目的 探讨化湿降浊方基于降尿酸效应对慢性心力衰竭(Chronic heart failure,CHF)合并高尿酸血症(Hyperuricemia,HUA)患者心功能的影响.方法 选取2020年1月-2021年12月期间南京市中医院心血管病科门诊及住院的CHF合并HUA患者60例作为研究对象,采用随机数字表法分为对照组和治疗组,每组各30例.对照组给予《指南》规范心力衰竭药物(包括ACEI/ARB/ARNI、β受体阻滞剂、螺内酯、SGL-T2抑制剂等)治疗;治疗组在此基础上加用名中医经验方化湿降浊方治疗,均治疗2周.观察比较两组患者临床疗效,治疗前后24 h尿尿酸(24-hour urinary uric acid,24 h UUA)、血尿酸(Serum uric acid,SUA)、N 末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)、总胆红素(Total bilirubin,TBIL)、6 min 步行距离(6-minute walk distance,6MWD)、左室射血分数(Left ventricular ejection fraction,LVEF)及中医证候积分的变化.结果 治疗后两组患者SUA水平均较治疗前降低,24 h UUA水平均较治疗前升高,差异有统计学意义(P＜0.05);且治疗组SUA水平明显低于对照组,24 h UUA水平明显高于对照组,差异有统计学意义(P＜0.05).治疗后两组患者NT-proBNP、TBIL水平均较治疗前降低,6MWD和LVEF水平均较治疗前升高,差异有统计学意义(P＜0.05);且治疗组NT-proBNP、TBIL水平明显低于对照组,6MWD、LVEF水平明显高于对照组,差异有统计学意义(P＜0.05).治疗后两组患者各项中医证候积分及总积分均较治疗前降低,差异有统计学意义(P＜0.05);且治疗组中医证候胸闷气喘、腹胀纳呆、肢体困重、大便溏及总积分明显低于对照组,差异有统计学意义(P＜0.05).治疗后治疗组高尿酸血症方面总有效率89.29％(25/28)明显高于对照组66.67％(18/27),差异有统计学意义(P＜0.05);治疗后治疗组心力衰竭方面总有效率96.43％(27/28)与对照组92.59％(25/27)比较,差异无统计学意义(P＞0.05).结论 化湿降浊方具有降低CHF合并HUA患者SUA和TBIL水平,改善中医证候积分和6MWD,从而改善患者心功能的作用,值得进一步研究与应用.
Effect of Huashi Jiangzhuo Formula on Cardiac Function in Patients with Chronic Heart Failure Based on Uric Acid-lowering Effect
Objective To explore the effect of Huashi Jiangzhuo Formula on cardiac function in patients with chronic heart failure(CHF)combined with hyperuricemia(HUA)based on its uric acid-lowering effect.Methods Sixty inpatients and outpatients with CHF and HUA who visited the Cardiovascular Department of Nanjing Hospital of Chinese Medicine from January 2020 to December 2021 were enrolled.Using a random number table,they were divided into a con-trol group and a treatment group,with 30 patients in each group.The control group received standard heart failure medica-tions according to guidelines,including ACEI/ARB/ARNI,β-blockers,spironolactone,and SGLT-2 inhibitors.The treatment group received Huashi Jiangzhuo Formula in addition to the standard treatment.Both groups were treated for two weeks.The clinical efficacy,as well as changes in 24-hour urinary uric acid(24 h UUA),serum uric acid(SUA),N-terminal pro-brain natriuretic peptide(NT-proBNP),total bilirubin(TBIL),6-minute walk distance(6MWD),left ventricular ejection fraction(LVEF),and traditional Chinese medicine(TCM)syndrome scores,were observed and compared between the two groups before and after treatment.Results After treatment,SUA levels decreased and 24 h UUA levels increased in both groups compared with pre-treatment levels(P＜0.05).The treatment group showed significantly lower SUA levels and significantly higher 24 h UUA levels than the control group(P＜0.05).NT-proBNP and TBIL levels de-creased,while 6MWD and LVEF increased in both groups after treatment(P＜0.05).Additionally,the treatment group ex-hibited significantly lower NT-proBNP and TBIL levels and significantly higher 6MWD and LVEF values than the control group(P＜0.05).The TCM syndrome scores and total scores decreased significantly in both groups after treatment(P＜0.05).The treatment group showed significantly lower scores for chest tightness and shortness of breath,abdominal disten-sion and poor appetite,heaviness in the limbs,loose stools,and total TCM syndrome scores than the control group(P＜0.05).Regarding the efficacy in treating HUA,the treatment group had a significantly higher total effective rate(89.29％,25/28)than the control group(66.67％,18/27)(P＜0.05).In terms of heart failure treatment,the total effective rate was 96.43％(27/28)in the treatment group,which was not significantly different from the 92.59％(25/27)in the control group(P＞0.05).Conclusion Huashi Jiangzhuo Formula can reduce SUA and TBIL levels,improve TCM syndrome scores,and enhance 6MWD,thereby improving cardiac function in patients with CHF combined with HUA.It is worthy of further research and clinical application.
Huashi Jiangzhuo FormulaChronic Heart FailureHyperuricemiaCardiac Function
万方数据
维普
