温阳利水法对心肾综合征病人心肾功能改善的临床观察

摘要

目的 观察温阳利水法对心肾综合征(心肾阳虚证)病人心肾功能改善的临床疗效.方法 将120例诊断为心肾综合征,中医辨证为心肾阳虚证病人,随机分为对照组(西药标准治疗,60例)和治疗组(西药标准联合加载真桃汤治疗,60例),治疗6个月,观察病人组的心脏病学会(NYHA)心功能分级、肾功能分类、血清学指标、中医症状积分和中医证候改善情况.结果 治疗组和对照组治疗后NYHA心功能分级显效率及有效率,比较差异无统计学意义(P>0.05);治疗组总有效率显著高于对照组(65.00%vs 46.67%,P=0.043).治疗组和对照组治疗后肾功能不全分期显效率及有效率两组比较差异无统计学意义(P>0.05);治疗组总有效率显著高于对照组(60.00%vs 41.67%,P=0.045).对照组治疗后脑钠肽(BNP)显著性下降(P<0.05);治疗组治疗前后BNP显著性下降(P<0.01);治疗组和对照组治疗前后肌酐(Scr)差值比较差异有统计学意义(P<0.05).对照组和治疗组治疗前后血红蛋白(Hb)均显著下降(P<0.01);治疗组和对照组治疗前后Hb差值比较差异有统计学意义(P<0.05).对照组和治疗组治疗前后左室舒张末内径(LVEDD)、左室收缩末内径(LVESD)和左心房内径(LAD)差异无统计学意义;对照组和治疗组治疗后LVEF差异有统计学意义(P<0.01).治疗组和对照组治疗前后中医症状积分下降率均有统计学意义(P<0.01);治疗组治疗后中医症状积分优于对照组(P<0.01).治疗组与对照组中医证候总有效率比较有统计学意义(P<0.01).结论 在西药标准治疗基础上加载中药温阳利水法治疗可进一步改善心肾综合征(心肾阳虚证)病人心功能分级、肾功能分期、中医症状积分和中医证候疗效,降低病人的BNP,升高Hb.%Objective To observe the clinical effects of warming yang for diuresis therapy improving heart and kidney function in pa-tients with cardiorenal syndrome(CRS). Methods One hundred and twenty patients with CRS and heart-kidney yang deficiency syndromes in traditional Chinese medicine(TCM)were randomly divided into two groups:control group(n=60)treated with routine treatment,and treatment group(n=60)treated with routine treatment plus Zhentao decoction.NYHA cardiac function classification, renal function stages,serum indexes,TCM symptoms scores were observed after 6 months of treatment. Results After the treat-ment,there were no significant differences in NYHA functional classification between two groups (P>0.05).Total effective rate in treatment group was better than that in control group(65.00% vs 46.67%,P=0.043).There were no significant differences in renal failure stages effective and efficient between two groups(P>0.05).The total effective rate in treatment group was significantly high-er than that in control group(60.00% vs 41.67%,P=0.045).B-type natriuretic peptide(BNP)level was significantly decreased af-ter treatment in control group(P<0.05).BNP level was decreased after treatment in treatment group (P<0.01).There was very significant decrease for serum creatinine after treatment in two groups(P<0.01).No difference of serum creatinine were observed before and after treatment between two groups(P>0.05). There was significant decrease for hemoglobin after treatment in two groups(P<0.01). There was significant difference in hemoglobin after treatment between two groups(P<0.05).There was no sig-nificant difference in LVEDD,LVESD and LAD before and after treatment between two groups(P>0.05).There was very significant difference for LVEF after than before treatment in two groups(P<0.01). There was no difference in LVEF after treatment between two groups(P>0.05). There was a very significant difference in symptom scores decline before and after treatment between two groups (P<0.01). There was very significant difference in TCM symptom score after treatment between two group (P<0.01). There was significant statistical difference of total effectiveness of TCM syndromes in treatment group compared with in control group (P<0.01). Conclusion Warming yang for diuresis therapy and western medicine routine treatment can further improve cardiac function classification and renal function stages,TCM symptom scores and efficacy,can reduce serum BNP level,increase Hb level in patients with CRS.