目的 测定慢性心力衰竭患者血清长正五聚蛋白3(pentraxin 3,PTX-3)、血清CA125(serum carbohydrate antigen 125,CA125)的表达水平及以“运脾转枢”学术思想为指导的中西医结合治疗对其的影响.方法 将80例慢性心力衰竭患者随机分为治疗组40例和对照组40例,对照组采用常规抗慢性心力衰竭治疗,治疗在对照组常规抗心力衰竭基础上又根据中医辨证分型为:①心肾阳虚,脾阳不振,气不化水型24例;②肺失通调,脾不健运,肝郁气滞型16例.以“运脾转枢”法加减用药,观察两组治疗前后患者血清PTX-3、CA125的表达水平.结果 ①慢性心力衰竭患者血清中PTX-3、CA125水平较高,且PTX-3、CA125水平上升趋势与心功能分级呈正相关(r=0.267,P=0.002);②中西医结合治疗能显著降低慢性心力衰竭患者外周血清的PTX-3、CA125水平,治疗后治疗组PTX-3及CA125均明显降低,两组比较差异有统计学意义(P＜0.05).结论 ①慢性心力衰竭患者血清PTX-3、CA125浓度与心功能分级呈正相关,可作为心衰严重程度及预后的指标;②以“运脾转枢”学术思想为指导的中西医结合治疗能显著降低患者外周血清PTX-3、CA125的表达水平,对临床治疗和预防心力衰竭进展具有重要意义,值得临床推广应用.%Objective To test the levels of serum PTX-3,CA125 in patients with chronic heart failure (CHF) and discuss the influence of combined treatment of traditional Chinese medicine (TCM) and western medicine (WM) guided by the academic thought "transport with the spleen" on PTX-3,CA125.Methods 80 patients with CHF were randomly divided into treatment group and control group,40 cases in each group.Control group was treated with conventional therapy for CHF;on the basis of control group,patients in treatment group were divided into:① pattern of heart-kidney yang deficiency,spleen yang deficiency,qi failing to promote water translation (24 cases),② pattern of lung governing regulation,spleen governing regulation deficiency,liver qi depression (16 cases) according to syndrome differentiation of TCM,added and subtracted drugs according to the thought "transport with the spleen".Observed the levels of serum PTX-3,CA125 of two groups before and after treatment.Results ① The levels of serum PTX-3,CA125 in patients with CHF were high,the rising trend of the levels of serum PTX-3,CA125 was positively related with cardiac functional classification (r=0.267,P=0.002).② Combined treatment of TCM and WM significantly decreased the levels of serum PTX-3,CA125 in patients with CHF,there were statistically significant differences in the levels of serum PTX-3,CA 125 after treatment between two groups (P＜0.05).Conclusions ① The levels of serum PTX-3,CA125 in patients with CHF are positively related with cardiac functional classification,which can be used as predictive indexes of severity and prognosis of CHF.② Combined treatment of TCM and WM guided by the academic thought "transport with the spleen" can significantly decreased the levels of serum PTX-3,CA125 in patients,which takes an important part in clinical treatment and preventing the process of CHF,worthy of clinical application.
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