加味真武汤联合盐酸伊伐布雷定片治疗慢性心力衰竭阳虚水泛证临床研究

Clinical Study of Modified Zhenwu Decoction Combined with Ivabradine Hydro⁃ chloride Tablets in Treating Chronic Heart Failure with Yang Deficiency and Water Overflow Syndrome

摘要:

目的：观察加味真武汤联合盐酸伊伐布雷定片治疗慢性心力衰竭（CHF） 阳虚水泛证的临床疗效。方法：选取2023年8月—2025年5月于许昌中医院就诊的90例CHF阳虚水泛证患者，采用随机数字表法分为研究组和对照组各45例。所有患者均接受常规标准化治疗，对照组予盐酸伊伐布雷定片口服，研究组在对照组基础上给予加味真武汤治疗，2组均连续治疗12周。评价2组临床疗效，比较2组治疗前后心功能、血清学指标、炎症因子、中医证候积分、运动耐力。结果： 研究组总有效率为95.56% （43/45）， 高于对照组82.22%（37/45）（P＜0.05）。治疗后，2组左室舒张末期内径（LVEDD） 较治疗前降低，心排血量（CO）、左室射血分数（LVEF） 较治疗前升高（P＜0.05）；且研究组LVEDD低于对照组，CO、LVEF高于对照组（P＜0.05）。治疗后，2组可溶性生长刺激表达基因2蛋白（sST2）、生长分化因子-15（GDF-15）、N末端脑钠肽前体（NT-proBNP）、单核细胞趋化蛋白-1（MCP-1）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α） 水平较治疗前降低（P＜0.05）； 且研究组sST2、GDF-15、NT-proBNP、MCP-1、IL-6、TNF-α 水平低于对照组（P＜0.05）。治疗后，2 组中医证候积分较治疗前降低，6 min 内最大步行距离（6MWD） 较治疗前增加（P＜0.05）；且研究组中医证候积分低于对照组，6MWD大于对照组（P＜0.05）。2组不良反应发生率比较，差异无统计学意义（P＞0.05）。结论：加味真武汤联合盐酸伊伐布雷定片治疗CHF阳虚水泛证临床效果较好，能减轻患者心衰症状，减缓心室重构，降低炎症因子水平，促进机体运动耐力恢复，且使用安全性较好。

Abstract:

Abstract：Objective：To observe the clinical efficacy of modified Zhenwu Decoction combined with Ivabradine Hydrochloride Tablets in treating chronic heart failure （CHF） with yang deficiency and water overflow syndrome. Methods：A total of 90 CHF patients with yang deficiency and water overflow syndrome admitted to Xuchang Hospital of Traditional Chinese Medicine from August 2023 to May 2025 were selected and randomly divided into a study group and a control group using the random number table method， with 45 cases in each group. All patients received conventional standard treatment. The control group received Ivabradine Hydrochloride Tablets， while the study group received modified Zhenwu Decoction in addition to the control group's regimen. Both groups were treated continuously for 12 weeks. Clinical efficacy was evaluated， and cardiac function， serological indicators， inflammatory factors， traditional Chinese medicine syndrome scores，and exercise tolerance were compared before and after treatment between the two groups. Results：The total effective rate was 95.56%（ 43/45） in the study group，significantly higher than that of 82.22%（ 37/45） in the control group（ P＜0.05）. After treatment，left ventricular end-diastolic dimension（ LVEDD） decreased in both groups， while cardiac output （CO） and left ventricular ejection fraction （LVEF） increased （P＜ 0.05）. The study group had lower LVEDD and higher CO and LVEF than the control group （P＜0.05）. Soluble growth stimulation expressed gene 2 protein （sST2）， growth differentiation factor-15 （GDF-15）， N-terminal pro-brain natriuretic peptide （NT-proBNP），monocyte chemoattractant protein-1 （MCP-1），interleukin-6 （IL-6），and tumor necrosis factor-alpha （TNF-α） levels decreased in both groups （P＜0.05），with lower levels in the study group （P＜ 0.05）. Traditional Chinese medicine syndrome scores decreased in both groups， while the 6-minute walking distance （6MWD） increased （P＜0.05）. The study group had lower traditional Chinese medicine syndrome scores and a greater 6MWD than the control group （P＜0.05）. No significant difference was observed in the incidence of adverse reactions between the two groups （P＞0.05）. Conclusion： Modified Zhenwu Decoction combined with Ivabradine Hydrochloride Tablets demonstrates good clinical efficacy in treating CHF with yang deficiency and water overflow syndrome. It alleviates heart failure symptoms， delays ventricular remodeling， reduces inflammatory factor levels， promotes exercise tolerance recovery，and exhibits favorable safety.