黄芪注射液联合牛磺酸对急性病毒性心肌炎患者免疫功能的影响
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摘要
目的:探讨黄芪注射液联合牛磺酸对急性病毒性心肌炎(AVMC)患者免疫功能的影响。方法:选取2014年4月至2017年5月阜外华中心血管病医院收治的AVMC患者135例作为研究对象,按照随机数字表法分为对照组(n=67)和观察组(n=68)。对照组给予常规治疗+牛磺酸治疗,观察组在对照组的基础上给予黄芪注射液治疗,2组均连续治疗4周。统计2组治疗后临床疗效、各中医证候积分及总积分;检测2组治疗前后心肌酶谱指标、血清炎性反应递质及细胞免疫指标。结果:治疗后观察组临床总有效率为92. 65%,显著高于对照组的68. 66%,差异有统计学意义(P <0. 05);与治疗前比较,治疗后2组心悸、胸闷、肢冷出汗、头晕、气短乏力积分及总积分显著降低,且观察组显著低于对照组,差异有统计学意义(P <0. 05);与治疗前比较,治疗后2组血清乳酸脱氢酶(LDH)、肌酸激酶(CK)、磷酸肌酸激酶同工酶(CKMB)、心肌肌钙蛋白(c Tn I)水平和肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、超敏C反应蛋白(hs-CRP)水平显著降低,且观察组显著低于对照组,差异有统计学意义(P <0. 05);与治疗前比较,治疗后2组全血CD3~+、CD4~+、NK比例及观察组CD4~+/CD8~+显著升高,且观察组显著高于对照组,差异有统计学意义(P <0. 05);治疗后2组全血CD8~+与治疗前及组间差异无统计学意义(P> 0. 05),对照组CD4~+/CD8~+与治疗前比较,差异无统计学意义(P> 0. 05)。结论:黄芪注射液联合牛磺酸可显著缓解AVMC患者临床症状,降低炎性反应,提高其免疫功能,改善心肌功能,且疗效优于单独牛磺酸治疗。
Objective: To explore the effects of astragalus injection combined with taurine on immune function of acute viral myocarditis( AVMC) patients. Methods: A total of 135 cases AVMC patients admitted to Fuwai Central China Cardiovascular Hospital from April 2014 to May 2017 were selected and divided into a control group( n = 67) and an observation group( n = 68) according to random number table method. The control group received conventional treatment + taurine treatment,and the observation group was treated with astragalus injection on the basis of the control group. Both groups were all treated continuously for 4 weeks. The clinical curative effect,traditional Chinese medicine syndrome scores and total scores in the 2 groups were calculated after treatment; the myocardial enzyme spectrum,serum inflammatory cytokines and cellular immunity index in the 2 groups were measured before and after treatment. Results: The total clinical efficiency in the observation group after treatment was 92. 65%,which was significantly higher than that 68. 66% in control group( P < 0. 01); compared with before treatment,the palpitations,chest tightness,limb cold and sweating,dizziness,shortness of breath and weakness scores and total scores in the 2 groups decreased significantly after treatment( P < 0. 01),and the observation group was significantly lower than the control group( P < 0. 05 or P <0. 01); compared with before treatment,the serum LDH,CK,CK-MB,c Tn I levels,and IL-6,TNF-α,hs-CRP levels in the 2 groups decreased significantly after treatment( P < 0. 01),and the observation group was significantly lower than the control group( P <0. 01); compared with before treatment,the proportion of whole blood CD3~+,CD4~+,NK in the 2 groups and CD4~+/CD8~+in the observation group increased significantly after treatment( P < 0. 01),and the observation group was significantly higher than the control group( P < 0. 01); there was no significant difference in the proportion of whole blood CD8~+between before and after treatment as well as the 2 groups after treatment. The CD4~+/CD8~+of control group had no difference compared with before treatment( P > 0. 05). Conclusion: Astragalus injection combined with taurine can significantly alleviate the clinical symptoms of AVMC patients,reduce the inflammatory response,enhance their immune function and improve myocardial function,and the efficacy is significantly better than taurine treatment alone.
Objective: To explore the effects of astragalus injection combined with taurine on immune function of acute viral myocarditis( AVMC) patients. Methods: A total of 135 cases AVMC patients admitted to Fuwai Central China Cardiovascular Hospital from April 2014 to May 2017 were selected and divided into a control group( n = 67) and an observation group( n = 68) according to random number table method. The control group received conventional treatment + taurine treatment,and the observation group was treated with astragalus injection on the basis of the control group. Both groups were all treated continuously for 4 weeks. The clinical curative effect,traditional Chinese medicine syndrome scores and total scores in the 2 groups were calculated after treatment; the myocardial enzyme spectrum,serum inflammatory cytokines and cellular immunity index in the 2 groups were measured before and after treatment. Results: The total clinical efficiency in the observation group after treatment was 92. 65%,which was significantly higher than that 68. 66% in control group( P < 0. 01); compared with before treatment,the palpitations,chest tightness,limb cold and sweating,dizziness,shortness of breath and weakness scores and total scores in the 2 groups decreased significantly after treatment( P < 0. 01),and the observation group was significantly lower than the control group( P < 0. 05 or P <0. 01); compared with before treatment,the serum LDH,CK,CK-MB,c Tn I levels,and IL-6,TNF-α,hs-CRP levels in the 2 groups decreased significantly after treatment( P < 0. 01),and the observation group was significantly lower than the control group( P <0. 01); compared with before treatment,the proportion of whole blood CD3~+,CD4~+,NK in the 2 groups and CD4~+/CD8~+in the observation group increased significantly after treatment( P < 0. 01),and the observation group was significantly higher than the control group( P < 0. 01); there was no significant difference in the proportion of whole blood CD8~+between before and after treatment as well as the 2 groups after treatment. The CD4~+/CD8~+of control group had no difference compared with before treatment( P > 0. 05). Conclusion: Astragalus injection combined with taurine can significantly alleviate the clinical symptoms of AVMC patients,reduce the inflammatory response,enhance their immune function and improve myocardial function,and the efficacy is significantly better than taurine treatment alone.
引文
[1]刘帅,牛珩,张金国.黄芪注射液联合曲美他嗪治疗病毒性心肌炎疗效与安全性的Meta分析[J].中国药房,2015,26(36):5113-5116.
[2]Shao L,Ma A,Figtree G,et al.Combination Therapy With Coenzyme Q10and Trimetazidine in Patients With Acute Viral Myocarditis[J].JCardiovasc Pharmacol,2016,68(2):150-154.
[3]Matsumori A,Nunokawa Y,Yamaki A,et al.Suppression of cytokines and nitric oxide production,and protection against lethal endotoxemia and viral myocarditis by a new NF-kappaB inhibitor[J].Eur J Heart Fail,2004,6(2):137-144.
[4]崔慎情.曲美他嗪联合黄芪注射液对急性病毒性心肌炎的抗炎及抗氧自由基作用[J].海南医学院学报,2018,24(7):737-739,742.
[5]曹爱华,庞艳雷,宋文静.黄芪注射液联合左卡尼汀治疗儿童病毒性心肌炎对心率减速力及心律变异性的影响[J].河北医药,2017,39(19):3003-3004,3010.
[6]陈濒珠.实用内科学[M].12版.北京:北京人民卫生出版社,2005:102-105.
[7]朱文锋.中医内科疾病诊疗常规[M].长沙:湖南科学技术出版社,1999:19-22.
[8]中华人民共和国卫生部.中药新药临床研究指导原则[S].北京:人民卫生出版社,1997:91-98.
[9]Jeserich M,Olschewski M,Kimmel S,et al.Acute results and longterm follow-up of patients with accompanying myocarditis after viral respiratory or gastrointestinal tract infection[J].Int J Cardiol,2014,174(3):853-855.
[10]于锡岭.黄芪注射液联合曲美他嗪治疗急性病毒性心肌炎的临床疗效观察[J].国际病毒学杂志,2014,21(5):226-230.
[11]张小飞.卡托普利辅助治疗病毒性心肌炎患儿的临床效果[J].中国医药,2017,12(2):198-202.
[12]王军伟,杨光,解翠,等.炎琥宁注射液联合抗病毒治疗邪毒侵心型急性病毒性心肌炎的疗效影响[J].世界中医药,2017,12(12):2988-2991.
[13]王响,田满荣,杨红梅.中医药治疗急性病毒性心肌炎临床研究进展[J].河北中医,2014,36(12):1905-1907,1908.
[14]陈苏宁,聂品晶,张虎.益心康对体外感染CVB-3病毒心肌细胞凋亡相关因子caspase-3 mRNA和颗粒酶B、穿孔素表达的影响[J].北京中医药,2016,35(12):1142-1145.
[15]彭建.黄芪珍珠母汤对病毒性心肌炎的临床疗效及血清心肌酶谱指标的影响[J].四川中医,2017,35(7):76-79.
[16]温小凤,王显,刘军利,等.黄芪注射液对病毒性心肌炎患者循环血miR及胶原指标的影响研究[J].中华医院感染学杂志,2016,26(16):3669-3670,3676.
[17]杨蓉,王亚玲,金鑫,等.替米沙坦对病毒性心肌炎小鼠脂联素及BNP表达的影响[J].贵州医药,2014,38(7):591-593.
[18]陶艳丽,曹敏,陈禧.解毒益气养阴方联合西药对病毒性心肌炎患者心功能及免疫功能的影响[J].中医药导报,2016,22(12):88-90.
[19]叶艳芳,李世林,于涛,等.黄芪注射液联合生脉饮治疗急性病毒性心肌炎的临床研究[J].中医学报,2014,29(7):1034-1035,1038.
[20]高芸.黄芪注射液与辅酶Q10联合治疗病毒性心肌炎的临床分析[J].中华全科医学,2015,13(3):506-508.
[2]Shao L,Ma A,Figtree G,et al.Combination Therapy With Coenzyme Q10and Trimetazidine in Patients With Acute Viral Myocarditis[J].JCardiovasc Pharmacol,2016,68(2):150-154.
[3]Matsumori A,Nunokawa Y,Yamaki A,et al.Suppression of cytokines and nitric oxide production,and protection against lethal endotoxemia and viral myocarditis by a new NF-kappaB inhibitor[J].Eur J Heart Fail,2004,6(2):137-144.
[4]崔慎情.曲美他嗪联合黄芪注射液对急性病毒性心肌炎的抗炎及抗氧自由基作用[J].海南医学院学报,2018,24(7):737-739,742.
[5]曹爱华,庞艳雷,宋文静.黄芪注射液联合左卡尼汀治疗儿童病毒性心肌炎对心率减速力及心律变异性的影响[J].河北医药,2017,39(19):3003-3004,3010.
[6]陈濒珠.实用内科学[M].12版.北京:北京人民卫生出版社,2005:102-105.
[7]朱文锋.中医内科疾病诊疗常规[M].长沙:湖南科学技术出版社,1999:19-22.
[8]中华人民共和国卫生部.中药新药临床研究指导原则[S].北京:人民卫生出版社,1997:91-98.
[9]Jeserich M,Olschewski M,Kimmel S,et al.Acute results and longterm follow-up of patients with accompanying myocarditis after viral respiratory or gastrointestinal tract infection[J].Int J Cardiol,2014,174(3):853-855.
[10]于锡岭.黄芪注射液联合曲美他嗪治疗急性病毒性心肌炎的临床疗效观察[J].国际病毒学杂志,2014,21(5):226-230.
[11]张小飞.卡托普利辅助治疗病毒性心肌炎患儿的临床效果[J].中国医药,2017,12(2):198-202.
[12]王军伟,杨光,解翠,等.炎琥宁注射液联合抗病毒治疗邪毒侵心型急性病毒性心肌炎的疗效影响[J].世界中医药,2017,12(12):2988-2991.
[13]王响,田满荣,杨红梅.中医药治疗急性病毒性心肌炎临床研究进展[J].河北中医,2014,36(12):1905-1907,1908.
[14]陈苏宁,聂品晶,张虎.益心康对体外感染CVB-3病毒心肌细胞凋亡相关因子caspase-3 mRNA和颗粒酶B、穿孔素表达的影响[J].北京中医药,2016,35(12):1142-1145.
[15]彭建.黄芪珍珠母汤对病毒性心肌炎的临床疗效及血清心肌酶谱指标的影响[J].四川中医,2017,35(7):76-79.
[16]温小凤,王显,刘军利,等.黄芪注射液对病毒性心肌炎患者循环血miR及胶原指标的影响研究[J].中华医院感染学杂志,2016,26(16):3669-3670,3676.
[17]杨蓉,王亚玲,金鑫,等.替米沙坦对病毒性心肌炎小鼠脂联素及BNP表达的影响[J].贵州医药,2014,38(7):591-593.
[18]陶艳丽,曹敏,陈禧.解毒益气养阴方联合西药对病毒性心肌炎患者心功能及免疫功能的影响[J].中医药导报,2016,22(12):88-90.
[19]叶艳芳,李世林,于涛,等.黄芪注射液联合生脉饮治疗急性病毒性心肌炎的临床研究[J].中医学报,2014,29(7):1034-1035,1038.
[20]高芸.黄芪注射液与辅酶Q10联合治疗病毒性心肌炎的临床分析[J].中华全科医学,2015,13(3):506-508.