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目的分析麝香保心丸联合曲美他嗪改善冠心病心力衰竭患者血管内皮功能及血浆B型脑钠肽(brain natriuretic peptide,BNP)浓度的效果。方法选择2013年10月—2015年10月收治的119例冠心病心力衰竭住院患者作为研究对象,随机分为单药组59例和联合组60例。单药组给予曲美他嗪片口服治疗,联合组给予麝香保心丸联合曲美他嗪片治疗,连续治疗3个月末对比两组患者血管内皮功能及血浆BNP浓度。计量资料组间比较采用t检验,组内比较采用配对t检验,计数资料采用χ2检验,P<0.05为差异有统计学意义。结果单药组治疗后左室射血分数(left ventricular ejection fraction,LVEF)和左室舒张末期内径(left ventricular end-diastolic dimension,LVEDd)、6分钟步行距离、C反应蛋白(C-reactionprotein,CRP)和血浆BNP浓度分别为(38.53±3.41)%、(55.68±5.45)mm、(308.55±26.07)m、(2.93±0.34)mg/L、(123.44±6.18)pg/ml,较治疗前(34.21±3.38)%、(59.32±5.47)mm、(223.64±25.36)m、(4.87±0.37)mg/L、(166.58±6.29)pg/ml明显改善,两组比较差异均有统计学意义(均P<0.05)。联合组治疗后LVEF、LVEDD、6分钟步行距离、CRP和血浆BNP浓度分别为(45.43±3.44)%、(50.74±5.43)mm、(371.49±26.10)m、(2.34±0.35)mg/L、(92.16±6.22)pg/ml,显著优于治疗前的(34.24±3.38)%、(59.35±5.48)mm、(224.29±25.40)m、(4.85±0.37)mg/L、(165.99±6.30)pg/ml,差异均有统计学意义(均P<0.05)。治疗后,联合组各指标均优于单药组,差异均有统计学意义(均P<0.05)。联合组总有效率为90.00%,明显高于单药组的76.27%,差异有统计学意义(P<0.05)。结论麝香保心丸联合曲美他嗪改善冠心病心力衰竭患者血管内皮功能及血浆BNP浓度效果确切,协同治疗效果显著,安全可靠,值得临床对作用机制继续研究。
Objective To analyze the effect of Shexiang Baoxin Pill combined with trimetazidine on vascular endothelial function and plasma concentration of brain natriuretic peptide (BNP) in patients with coronary heart disease and heart failure. Methods A total of 119 hospitalized CHD patients with heart failure admitted from October 2013 to October 2015 were randomly divided into single drug group (n = 59) and combination group (n = 60). The monotherapy group was treated with trimetazidine tablets orally, the combination group was given Shexiang Baoxin Pill combined with trimetazidine tablets, and the endothelium function and plasma BNP concentration were compared between the two groups at the end of 3 consecutive months. Measurement data were compared between groups using t test, the group was compared using paired t test, count data using χ2 test, P <0.05 for the difference was statistically significant. Results After left ventricular ejection fraction (LVEF) and left ventricular end-diastolic dimension (LVEDd), 6-minute walking distance, C-reaction protein (CRP (38.53 ± 3.41)%, (55.68 ± 5.45) mm, (308.55 ± 26.07) m, (2.93 ± 0.34) mg / L and (123.44 ± 6.18) pg / ml respectively 34.21 ± 3.38%, 59.32 ± 5.47 mm, 223.64 ± 25.36 m, 4.87 ± 0.37 mg / L and 166.58 ± 6.29 pg / ml, respectively, with significant difference between the two groups (P < All P <0.05). The LVEF, LVEDD, 6-minute walking distance, CRP and plasma BNP concentrations were (45.43 ± 3.44)%, (50.74 ± 5.43) mm, (371.49 ± 26.10) m and (2.34 ± 0.35) mg / (92.16 ± 6.22) pg / ml was significantly higher than that before treatment (34.24 ± 3.38)%, (59.35 ± 5.48) mm, (224.29 ± 25.40) m and (4.85 ± 0.37) mg / pg / ml, the differences were statistically significant (all P <0.05). After treatment, the indexes in the combined group were better than those in the single drug group (all P <0.05). The total effective rate was 90.00% in the combination group, which was significantly higher than that in the single drug group (76.27%), the difference was statistically significant (P <0.05). Conclusions Shexiang Baoxin Pill combined with trimetazidine is effective in improving vascular endothelial function and plasma BNP concentration in patients with coronary heart disease and heart failure. The synergistic effect is significant, safe and reliable, and it is worth to continue to study the mechanism of action.