作者：石炜琦，刘水花，张诗雨，黄敏，蔡宗余，卢健棋

单位：

1.广西中医药大学2.广西中医药大学第一附属医院心血管内科

Units：

1.Guangxi University of Chinese Medicine, Nanning 530001, China2.Cardiovascular Internal Medicine, the First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning 530023,China

关键词：

慢性心力衰竭; 抑郁状态; 强心汤; 耳穴埋针;

Keywords：

Chronic heart failure; Depression; Qiangxin decoction; Auricular acupuncture

CLC：

DOI：

10.12114/j.issn.1008-5971.2023.00.076

Funds：

国家自然科学基金资助项目（81673891,82160887）； 广西自然科学基金资助项目（2021GXNSFBA196018）；

摘要：

目的 探讨强心汤联合耳穴埋针治疗慢性心力衰竭（CHF）合并抑郁状态患者的临床疗效。方法 选取2020年9月至2022年4月广西中医药大学第一附属医院收治的CHF合并抑郁状态患者120例为研究对象，采用随机数字表法将其分为西药组（A组）、强心汤组（B组）、耳穴埋针组（C组）、强心汤+耳穴埋针组（D组），每组30例。本研究脱落3例患者，最后共纳入117例患者，其中A组30例、B组28例、C组30例、D组29例。A组患者给予西医常规治疗，B组患者在A组治疗基础上给予强心汤口服，C组患者在A组治疗基础上给予耳穴埋针治疗，D组患者在A组治疗基础上给予强心汤联合耳穴埋针治疗，均连续治疗4周。分别于治疗前、治疗后评估患者中医证候积分（分为主症、次症积分），采用汉密尔顿抑郁量表（HAMD）评估患者抑郁程度，采用酶联免疫吸附试验（ELISA）检测实验室检查指标[N末端脑钠肽前体（NT-proBNP）、心肌肌钙蛋白I(cTnI)、5-羟色胺（5-HT）、多巴胺（DA）]，采用心脏彩超测定左心室舒张末期内径（LVEDD）及左心室射血分数（LVEF），治疗后评定心力衰竭临床疗效及抑郁临床疗效，统计患者治疗期间不良反应发生情况。结果 四组治疗后主症、次症积分分别较本组治疗前降低（P<0.05）；治疗后，B组和C组主症、次症积分较A组降低，D组主症、次症积分较A组、B组、C组降低（P<0.05）。四组治疗后HAMD评分、NT-proBNP、cTnI分别较本组治疗前降低，5-HT、DA、LVEF分别较本组治疗前升高，LVEDD分别较本组治疗前缩小（P<0.05）；治疗后，B组和C组HAMD评分、NT-proBNP、cTnI较A组降低，5-HT、DA、LVEF较A组升高，LVEDD较A组缩小（P<0.05）；治疗后，C组HAMD评分较B组降低（P<0.05）；治疗后，D组HAMD评分、NT-proBNP、cTnI较A组、B组、C组降低，5-HT、DA、LVEF较A组、B组、C组升高，LVEDD较A组、B组、C组缩小（P<0.05）。D组心力衰竭、抑郁临床疗效总有效率高于A组（P<0.05）。四组不良反应发生率比较，差异无统计学意义（P>0.05）。结论 强心汤联合耳穴埋针可有效降低CHF合并抑郁状态患者中医证候积分，减轻抑郁程度，改善心功能及减轻左心室重构，提高临床疗效。

Abstract：

Objective To investigate the clinical effect of Qiangxin decoction combined with auricular acupuncturein the treatment of chronic heart failure (CHF) patients complicated with depression. Methods A total of 120 patients with CHFcomplicated with depression treated in the First Affiliated Hospital of Guangxi University of Chinese Medicine from September2020 to April 2022 were selected. The patients were divided into western medicine group (group A) , Qiangxin decoction group(group B) , auricular acupuncture group (group C) , and Qiangxin decoction+auricular acupuncture group (group D) by randomnumber table method, with 30 cases in each group. In this study, 3 cases were lost, and 117 cases were included, including 30cases in group A, 28 cases in group B, 30 cases in group C and 29 cases in group D. Patients in group A were given standardwestern medicine treatment, patients in group B were given Qiangxin decoction on the basis of treatment in group A, patientsin group C were given auricular acupuncture on the basis of treatment in group A, and patients in group D were given Qiangxin decoction combined with auricular acupuncture on the basis of treatment in group A, all were continuously treated for 4 weeks. TheTCM symptom score (including primary symptoms score and secondary symptoms score) was evaluated, the degree of depressionwas assessed using the Hamilton Depression Scale (HAMD) , laboratory examination indexes [N-terminal pro-brain natriureticpeptide(NT-proBNP) , cardiac troponin I (cTnI) , 5-hydroxytryptamine (5-HT) and dopamine (DA) ] were measured by enzymelinked immunosorbent assay (ELISA) , and left ventricular end diastolic dimension (LVEDD) and left ventricular ejection fraction(LVEF) were measured by cardiac color Doppler before and after treatment, the clinical efficacy of heart failure and depressionwere evaluated after treatment, and adverse reactions during treatment was counted. Results After treatment, the primarysymptoms and secondary symptoms score in the four groups decreased compared with those before treatment respectively (P <0.05) . After treatment, the primary symptoms score and secondary symptoms score in group B and group C were lower than thosein group A, the primary symptoms score and secondary symptoms score in group D were lower than those in group A, group B andgroup C (P < 0.05) . After treatment, the HAMD score, NT-proBNP, cTnI in the four groups decreased compared with those beforetreatment, 5-HT, DA, LVEF in the four groups elevated compared with those before treatment, LVEDD in the four groups reducedcompared with this before treatment, respectively (P < 0.05) . After treatment, the HAMD score, NT-proBNP, cTnI in group B andgroup C were lower than those in group A, 5-HT, DA, LVEF in group B and group C were higher than those in group A, LVEDD ingroup B and group C was smaller than that in group A (P < 0.05) ; after treatment, the HAMD score in group C was lower than thatin group B (P < 0.05) ; after treatment, the HAMD score, NT-proBNP, cTnI in group D were lower than those in group A, groupB and group C, 5-HT, DA, LVEF in group D were higher than those in group A, group B and group C, LVEDD in group D wassmaller than that in group A, group B and group C (P < 0.05) . The total effective rate of heart failure and depression in group Dwere higher than those in group A (P < 0.05) . There was no statistically significant difference in the incidence of adverse reactionsamong the four groups (P > 0.05) . Conclusion Qiangxin decoction combined with auricular acupuncture can reduce the TCMsyndrome score of patients with CHF complicated with depression, reduce the degree of depression, improve cardiac function,reduce left ventricular remodeling, and improve clinical efficacy.

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