| 引用本文:张晶，马强，陈荣.益气固本祛瘀汤联合血管紧张素受体阻滞剂防治糖尿病心肌病患者心室重构的疗效及对血液流变学、TGF-β、TNF-α、VEGF的影响[J].世界中医药,2018,(04):. |
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| 益气固本祛瘀汤联合血管紧张素受体阻滞剂防治糖尿病心肌病患者心室重构的疗效及对血液流变学、TGF-β、TNF-α、VEGF的影响 |
| Clinical Observation on Yiqi Guben Quyu Decoction Combined with Angiotensin Receptor Blocker (ARB) in Prophylaxis and Treatment of Ventricular Remodeling on Patients with Diabetic Cardiomyopathy |
| 投稿时间：2017-09-25 |
| DOI：10.3969/j.issn.1673-7202.2018.04.021 |
| 中文关键词: 益气固本祛瘀汤 血管紧张素受体阻滞剂 糖尿病心肌病 心室重构 血液流变学 |
| English Keywords:Yiqi Guben Quyu decoction Angiotensin receptor blockers Diabetic cardiomyopathy Ventricular remodeling Hemorheology |
| 基金项目:陕西省卫生厅医学联合基金项目（2015211C209） |
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| 中文摘要: |
| 目的:观察益气固本祛瘀汤联合血管紧张素受体阻滞剂(ARB)类药物防治糖尿病心肌病(DCM)患者心室重构的疗效及对血液流变学、血清转化生长因子-β(TGF-β)、肿瘤坏死因子-α(TNF-α)、血管内皮生长因子(VEGF)的影响。方法：选取140例DCM患者，按照随机数字表分为观察组和对照组，每组70例，2组均给予常规基础治疗，对照组在以上常规基础治疗上给予替米沙坦片(80 mg/次，1次/d)，观察组在对照组基础上给予自拟益气固本祛瘀汤治疗，2组疗程为6个月；观察2组治疗前、治疗后3个月、6个月心脏超声学检查、心电学检查相关指标；记录2组治疗前、治疗后3个月、6个月不同性别的心室重构的发生率。检测不同时间点血液流变学、血清TGF-β、TNF-α、VEGF水平的变化。结果：观察组治疗后3个月、6个月LVEF、LVEDD、LVESD、LVMI、SDNN、SDANN、SDNN5、rMSSD均显著改善，观察组上述指标的改善情况均优于对照组(P<0.05)；2组治疗后3个月、6个月的心室重构发生率均显著降低(P均＜0.05)，观察组改善情况均优于对照组(P<0.05)；2组治疗后全血黏度(高切、低切)、血浆黏度、纤维蛋白原、红细胞聚集指数、血清TGF-β、TNF-α、VEGF水平均显著降低，观察组上述指标均低于对照组(P<0.05)。结论：益气固本祛瘀汤联合ARB类药物能够显著改善DCM患者心室重构和电重构，提高心肌功能，其机制可能与其改善血液流变学，抑制血清TGF-β、TNF-α、VEGF水平表达有关。 |
| English Summary: |
| To observe the effects of Yiqi Guben Quyu Decoction combined with angiotensin receptor blocker (ARB) on prophylaxis and treatment of ventricular remodeling in patients with diabetic cardiomyopathy (DCM) and its effects on hemorheology, serum transforming growth factor-β (TGF-β), tumor necrosis factor-α (TNF-α) and vascular endothelial growth factor (VEGF). Methods:A total of 140 patients with DCM were divided into observation group (70 cases) and control group (70 cases) according to the random number table admitted and treated in Yan'an Hospital of TCM from November 2014 to November 2016. Both groups of patients were given conventional basic therapy. The control group patients were treated with telmisartan tablets (80 mg / time, 1 time /day) on the basis of conventional basic therapy, and the observation group patients were treated on the basis of the control group by self-made Yiqi Guben Quyu Decoction. Patients of both groups were treated for 6 months; cardiac ultrasonography and electrocardiography related indexes of the two groups before treatment, 3 months and 6 months after treatment were observed; The incidence rate of ventricular remodeling of different sexes of the two groups before treatment, 3 months and 6 months after treatment was caculated. Blood rheology, serum TGF-β, TNF-α and VEGF levels were measured at the above time points. Results:The levels of LVEF, LVEDD, LVESD, LVMI, SDNN, SDANN, SDNN5 and rMSSD were significantly improved in the observation group after 3 months' and 6 months' treatment. The improvement of the above indexes was better than those of the control group (P<0.05); The incidence rates of ventricular remodeling were significantly lower in the two groups after 3 months' and 6 months' treatment (P<0.05); The improvement of patients in the observation group was better than that in the control group (P<0.05); Whole blood viscosity, plasma viscosity, fibrinogen, erythrocyte aggregation index, serum TGF-β, TNF-α and VEGF levels were significantly lower in the two groups after treatment. The above indexes were lower than those in the control group (P<0.05). Conclusion:Yiqi Guben Quyu Decoction combined with ARB can significantly improve ventricular remodeling and electrical remodeling and improve myocardial function in DCM patients. The mechanism may be related to the improvement of hemorheology and the inhibition of serum TGF-β, TNF-α and VEGF expression. |
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