CAJ | 학술논문

目的：观察芪苈强心胶囊联合糖皮质激素辅助治疗扩张型心肌病（DCM）难治性心力衰竭（心衰）患者的临床疗效。方法采用前瞻性研究方法，选择河北省沧州市中心医院收治的48例DCM难治性心衰患者，按随机数字表法分为对照组、治疗Ⅰ组及治疗Ⅱ组，每组16例。对照组予以常规抗心衰西药治疗；治疗Ⅰ组在常规治疗基础上加用泼尼松40 mg/d，每5 d减5 mg，至5 mg/d维持；治疗Ⅱ组在治疗Ⅰ组的基础上，加用芪苈强心胶囊4粒（每粒0.3 g），每日3次。3组疗程均为2个月。于治疗后1周、2个月观察3组临床疗效、心功能指示左室舒张期末容积（LVEDV）、左室收缩期末容积（LVESV），左室射血分数（LVEF）、血浆B型脑钠肽（BNP）等指标，同时观察心电图、天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、尿素氮（BUN）、血肌酐（SCr）、血常规、尿常规的变化及不良反应的发生情况。结果治疗Ⅰ组及治疗Ⅱ组治疗后总有效率均明显高于对照组〔治疗后1周：81.2%（13/16），81.2%（13/16）比43.8%（7/16）；治疗后2个月：87.5%（14/16），93.7%（15/16）比50.0（8/16），均P＜0.05〕，3组治疗后LVEDV、LVESV、BNP降低，LVEF均升高，且治疗后2个月治疗Ⅱ组上述指标的改善程度明显优于治疗Ⅰ组〔LVEDV（mL）：142.4±33.0比174.8±52.5，LVESV（mL）：111.6±23.7比132.4±29.0，LVEF：0.421±0.037比0.390±0.045，BNP（μg/L）：1.944±0.751比3.038±1.905，均P＜0.05〕。结论芪苈强心胶囊联合糖皮质激素能有效改善DCM难治性心衰患者的近期及远期临床症状，改善心功能，提高生活质量。
목적：관찰기력강심효낭연합당피질격소보조치료확장형심기병（DCM）난치성심력쇠갈（심쇠）환자적림상료효。방법채용전첨성연구방법，선택하북성창주시중심의원수치적48례DCM난치성심쇠환자，안수궤수자표법분위대조조、치료Ⅰ조급치료Ⅱ조，매조16례。대조조여이상규항심쇠서약치료；치료Ⅰ조재상규치료기출상가용발니송40 mg/d，매5 d감5 mg，지5 mg/d유지；치료Ⅱ조재치료Ⅰ조적기출상，가용기력강심효낭4립（매립0.3 g），매일3차。3조료정균위2개월。우치료후1주、2개월관찰3조림상료효、심공능지시좌실서장기말용적（LVEDV）、좌실수축기말용적（LVESV），좌실사혈분수（LVEF）、혈장B형뇌납태（BNP）등지표，동시관찰심전도、천동안산전안매（AST）、병안산전안매（ALT）、뇨소담（BUN）、혈기항（SCr）、혈상규、뇨상규적변화급불량반응적발생정황。결과치료Ⅰ조급치료Ⅱ조치료후총유효솔균명현고우대조조〔치료후1주：81.2%（13/16），81.2%（13/16）비43.8%（7/16）；치료후2개월：87.5%（14/16），93.7%（15/16）비50.0（8/16），균P＜0.05〕，3조치료후LVEDV、LVESV、BNP강저，LVEF균승고，차치료후2개월치료Ⅱ조상술지표적개선정도명현우우치료Ⅰ조〔LVEDV（mL）：142.4±33.0비174.8±52.5，LVESV（mL）：111.6±23.7비132.4±29.0，LVEF：0.421±0.037비0.390±0.045，BNP（μg/L）：1.944±0.751비3.038±1.905，균P＜0.05〕。결론기력강심효낭연합당피질격소능유효개선DCM난치성심쇠환자적근기급원기림상증상，개선심공능，제고생활질량。
Objective To observe the therapeutic effect of Qili Qiangxin capsule combined with glucocorticoid for treatment of patients with dilated cardiomyopathy accompanied by refractory heart failure. Methods A prospective study was conducted. Forty-eight patients with dilated cardiomyopathy and refractory heart failure in Hebei Cangzhou Central Hospital were enrolled,and they were randomly divided into three groups:control group,treatmentⅠand treatmentⅡgroups(each,16 cases). All groups were treated with conventional anti-heart failure western treatment, meanwhile additionally prednisone was given to treatment groupⅠand groupⅡ,firstly 40 mg/d,then the dosage of 5 mg was decreased in every 5 days until reaching 5 mg per day;in treatment groupⅡ,besides the same treatment of group I,the traditional Chinese medicine therapy Qili Qiangxin capsule 4 granules(one capsule 0.3 g)each time and 3 times a day was added,2 months being the therapeutic course in all the patients. The clinical efficacy and cardiac functional indexes,such as the left ventricular end-diastolic volume(LVEDV),the left ventricular end-systolic volume(LVESV),the left ventricular ejection fraction(LVEF)and the plasma B type brain natriuretic peptide (BNP),etc. were observed in 1 week and 2 months after treatment. Meanwhile the electrocardiogram(ECG),aspartate transaminase(AST),alanine aminotransferase(ALT),urea nitrogen(BUN),serum creatinine(SCr),blood routine, urine routine examination and the adverse effects were investigated. Results The total effective rates in treatment groupⅠand treatment groupⅡwere significantly higher than those in the control group〔after treatment for 1 week:81.2%(13/16),81.2%(13/16)vs. 43.8%(7/16);after 2 months:87.5%(14/16),93.7%(15/16)vs. 50.0%(8/16), all P<0.05〕. After treatment,the LVEDV,LVESV and BNP were lowered and the LVEF was increased in the three groups,and the above indexes in treatment groupⅡwere improved more significantly than those in groupⅠ〔LVEDV (mL):142.4±33.0 vs. 174.8±52.5,LVESV(mL):111.6±23.7 vs. 132.4±29.0,LVEF:0.421±0.037 vs. 0.390±0.045,BNP(μg/L):1.944±0.751 vs. 3.038±1.905,all P<0.05〕. Conclusion Qili Qiangxin capsule combined with glucocorticoid may effectively improve the cardiac function and clinical symptoms in near and forward future in patients with dilated cardiomyopathy accompanied by refractory heart failure,thus it may elevate the patients' life quality.