| 陈婷,祝小芬,漆良琴,等.炙甘草汤辨证论治病毒性心肌炎的临床研究[J].浙江中医药大学学报,2019,43(5):460-464. |
| 炙甘草汤辨证论治病毒性心肌炎的临床研究 |
| Clinical Research of Zhigancao Decoction in Treating Viral Myocarditis |
| DOI：10.16466/j.issn1005-5509.2019.05.017 |
| 中文关键词: 炙甘草汤 病毒性心肌炎 气阴两虚 炎症反应 氧化应激 辨证论治 经方 |
| 英文关键词: Zhigancao Decoction viral myocarditis Qi-Yin deficiency inflammatory responses oxidative stress treatment according to syndrome differentiation classical prescription |
| 基金项目:衢州市指导性科技计划项目(2016134) |
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| 中文摘要: |
| [目的]探讨炙甘草汤辨证论治病毒性心肌炎(气阴两虚证)的临床疗效及作用机制。[方法]采用平行、随机、对照试验方案，选择符合病毒性心肌炎(气阴两虚证)诊断标准的患者76例，随机分为治疗组和对照组各38例。对照组予常规治疗，治疗组在常规治疗基础上联合炙甘草汤口服，疗程4周。分别记录两组患者治疗前、后中医证候积分、心电图及心脏彩超检查结果；检测血浆N末端-B型利钠肽前体(N-terminal prohormone of brain natriuretic peptide，NT-proBNP)、肌酸激酶(creatine kinase，CK)、肌酸激酶同工酶(creatine kinase-MB，CK-MB)、肌钙蛋白I(cardiac troponin I，cTnI)、高敏C反应蛋白(hypersensitive C-reactive protein，hs-CRP)、白介素-6(interleukin-6，IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α，TNF-α)、丙二醛 (malonaldehyde，MDA)、超氧化物歧化酶(superoxide dismutase，SOD)含量，并记录相关安全性指标(三大常规、肝肾功能等)及不良反应。[结果]治疗组总有效率为92.10%，对照组为73.68%，治疗组优于对照组(P＜0.05)，治疗组中医证候积分较对照组降低更明显(P＜0.05)。治疗后两组患者NT-proBNP、CK、CK-MB、cTnI均较治疗前明显降低(P＜0.05)，且治疗组CK、CK-MB下降幅度优于对照组(P＜0.05)。同时，治疗后两组患者血浆hs-CRP、TNF-α、IL-6、MDA含量均较治疗前显著降低(P＜0.05)，且治疗组下降幅度均大于对照组(P＜0.05)；SOD含量均较治疗前升高，治疗组升高幅度大于对照组(P＜0.05)。[结论] 常规治疗基础上加用炙甘草汤辨治病毒性心肌炎(气阴两虚证)疗效显著，可显著改善患者的临床症状，减少心肌细胞损伤，促进心肌细胞修复，其作用机制可能包括抑制体内炎症和抗氧化应激两个方面。 |
| 英文摘要: |
| [Objective] To investigate clinical effect and mechanism of Zhigancao Decoction on viral myocarditis(VMC) of Qi-Yin deficiency. [Methods] In a parallel, randomized trial, 76 patients with VMC(syndrome of Qi-Yin deficiency) were enrolled and divided into treatment group and control group, 38 cases in each group. Patients in control group were given routine treatments, while patients in treatment group were given Zhigancao Decoction combined with routine treatments.The TCM syndrome scores, electrocardiograms, echocardiography, N-terminal prohormone of brain natriuretic peptide(NT-proBNP), creatine kinase(CK), creatine kinase-MB(CK-MB), cardiac troponin I(cTnI), hypersensitive C-reactive protein(hs-CRP), tumor necrosis factor-α(TNF-α), interleukin-6(IL-6), malonaldehyde(MDA)and superoxide dismutase(SOD) were recorded respectively before and 4 weeks after treatment, as well as security indicators of blood, urine and excrement tests, liver and kidney functions, and adverse events. [Results] Four weeks after treatment, the total effective rate of treatment group was 92.10%, while that of control group was 73.68%, which suggested that treatment group worked better(P＜0.05); TCM syndrome scores of treatment group were significantly lower than those of control group(P＜0.05). After treatments, the level of NT-proBNP, CK, CK-MB and cTnI were lower than before in both groups(P＜0.05). In addition, CK and CK-MB in treatment group decreased significantly compared with control group(P＜0.05). The level of hs-CRP, TNF-α, IL-6 and MDA were lower than before in both groups(P＜0.05), meanwhile, those in treatment group were decreased significantly compared with control group(P＜0.05). Besides, the level of SOD was increased in both groups(P＜0.05), but increased significantly in treatment group(P＜0.05).[Conclusion] The effect of Zhigancao Decoction combined with routine treatments on VMC(syndrome of Qi-Yin deficiency) was remarkable. Zhigancao Decoction was effective in improving patients’ clinical symptoms and reducing myocardial cell damages.The mechanism of action might be related to inhibition of inflammatory responses and anti-oxidative stress reactions. |
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