目的 探讨人参养荣汤对血管迷走性晕厥(VVS)患者生物节律的改善效果。方法 选取2022年1月至2024年1月宁波大学附属第一医院收治的97例VVS患者作为研究对象, 随机分为观察组(n=48)和对照组(n=49), 并采用倾向性评分匹配法按照1∶1匹配后, 两组各为45例。对照组采用常规治疗, 观察组采用常规治疗联合人参养荣汤治疗。比较两组患者治疗前后血清电解质水平、血液流变学、激素水平及中医证候评分变化; 重点比较分析患者治疗前后生物节律指标变化, 并采用广义估计方程(GEE)模型分析其改善情况; 采用Pearson进行相关性分析, 采用双重差分全模型分析患者治疗效果。结果 与对照组相比, 观察组VVS治疗效果得到显著改善(P<0.05); 与治疗前相比, 两组患者治疗2、4周正常窦性心搏间期标准差(SDNN)、每5 min窦性心搏间期平均值的标准差(SDANN)、相邻窦性心搏间期差值的均方根(rMSSD)、相邻窦性心搏间期差值>50 ms的心搏数百分比(PNN50)、低频(LF)、LF/高频(HF)、钠、钙、氯水平明显升高, HF、钾、磷、纤维蛋白原(Fib)、全血低切黏度(LBV)、血浆黏度(PV)、全血高切黏度(HBV)、肾上腺素(AD)、催乳素(PRL)、皮质醇(Cor)水平明显降低, 且观察组上述指标水平变化明显大于对照组(P<0.05); Pearson相关分析表明患者SDNN、SDANN、rMSSD、PNN50、LF、LF/HF水平分别与血清钠、钙、氯水平呈正相关(r>0, P<0.05), 与钾、磷、Fib、LBV、PV、HBV、AD、PRL、Cor呈负相关(r<0, P<0.05), 而HF水平分别与血清钠、钙、氯水平呈负相关(r<0, P<0.05), 与钾、磷、Fib、LBV、PV、HBV、AD、PRL、Cor呈正相关(r>0, P<0.05); GEE模型分析结果显示, 观察组SDNN、SDANN、rMSSD、PNN50、LF、HF、LF/HF的改善情况均优于对照组(P<0.05); 治疗后两组患者中医证候主症、次症评分均明显低于治疗前, 且观察组明显低于对照组(P<0.05); 双重差分全模型结果显示观察组对中医证候主症评分(β=-1.501, P<0.001)、次症评分(β=-6.488, P<0.001)的改善明显优于对照组, 且治疗后观察组总有效率(91.11%)显著高于对照组(73.33%)。结论 采用人参养荣汤治疗VVS患者能显著降低其血液流变学及激素水平, 调节血清电解质水平, 并能促进其生物节律的改善以及提高生活质量, 可在临床推广应用。
Objective To explore the improvement effect of Renshen Yangrong Decoction on the biological rhythm of patients with vasovagal syncope (VVS). Methods A total of 97 VVS patients admitted to the First Affiliated Hospital of Ningbo University from January 2022 to January 2024 were selected as the research subjects and randomly divided into observation group (n=48) and control group (n=49). Propensity score matching method was used to match them in a 1∶1 ratio, with 45 patients in each group. The control group received conventional treatment, while the observation group was treated with Renshen Yangrong Decoction on the basis of the control group's treatment. Changes in serum electrolyte levels, hemorheology, hormone levels, and traditional Chinese medicine (TCM) syndrome scores were compared between the two groups of patients before and after treatment. Changes in biological rhythm indicators of patients before and after treatment were compared and analyzed, and generalized estimating equation (GEE) model was used to analyze their improvement. Pearson correlation analysis was conducted, and difference-in-difference model was used to analyze the treatment efficacy of patients. Results Compared with the control group, the treatment effect of VVS in the observation group was significantly improved (P<0.05). Compared with before treatment, the levels of standard deviation of R-R intervals (SDNN), standard deviation of the averages of NN intervals (SDANN), root mean square of successive differences (rMSSD), percentage of successive RR intervals that differ by more than 50 ms (PNN50), low frequency (LF), LF/high frequency (HF), sodium, calcium, and chlorine in both groups of patients significantly increased after 2 and 4 weeks of treatment, while the levels of HF, potassium, phosphorus, fibrinogen (Fib), low shear blood viscosity (LBV), plasma viscosity (PV), high shear blood viscosity (HBV), adrenaline (AD), prolactin (PRL), and cortisol (Cor) significantly decreased. Moreover, the changes in these indicators in the observation group were significantly greater than those in the control group (P<0.05). Pearson correlation analysis showed that the levels of SDNN, SDANN, rMSSD, PNN50, LF, and LF/HF in patients were positively correlated with sodium, calcium, and chlorine (r>0, P<0.05), and negatively correlated with potassium, phosphorus, Fib, LBV, PV, HBV, AD, PRL, and Cor (r<0, P<0.05). HF levels were negatively correlated with sodium, calcium, and chlorine (r<0, P<0.05), and positively correlated with potassium, phosphorus, Fib, LBV, PV, HBV, AD, PRL, and Cor (r>0, P<0.05). The results of GEE model analysis showed that the improvement of SDNN, SDANN, rMSSD, PNN50, LF, HF, and LF/HF in the observation group was better than that in the control group (P<0.05). After treatment, the scores of the main and secondary symptoms of TCM syndromes in both groups of patients were significantly lower than before treatment, and the observation group was significantly lower than the control group (P<0.05). The results of the difference-in-difference model showed that the improvement of the main symptom score (β=-1.501, P<0.001) and secondary symptom score (β=-6.488, P<0.001) of the observation group was significantly better than that of the control group, and the total effective rate of the observation group (91.11%) was significantly higher than that of the control group (73.33%) after treatment. Conclusion The use of Renshen Yangrong Decoction in the treatment of VVS patients can significantly reduce their hemorheology and hormone levels, regulate serum electrolyte levels, and promote the improvement of their biological rhythms and quality of life, which can be widely applied in clinical practice.
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