|
|
|
| Effect of Yiqi Huoxue Lishui Prescription combined with Spironolactone in the treatment of heart failure and preserved ejection fraction in the elderly |
| PENG Lang1,2 LU Xiaobin1,3 MEI Yingbing1,2 LIU Jinjin1,2 NI Wei1,4 |
1.Hubei Province Academy of Traditional Chinese Medicine, Hubei Province, Wuhan 430074, China;
2.Department of Geriatrics, Hubei Provincial Hospital of Traditional Chinese Medicine, Hubei Province, Wuhan 430060, China;
3.Department of Cardiovascular, Hubei Provincial Hospital of Traditional Chinese Medicine, Hubei Province, Wuhan 430060, China;
4.Clinical Laboratory, Hubei Provincial Hospital of Traditional Chinese Medicine, Hubei Province, Wuhan 430060, China |
|
|
|
Abstract Objective To investigate the clinical effect of treating heart failure and preserved ejection fraction (HFpEF) in elderly patients with Yiqi Huoxue Lishui Prescription combined with aldosterone receptor antagonist. Methods A prospective, open and blank controlled clinical study was conducted to collect 120 cases of HFpEF patients in the outpatient and in-patient department of Hubei Provincial Hospital of Traditional Chinese Medicine from December 2017 to December 2018. According to the random number table method, they were divided into the traditional Chinese medicine group, the Spironolactone group, the combined group and the control group, each group with 30 cases. The control group was treated with western medicine basic treatment, the traditional Chinese medicine group was treated with Yiqi Huoxue Lishui Prescription, the Spironolactone group was treated with Spironolactone 20 mg/tablet/day, and the combined group received the same therapeutic intervention as the traditional Chinese medicine group and spironolactone group at the same time. Each group was treated continuously for 2 weeks. The results of N terminal pro B type natriuretic peptide (NT-proBNP) level, traditional Chinese medicine syndrome score and 6 min walking test were recorded and compared before and after treatment. Results Five cases were shed during the study, and 115 cases were actually completed. There were 30 cases in the control group, 28 cases in the traditional Chinese medicine group, 29 cases in the Spirolactone group and 28 cases in the combined group. There was no statistically significant difference in the level of NT-proBNP between the four groups before treatment (P ＞ 0.05). The level of NT-proBNP after treatment in the combined group, the traditional Chinese medicine group and the Spironolactone group was lower than that before treatment, and the differences were statistically significant (all P ＜ 0.05). Compared with the control group after treatment, the level of NT-proBNP in the combined group, the Spironolactone group and the traditional Chinese medicine group decreased, and the combined group was lower than the Spironolactone group, the differences were statistically significant (all P ＜ 0.05). There was no significant difference in traditional Chinese medicine syndrome score among the four groups before treatment (P ＞ 0.05). The traditional Chinese medicine syndrome scores of each group were lower after treatment than before treatment, and the differences were statistically significant (P ＜ 0.05). Compared with the control group after treatment, the traditional Chinese medicine syndrome scores of the combined group, the traditional Chinese medicine group and the Spironolactone group all decreased, and the traditional Chinese medicine syndrome scores of the combined group and the traditional Chinese medicine group were all lower than those of the Spironolactone group, with statistically significant differences (all P ＜ 0.05). There was no significant difference in traditional Chinese medicine syndrome scores between the combined group and the traditional Chinese medicine group (P ＞ 0.05). There was no statistically significant difference in 6 min walking distance among the four groups before treatment (P ＞ 0.05). The 6 min walking distance of each group after treatment was greater than that before treatment, and the differences were statistically significant (all P ＜ 0.05). After treatment, the 6 min walking distance of the combined group was greater than that of the Spirolactone group and the control group, and the differences were statistically significant (all P ＜ 0.05). There was no significant difference in 6 min walking distance between the combined group and the traditional Chinese medicine group (P > 0.05). Conclusion The advantage of the Yiqi Huoxue Lishui Prescription lies in the improvement of traditional Chinese medicine syndrome and activity endurance, and the advantage of Spironolactone lies in the reduction of NT-proBNP level. The combination of the two is an effective method for the treatment of HFpEF.
|
|
|
|
|
|
[1] Miller RJH，Howlett JG. Evolving role for mineralocorticoid receptor antagonists in heart failure with preserved ejection fraction [J]. Curr Opin Cardiol，2015，30（2）：168-172.
[2] Dickstein K，Cohen-Solal A，Filippatos G，et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008：the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology [J]. Eur J Heart Fail，2008， 10（10）：933-989.
[3] Eldeman F，Wachter R，Schmidt AG，et al. Effect of spironolactone on diastolic function and exercise capacity in patients with heart failure with preserved ejection fraction：the Aldo-DHF randomized controlled trial [J]. JAMA，2013， 309（8）：781-791.
[4] Capuano A，Scavone C，Vitale C，et al. Mineralocorticoid receptor antagonists in heart failure with preserved ejection fraction（HFpEF）[J]. Int J Cardiol，2015，200：15-19.
[5] Pitt B，Pfeffer MA，Assmann SF，et al. Spironolactone for heart failure with preserved ejection fraction [J]. N Engl J Med，2014，370（15）：1383-1392.
[6] 罗良涛，赵慧辉，郭淑贞，等.中国17家中医医院冠心病慢性心力衰竭住院患者临床特征及治疗情况调查[J].中西医结合心脑血管病杂志，2013，11（9）：1030-1033.
[7] 中华医学会心血管病学分会，中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志，2014，42（2）：98-122.
[8] WRITING COMMITTEE MEMBERS，Yancy CW，Jessup M，et al. 2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure: An Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America [J]. Circulation，2016，134（13）：e282-e293.
[9] 郑筱萸.中药新药临床研究指导原则[M].北京：中国医药科技出版社，2002：77-85.
[10] 荆志成.六分钟步行距离试验的临床应用[J].中华心血管病杂志，2006，34（4）：381-384.
[11] Yamamto K，Origasa H，Hori M，et al. Effects of carvedilol on the heart failure with preserved ejection fraction：the Japaneses diastiolic heart failure study（J-DHF）[J]. Eur J Heart Fail，2013，15（1）：110-118.
[12] Xanthakis V，Vasan RS. Aldosterone and the risk of hypertension [J]. Curr Hypertens Rep，2013，15（2）：102-107.
[13] Briet M，Schiffrin EL. Vascular actions of aldosterone [J]. J Vasc Res，2013，50（2）：89-99.
[14] Anand IS，Rector TS，Cleland JG，et al. Prognostic value of baseline plasma amino-terminal pro-brain natriuretic peptide and its interactions with irbesartan treatment effects in patients with heart failure and preserved ejection fraction：findings from the I-PRESERVE trial [J]. Circ Heart Fail，2011，4（5），569-577.
[15] Xiang Y，Shi W，Li Z，et al. Efficacy and safety of spironolactone in the heart failure with mid-rangeejection fraction and heart failure with preserved ejection fraction：A meta-analysis of randomized clinical trials [J]. Medicine （Baltimore），2019，98（13）：e14967.
[16] Pandey A，Garg S，Matulevicius SA，et al. Effect of Mineralocorticoid Receptor Antagonists on Cardiac Structure and Function in Patients With Diastolic Dysfunction and Heart Failure With Preserved Ejection Fraction：A Meta-Analysis and Systematic Review [J]. J Am Heart Assoc，2015，4（10）：e002137.
[17] 李崇耀，张曼，赵鸿斌，等.收缩性心力衰竭患者降钙素原、氨基末端脑钠肽前体水平及超声心动图变化分析[J].疑难病杂志，2019，18（12）：1208-1211，1217.
[18] 中华医学会心血管病学分会心力衰竭学组，中国医师协会心力衰竭专业委员会，中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2018[J].中华心血管病杂志，2018，46（10）：760-789.
[19] 程冕，严金华，翟茂才，等.盐酸曲美他嗪对老年慢性心力衰竭患者疗效及血清BNP和IL-6水平的影响[J].疑难病杂志，2018，17（9）：865-868.
[20] 戴雁彦，张立山.水饮与心衰[J].北京中医药大学学报：中医临床版，2007，14（5）：31-32.
[21] 关继华，郝桂芳.益气活血温阳利水法治疗心衰的文献分析[J].陕西中医，1995，16（3）：98-99.
[22] 省格丽，赵勇.郭维琴教授证治心衰的经验[J].新疆中医药，2015，33（4）：51-52.
[23] 李立志.陈可冀治疗充血性心力衰竭经验[J].中西医结合心脑血管病杂志，2006，4（2）：136-138. |
|
|
|
