CAJ | 학술논문

目的：探讨参麦注射液联合自体骨髓干细胞心脏移植治疗难治性心力衰竭（RHF）临床疗效。方法选择郑州大学第一附属医院收治的RHF患者200例，按随机原则分为对照组和治疗1、2、3组，每组50例。对照组给予心力衰竭（心衰）标准治疗；治疗1组给予心衰标准治疗+自体骨髓干细胞心脏移植；治疗2组给予心衰标准治疗+参麦注射液；治疗3组给予心衰标准治疗+自体骨髓干细胞心脏移植+参麦注射液。平均随访24个月，观察治疗期间各组患者预后、再住院率、临床疗效、心功能指标及B型脑钠肽（BNP）水平的变化。结果治疗期间对照组有10例死亡，治疗1、2组各有4例死亡，治疗3组有3例死亡；治疗1、2、3组再住院率较对照组明显降低（38%、36%、24%比48%，P＜0.05或P＜0.01），治疗1、2、3组总有效率较对照组明显提高（88%、86%、94%比76%，均P＜0.05）；3个治疗组治疗后心功能指标左室射血分数（LVEF）、左心室短轴缩短率（FS）、左心室收缩期末内径（LVESD）均较治疗前明显升高，左心室舒张期末内径（LVEDD）及BNP水平均较治疗前明显降低；且3个治疗组治疗后上述指标均较对照组同期明显改善，且以治疗3组改善更显著〔LVEF：0.477±0.099比0.396±0.098，FS：（30.0±5.1）%比（26.8±7.5）%，LVESD（mm）：40.6±9.1比45.8±9.4，LVEDD（mm）：44.9±9.8比52.8±10.1，BNP（ng/L）：515±400比1875±400，均P＜0.05〕。结论参麦注射液联合自体骨髓干细胞心脏移植治疗RHF疗效显著。
목적：탐토삼맥주사액연합자체골수간세포심장이식치료난치성심력쇠갈（RHF）림상료효。방법선택정주대학제일부속의원수치적RHF환자200례，안수궤원칙분위대조조화치료1、2、3조，매조50례。대조조급여심력쇠갈（심쇠）표준치료；치료1조급여심쇠표준치료+자체골수간세포심장이식；치료2조급여심쇠표준치료+삼맥주사액；치료3조급여심쇠표준치료+자체골수간세포심장이식+삼맥주사액。평균수방24개월，관찰치료기간각조환자예후、재주원솔、림상료효、심공능지표급B형뇌납태（BNP）수평적변화。결과치료기간대조조유10례사망，치료1、2조각유4례사망，치료3조유3례사망；치료1、2、3조재주원솔교대조조명현강저（38%、36%、24%비48%，P＜0.05혹P＜0.01），치료1、2、3조총유효솔교대조조명현제고（88%、86%、94%비76%，균P＜0.05）；3개치료조치료후심공능지표좌실사혈분수（LVEF）、좌심실단축축단솔（FS）、좌심실수축기말내경（LVESD）균교치료전명현승고，좌심실서장기말내경（LVEDD）급BNP수평균교치료전명현강저；차3개치료조치료후상술지표균교대조조동기명현개선，차이치료3조개선경현저〔LVEF：0.477±0.099비0.396±0.098，FS：（30.0±5.1）%비（26.8±7.5）%，LVESD（mm）：40.6±9.1비45.8±9.4，LVEDD（mm）：44.9±9.8비52.8±10.1，BNP（ng/L）：515±400비1875±400，균P＜0.05〕。결론삼맥주사액연합자체골수간세포심장이식치료RHF료효현저。
Objective To investigate the clinical efficacy of Shenmai injection (SMI) combined with heart transplantation of autologous bone marrow stem cells in the treatment of refractory heart failure(RHF). Methods Two hundred patients with RHF were selected from the Emergency Department of the First Affiliated Hospital of Zhengzhou University and the Cardiology Department of the First Affiliated Hospital of Henan College of Traditional Chinese Medicine. They were randomly divided into control group and treatment 1,2 and 3 groups(each 50 cases). In the control group,heart failure standard treatment was given;group 1 received a standard treatment for heart failure combined with autologous bone marrow stem cell heart transplantation;group 2 received a standard treatment for heart failure with SMI;group 3 received a standard treatment for heart failure combined with autologous bone marrow stem cell heart transplantation and SMI. The mean follow-up was 24 months. The prognosis,readmission rate,clinical efficacy,cardiac function and the change in levels of B-type natriuretic peptide(BNP)of patients in each group were observed during the therapeutic course and observation period. Results During the course of treatment,there were 10 cases dead in the control group,4 in each group 1 and 2 respectively,and 3 in group 3. Readmission rates in group 1,2 and 3 were significantly lower than that in control group(38%,36%,24%vs. 48%, P<0.05 or P<0.01). The rates of total efficiency in group 1,2 and 3 were obviously higher than that in the control group(88%,86%,94%vs. 76%,all P<0.05). After treatment,the left ventricular ejection fraction(LVEF),left ventricular fractional shortening(FS)and left ventricular end-systolic diameter(LVESD)in three therapeutic groups were significantly higher than those before treatment,while the left ventricular end-diastolic diameter(LVEDD)and BNP level were significantly lower than those before treatment. All the above indexes in three therapeutic groups after treatment were much more remarkably improved than those in the control group during the same period,and the group 3 being the most significant〔LVEF:0.477±0.099 vs. 0.396±0.098,FS:(30.0±5.1)%vs.(26.8±7.5)%,LVESD (mm):40.6±9.1 vs. 45.8±9.4,LVEDD(mm):44.9±9.8 vs. 52.8±10.1,BNP(ng/L):515±400 vs. 1 875±400, all P<0.05〕. Conclusion SMI combined with heart transplantation of autologous bone marrow stem cells has obvious therapeutic effect for treatment of RHF.