会限制、体力限制、症状及情绪评分均低于对照组,差异有统计学意义(P＜0.05).治疗后观察组总有效率95.45％(42/44)明显高于对照组79.55％(35/44),差异有统计学意义(P＜0.05).治疗期间,两组患者肝肾功能、血常规均未发生异常,术后也未出现明显用药不良反应.结论 复脉益心方辅助二尖瓣置换术治疗风湿性心脏瓣膜病,能够降低MMP-9、NT-proBNP水平,有助于改善患者心功能,保护心肌,快速缓解患者临床症状,提高生活质量.
Abstract
Objective To explore the therapeutic effect of Fumai Yixin Formula in the adjuvant treatment of rheu-matic heart valve disease and its effects on patient heart function,serum matrix metalloproteinase-9(MMP-9)levels,and N-terminal pro-brain natriuretic peptide(NT-proBNP)levels.Methods A total of 88 patients with rheumatic heart valve disease admitted to the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine from February 2021 to February 2022 were selected as the research subjects.The patients were divided into a control group and an obser-vation group using a random number table method,with 44 cases in each group.Both groups of patients underwent mitral valve replacement surgery,receiving routine Western medicine treatment based on their condition after surgery.The obser-vation group received a combination of Fumai Yixin Formula and conventional Western medicine treatment for 4 weeks after surgery.Changes in the traditional Chinese medicine syndrome scores,MMP-9,NT-proBNP levels,the cardiac function indicators(minute cardiac output,stroke output,heart index,left ventricular ejection fraction),and the quality of life scores(social and physical limitations,symptoms,emotions)between two groups of patients after 4 weeks of treatment were ob-served and compared.Clinical efficacy after 4 weeks of treatment and the safety of the treatment plans for both groups of patients was evaluated.Results After treatment,the scores of palpitations,fatigue,shortness of breath,night or spontane-ous sweating,restlessness,insomnia,and multiple dreams in both groups of patients were decreased compared to before treatment,and the difference was statistically significant(P＜0.05);the scores of the observation group was lower than those of the control group,with a statistically significant difference(P＜0.05).The serum levels of MMP-9 and NT-proBNP in both groups of patients were reduced compared to before treatment,and the difference was statistically significant(P＜0.05);the observation group was significantly lower than the control group,with a statistically significant difference(P＜0.05).The minute cardiac output,stroke output,cardiac index,and the left ventricular ejection fraction of the two groups of patients were increased compared to before treatment,and the difference was statistically significant(P＜0.05);the observation group was higher than the control group,with a statistically significant difference(P＜0.05).The social and physical limitations,symptoms,and emotional scores of the two groups of patients were reduced compared to before treatment,and the difference was statistically significant(P＜0.05);the observation group was lower than the control group,with a statistically significant difference(P＜0.05).The total effective rate of the observation group was 95.45％(42/44),which was significantly higher than that of the control group at 79.55％(35/44),and the difference was statisti-cally significant(P＜0.05).Both groups of patients showed no abnormalities in liver and kidney function or blood routine before and after treatment,and there were no significant adverse reactions to medication after surgery.Conclusion Fumai Yixin Formula assisted mitral valve replacement surgery for rheumatic heart valve disease can reduce MMP-9 and NT-proBNP levels to help improve patient heart function,protect the myocardium,and quickly alleviate clinical symptoms,which improves the quality of life.
维普
万方数据