Effect of Yiqi Huoxue Formula on Myocardial Fibrosis in Patients with Heart Failure after Acute ST-Segment Elevation Myocardial Infarction
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摘要:
目的 评价益气活血方对急性ST段抬高型心肌梗死后心力衰竭患者心肌纤维化的影响。 方法 选取2019年2月至2021年1月在南京中医药大学附属中西医结合医院就诊的气虚血瘀型急性ST段抬高型心肌梗死患者41例, 按随机数字表法分为对照组20例和观察组21例, 对照组予心肌梗死标准治疗, 观察组加用益气活血方治疗。疗程12周。观察2组患者治疗前后中医证候积分、临床疗效、人血浆脂蛋白相关磷脂酶A2(Lp-PLA2)、超敏C反应蛋白(hs-CRP)、白介素-6(IL-6)、N末端B型脑钠肽前体(NT-proBNP)、6 min步行试验(6MWT)、超声心动图指标[左室射血分数(LVEF)、左心房前后径(LAD)、左心室舒张末期内径(LVEDD)]、心脏磁共振成像心肌细胞外容积(ECV)和纵向弛豫时间(T1)的变化情况。 结果 治疗后, 2组中医证候积分均下降(P < 0.05, P < 0.01), 观察组在改善胸部刺痛、气短乏力、语声低微、面色少华、活动后劳累、自汗、肌肤甲错及总积分方面优于对照组(P < 0.05, P < 0.01);观察组中医临床疗效优于对照组(P < 0.05);2组Lp-PLA2、hs-CRP、IL-6、NT-proBNP、ECV和T1值均下降(P < 0.05), 观察组优于对照组(P < 0.05);2组6MWT和LVEF均升高(P < 0.05), 观察组优于对照组(P < 0.05)。2组主要心血管不良事件比较, 差异无统计学意义(P>0.05)。 结论 益气活血方可改善急性ST段抬高型心肌梗死经皮冠状动脉介入治疗(PCI)术后患者的临床症状, 提高中医临床疗效, 抑制心肌纤维化, 其机制可能与降低炎症反应相关。 -
关键词:
- 急性ST段抬高型心肌梗死 /
- 心力衰竭 /
- 心肌纤维化 /
- 炎性损伤 /
- 益气活血方
Abstract:OBJECTIVE To evaluate the effect of Yiqi Huoxue formula on myocardial fibrosis in patients with heart failure after acute ST-segment elevation myocardial infarction. METHODS A total of 41 patients with acute ST-segment elevation myocardial infarction with qi deficiency and blood stasis who attended the Jiangsu Integrated Chinese and Western Medicine Hospital Affiliated to Nanjing University of Chinese from February 2019 to January 2021 were selected and divided into 20 cases in the control group and 21 cases in the study group according to the random number table. The control group was given standard treatment for myocardial infarction, while the study group was treated with Yiqi Huoxue formula based on the standard treatment. The course of treatment was 12 weeks. Before and after treatment, we observed the changes of both groups in the traditional Chinese medicine (TCM) syndrome score, clinical efficacy, human plasma lipoprotein-related phospholipase A2 (Lp-PLA2), hypersensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), N-terminal pro-brain natriuretic peptide (NT-proBNP), 6 minutes walk test (6MWT), echocardiographic parameters [left ventricular ejection fraction (LVEF), left atrium dimension (LAD), left ventricular end-diastolic dimension (LVEDD)], extracellular volume (ECV) and longitudinal relaxation time (T1) by cardiac magnetic resonance imaging. RESULTS After treatment, the TCM syndrome scores were reduced in both groups (P < 0.05, P < 0.01), but study group presented better curative effects in chest tingling, shortness of breath, faint low voice, lusterless complexion, post-activity fatigue, spontaneous sweating, scaly skin, as well as total score (P < 0.05, P < 0.01). In addition, the clinical efficacy of TCM in the study group was better than that in the control group (P < 0.05). The levels of Lp-PLA2, hs-CRP, IL-6, NT-proBNP, ECV and T1 were reduced in both groups (P < 0.05), but the results of the study group were better than those of the control group (P < 0.05). Besides, the results of 6MWT and LVEF were increased in both groups (P < 0.05), but the results of the study group were better than those of the control group (P < 0.05). There was no statistically significant difference in the comparison of major cardiovascular adverse events between the two groups (P>0.05). CONCLUSION Yiqi Huoxue formula can mitigate the clinical symptoms of patients with acute ST-segment elevation myocardial infarction after percutaneous coronary intervention (PCI), improve the clinical efficacy of traditional Chinese medicine, and inhibit myocardial fibrosis. The mechanism may be related to the reduction of the inflammatory response. -
表 1 2组患者基线资料比较(x±s)
Table 1. Comparison of baseline information of patients in the two groups(x±s)
组别 性别 年龄/岁 病程/a BMI LDL-C/(mmol·L-1) 男 女 对照组 15 5 67.20±8.08 4.79±1.12 25.55±2.16 2.98±0.82 观察组 15 6 67.81±9.26 5.28±1.35 25.62±2.71 3.01±0.76 组别 合并症 罪犯血管 Killip分级 高血压 糖尿病 高脂血症 左前降支 左回旋支 右冠状动脉 Ⅱ级 Ⅲ级 对照组 17 13 15 7 6 6 13 7 观察组 18 12 14 8 7 5 13 8 
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表 2 2组患者治疗前后中医证候积分比较(x±s)
Table 2. Comparison of TCM syndrome scores between 2 groups before and after treatment (x±s)
组别 例数 时间 胸部刺痛 气短乏力 心悸 语声低微 面白少华 对照组 20 治疗前 5.12±2.20 4.20±1.44 5.60±1.78 3.10±1.97 2.39±1.06 治疗后 3.40±0.89** 3.10±1.21* 3.60±1.98** 1.82±1.01** 2.70±1.57 观察组 21 治疗前 4.86±1.13 4.19±1.40 5.49±1.74 2.82±1.67 2.38±1.59 治疗后 2.23±1.98**# 1.99±1.00**## 2.30±1.91** 0.98±0.76**## 1.32±1.78*# 组别 例数 时间 活动后劳累 面部、口唇色暗
或青紫自汗 肌肤甲错 总积分 对照组 20 治疗前 4.37±1.69 3.99±0.55 2.42±0.79 0.88±0.27 32.07±10.52 治疗后 4.55±1.61 3.40±0.96* 2.11±1.09 0.79±0.40 25.46±8.72* 观察组 21 治疗前 4.95±1.97 4.18±0.68 2.17±0.97 0.84±0.29 31.88±10.33 治疗后 2.71±1.52**## 3.38±0.93** 1.12±1.03**## 0.32±0.14**## 16.35±6.78**## 注: 组内比较, *P < 0.05, * *P < 0.01;组间比较, #P < 0.05, ## P < 0.01。
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表 3 2组患者中医临床疗效比较
Table 3. Comparison of clinical efficacy of TCM symptoms between 2 groups
组别 例数 显效 有效 无效 总有效率/% 对照组 20 5 8 7 65.00 观察组 21 5 12 4 80.95# 注: 组间比较, χ2=6.494, #P < 0.05。
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表 4 2组患者治疗前后Lp-PLA2、hs-CRP及IL-6水平比较(x±s)
Table 4. Comparison of Lp-PLA2, hs-CRP and IL-6 levels between 2 groups before and after treatment(x±s)
组别 例数 时间 Lp-PLA2/(ng·mL-1) hs-CRP/(mg·L-1) IL-6/(pg·mL-1) 对照组 20 治疗前 197.05±31.92 46.75±20.64 34.35±8.42 治疗后 106.05±19.24* 13.65±3.47* 17.60±4.47* 观察组 21 治疗前 178.33±36.75 48.29±17.07 35.29±8.67 治疗后 84.62±13.46*# 9.90±3.33*# 13.52±5.20*# 注: 组内比较, *P < 0.05;组间比较, #P < 0.05。
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表 5 2组患者治疗前后心功能指标比较(x±s)
Table 5. Comparison of cardiac function indexes between 2 groups before and after treatment(x±s)
组别 例数 时间 NT-proBNP/
(pg·mL-1)6MWT/m LVEF/% LAD/mm LVEDD/mm 对照组 20 治疗前 2 422.00±713.25 280.60±126.49 38.85±7.01 37.55±3.39 49.90±6.40 治疗后 498.50±83.75* 401.90±61.73* 42.00±8.89* 37.85±4.40 49.30±7.23 观察组 21 治疗前 2 842.00±1 215.00 316.52±98.65 38.14±5.39 38.38±4.62 50.05±6.97 治疗后 219.00±101.00*# 479.38±95.76*# 49.29±8.35*# 38.19±3.88 49.14±7.68 注: 组内比较, *P < 0.05;组间比较, #P < 0.05。
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表 6 2组患者治疗前后心肌纤维化指标比较(x±s)
Table 6. Comparison of myocardial fibrosis indexes between 2 groups before and after treatment(x±s)
组别 例数 时间 ECV/% T1/ms 对照组 20 治疗前 28.67±4.35 1 384.89±77.14 治疗后 26.12±5.43* 1 311.94±58.25* 观察组 21 治疗前 29.47±3.67 1 373.16±89.04 治疗后 20.67±3.93*# 1 213.06±50.48*# 注: 组内比较, *P < 0.05;组间比较, #P < 0.05。
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