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Article(id=1322926175030485375, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322925862630339452, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.07.045, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793339778907, onlineDateStr=2026-10-30, pubDate=1752076800000, pubDateStr=2025-07-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793339778907, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793339778907, creator=13701087609, updateTime=1793339778907, updator=13701087609, issue=Issue{id=1322925862630339452, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='7', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1752076800000', pubDateStr='2025-07-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793339704424, creator='13701087609', updateTime=1793340532184, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322929334587105328, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322925862630339452, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322929334587105329, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322925862630339452, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=225, endPage=228, ext={EN=ArticleExt(id=1322926175236006272, articleId=1322926175030485375, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Related Factors of Senile CHD Patients Complicated with Weakness and The Effect of Gancao Xiexin Decoction（甘草泻心汤）and Modified LI Ke’ s Shensiwei（李可肾四味加减）, columnId=1256183365644968140, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Platform of Provincial Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the risk factors of elderly patients with coronary heart disease（CHD）and weakness and the effect of using traditional Chinese medicine Gancao Xiexin Decoction（甘草泻心汤）combined with Modified LI Ke’s Shensiwei（李可肾四味加减）.

Methods

A total of 120 elderly CHD patients complicated with weakness who received the treatment in the hospital from February 2020 to February 2021 were as the weakness group，and another 120 elderly CHD patients without weakness were as the non weakness group to analyze the risk factors that caused weakness. The weakness group was randomly divided into a combination group and a Western medicine group，with 60 cases in each. The Western medicine group received conventional Western medicine treatment，while the combination group received additional treatment with Gancao Xiexin Decoction combined with Modified LI Ke’s Shensiwei on the basis of the Western medicine group. The treatment courses were both 12 weeks，and the differences in treatment effects between the two groups were compared.

Results

（1）According to Logistic regression model analysis，decreased body mass index（BMI），complicated with acute coronary syndrome，increased Mini Nutritional Assessment Short Form（MNA-SF）score and Charlson comorbidity index were independent risk factors for weakness in elderly CHD patients（P<0.05）. Increased Charlson comorbidity index was an independent risk factor for weakness in elderly CHD patients（P<0.05）. The elevated levels of albumin（ALB）and total protein（TP）can effectively reduce the risk of weakness in elderly CHD patients and were protective factors（P<0.05）.（2）Before treatment，there was no significant difference in serum hemoglobin（Hb），ALB，TP or prealbumin（PA）between the Western medicine group and the combination group（P>0.05）. After treatment，the serum levels of Hb，ALB，TP and PA of the two groups were significantly increased compared to those before treatment（P<0.05），while the serum levels of Hb，ALBand PA of the combination group were higher than those of the Western medicine group（P<0.05）. Before treatment，the grip strength，the levels of Timed Up and Go Test（TUG）and Functional Sit-to-Stand Test（FTSS）between the western and combination groups were not significant（P>0.05）. After treatment，the grip strength of both groups was significantly improved and the levels of TUG and FTSS were significantly reduced（P<0.05）. The grip strength in the combination group was higher than that in the Western medicine group，and the TUGwas lower than that in the Western medicine group（P<0.05）.

Conclusion

Malnutrition and comorbidities are risk factors for concurrent weakness in elderly CHD patients. On the basis of the basic treatment plan of Western medicine，the addition of traditional Chinese medicine Gancao Xiexin Decoction combined with Modified LI Ke’s Shensiwei can significantly improve the treatment effect.

, authors=Ru LI, Shucan MA, Hong XIAO, Junqi YING, Zhifen LIU, authorsList=Ru LI, Shucan MA, Hong XIAO, Junqi YING, Zhifen LIU, authorCompany=null, correspAuthors=Zhifen LIU, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322926179765854627, articleId=1322926175030485375, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=老年冠心病并发衰弱的相关因素及甘草泻心汤加李可肾四味增减治疗效果, columnId=1256183369033965799, journalTitle=中华中医药学刊, columnName=省级项目平台, runingTitle=null, highlight=null, articleAbstract=
目的

探讨老年冠心病（Coronary heart disease，CHD）患者并发衰弱的危险因素及采取中医甘草泻心汤加李可肾四味增减治疗的效果。

方法

选取2020年2月—2021年2月在医院接受治疗的老年CHD且合并衰弱患者120例作为衰弱组、另外选取120例不合并衰弱的老年CHD患者作为非衰弱组，分析引起CHD患者发生衰弱的危险因素；将衰弱组患者采用随机数字表分为联合组和西医组各60例，西医组采用常规西医治疗方案，联合组在西医组基础上加用中医甘草泻心汤加李可肾四味增减治疗，疗程均为12周，对比两组治疗效果差异。

结果

（1）经Logistic回归模型分析，体质量指数（Body mass index，BMI）降低、合并急性冠脉综合征、微营养评估（Mini Nutritional Assessment Short Form，MNASF）评分增高、Charlson共病指数增高是老年CHD患者发生衰弱的独立危险因素（P<0.05），白蛋白（Albumin，ALB）、总蛋白（Total protein，TP）水平升高可有效降低老年CHD患者发生衰弱的风险，属于保护性因素（P<0.05）。（2）治疗前，西医组和联合组两组患者的血红蛋白（Hemoglobin，Hb）、ALB、TP、前白蛋白（Prealbumin，PA）水平差异无统计学意义（P>0.05）；治疗后，两组患者的血清Hb、ALB、TP、PA水平与治疗之前对比均显著提高（P<0.05），联合组患者的血清Hb、ALB、PA水平高于西医组（P<0.05）；治疗前，西医组和联合组两组患者的握力、起立-行走计时测试（Timed Up and Go test，TUG）、重复坐站测试（Functional Sit-to-Stand Test，FTSS）水平差异无统计学意义（P>0.05）；治疗后，两组患者的握力与治疗之前对比均显著提高，TUG、FTSS水平显著降低（P<0.05），联合组患者的握力高于西医组，TUG小于西医组（P<0.05）。

结论

营养不良和共病是老年CHD患者并发衰弱的危险因素；在西医基础治疗方案的基础上加用中医甘草泻心汤加李可肾四味增减治疗能显著提升治疗效果。

, authors=李茹, 马树灿, 肖红, 英俊岐, 刘智芬, authorsList=李茹, 马树灿, 肖红, 英俊岐, 刘智芬, authorCompany=null, correspAuthors=刘智芬, authorNote=

李茹（1985-），女，河北武邑人，主治医师，硕士，研究方向：老年心脑血管病、老年综合评估。

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刘智芬（1972-），女，衡水景县人，副主任医师，学士，研究方向：老年心血管、老年综合评估。E-mail：。
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李茹（1985-），女，河北武邑人，主治医师，硕士，研究方向：老年心脑血管病、老年综合评估。

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李茹（1985-），女，河北武邑人，主治医师，硕士，研究方向：老年心脑血管病、老年综合评估。

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articleId=1322926175030485375, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数年龄/（岁，±s）BMI/（kg/m2，±s）性别/［例（%）］吸烟/［例（%）］饮酒/［例（%）］合并疾病/［例（%）］
男女高血压糖尿病血脂异常
衰弱组12071.6±7.519.71±2.0357（47.5）63（52.5）34（28.33）28（23.33）70（58.33）37（30.83）71（59.17）
非衰弱组12070.4±6.921.85±2.2064（53.33）56（46.67）28（23.33）34（28.33）61（50.83）24（20.00）60（50.00）
t/χ21.290-7.8310.8170.7830.7831.3615.4762.054
P值0.1980.0000.3660.3760.3760.2430.0190.154
组别例数冠脉病变支数/［例（%）］NYHA心功能/［例（%）］急性冠脉综合征/［例（%）］MNA-SF评分/（分，±s）Charlson共病指数/（±s）ALB/（g/L，±s）
≤2支>2支≥Ⅱ级<Ⅱ级是否
衰弱组12052（43.33）68（56.67）61（50.83）59（49.17）33（27.50）87（72.50）10.74±2.042.39±0.8032.93±3.31
非衰弱组12062（51.67）58（48.33）40（33.33）80（66.67）18（15.00）102（85.00）12.28±2.231.64±0.6338.94±4.00
t/χ21.6717.3595.602-5.5828.068-12.681
P值0.1960.0010.0180.0000.0000.000
组别例数TP/（g/L，±s）Hb/（g/L，±s）PA/（mg/L，±s）TC/（mmol/L，±s）TG/（mmol/L，±s）HDL-C/（mmol/L，±s）LDL-C/（mmol/L，±s）
衰弱组12057.42±6.0097.42±7.04324.9±29.523.90±0.661.63±0.241.30±0.172.73±0.50
非衰弱组12071.49±6.38119.34±6.81432.8±34.04.01±0.921.57±0.311.26±0.242.86±0.64
t/χ2-17.598-24.515-26.251-1.0641.6771.490-1.753
P值0.0000.0000.0000.2880.0950.1380.081
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老年冠心病患者发生衰弱的单因素分析

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组别例数年龄/（岁，±s）BMI/（kg/m2，±s）性别/［例（%）］吸烟/［例（%）］饮酒/［例（%）］合并疾病/［例（%）］
男女高血压糖尿病血脂异常
衰弱组12071.6±7.519.71±2.0357（47.5）63（52.5）34（28.33）28（23.33）70（58.33）37（30.83）71（59.17）
非衰弱组12070.4±6.921.85±2.2064（53.33）56（46.67）28（23.33）34（28.33）61（50.83）24（20.00）60（50.00）
t/χ21.290-7.8310.8170.7830.7831.3615.4762.054
P值0.1980.0000.3660.3760.3760.2430.0190.154
组别例数冠脉病变支数/［例（%）］NYHA心功能/［例（%）］急性冠脉综合征/［例（%）］MNA-SF评分/（分，±s）Charlson共病指数/（±s）ALB/（g/L，±s）
≤2支>2支≥Ⅱ级<Ⅱ级是否
衰弱组12052（43.33）68（56.67）61（50.83）59（49.17）33（27.50）87（72.50）10.74±2.042.39±0.8032.93±3.31
非衰弱组12062（51.67）58（48.33）40（33.33）80（66.67）18（15.00）102（85.00）12.28±2.231.64±0.6338.94±4.00
t/χ21.6717.3595.602-5.5828.068-12.681
P值0.1960.0010.0180.0000.0000.000
组别例数TP/（g/L，±s）Hb/（g/L，±s）PA/（mg/L，±s）TC/（mmol/L，±s）TG/（mmol/L，±s）HDL-C/（mmol/L，±s）LDL-C/（mmol/L，±s）
衰弱组12057.42±6.0097.42±7.04324.9±29.523.90±0.661.63±0.241.30±0.172.73±0.50
非衰弱组12071.49±6.38119.34±6.81432.8±34.04.01±0.921.57±0.311.26±0.242.86±0.64
t/χ2-17.598-24.515-26.251-1.0641.6771.490-1.753
P值0.0000.0000.0000.2880.0950.1380.081
), ArticleFig(id=1322926184392171982, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926175030485375, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
因素βSEWaldsPOR95%CI
BMI0.5940.2286.7870.0001.8111.1582.832
糖尿病0.5770.4012.0700.2211.7810.8113.908
NYHA心功能0.6110.3133.8110.0611.8420.9983.402
急性冠脉综合征0.4810.1886.5460.0001.6181.1192.338
MNA-SF评分0.6690.2915.2850.0331.9521.1043.453
Charlson共病指数0.7120.3015.5950.0262.0381.1303.676
ALB-0.7110.2896.0530.0000.4910.2790.865
TP-0.8130.3325.9970.0030.4440.2310.850
Hb-0.6090.4012.3060.1750.5440.2481.194
PA-0.5520.2983.4310.0880.5760.3211.033
常数项1.3090.6044.6970.0443.7021.13312.096
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老年CHD患者发生衰弱的多因素分析

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因素βSEWaldsPOR95%CI
BMI0.5940.2286.7870.0001.8111.1582.832
糖尿病0.5770.4012.0700.2211.7810.8113.908
NYHA心功能0.6110.3133.8110.0611.8420.9983.402
急性冠脉综合征0.4810.1886.5460.0001.6181.1192.338
MNA-SF评分0.6690.2915.2850.0331.9521.1043.453
Charlson共病指数0.7120.3015.5950.0262.0381.1303.676
ALB-0.7110.2896.0530.0000.4910.2790.865
TP-0.8130.3325.9970.0030.4440.2310.850
Hb-0.6090.4012.3060.1750.5440.2481.194
PA-0.5520.2983.4310.0880.5760.3211.033
常数项1.3090.6044.6970.0443.7021.13312.096
), ArticleFig(id=1322926186216694224, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926175030485375, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数年龄/（岁，±s）BMI/（kg/m2，±s）性别/［例（%）］吸烟/［例（%）］饮酒/［例（%）］合并疾病/［例（%）］
男女高血压糖尿病血脂异常
联合组6072.3±6.119.87±1.6326（43.33）34（56.67）15（25.00）12（20.00）39（65.00）22（36.67）27（45.00）
西医组6070.8±7.319.55±1.8031（51.67）29（48.33）19（31.67）16（26.67）31（51.67）15（25.00）33（55.00）
t/χ21.2211.0210.8350.6570.4302.1941.9151.200
P值0.2240.3090.3610.4180.5120.1390.1660.273
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联合组和西医组冠心病并发衰弱患者一般资料对比

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组别例数年龄/（岁，±s）BMI/（kg/m2，±s）性别/［例（%）］吸烟/［例（%）］饮酒/［例（%）］合并疾病/［例（%）］
男女高血压糖尿病血脂异常
联合组6072.3±6.119.87±1.6326（43.33）34（56.67）15（25.00）12（20.00）39（65.00）22（36.67）27（45.00）
西医组6070.8±7.319.55±1.8031（51.67）29（48.33）19（31.67）16（26.67）31（51.67）15（25.00）33（55.00）
t/χ21.2211.0210.8350.6570.4302.1941.9151.200
P值0.2240.3090.3610.4180.5120.1390.1660.273
), ArticleFig(id=1322926186472546770, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926175030485375, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数Hb/（g/L）ALB/（g/L）TP/（g/L）PA/（mg/L）
治疗前治疗后治疗前治疗后治疗前治疗后治疗前治疗后
联合组6096.61±5.17109.42±6.61*32.54±2.9137.11±3.03*56.81±7.4468.40±5.99*321.5±32.6398.5±38.1*
西医组6098.22±5.81105.76±5.98*33.31±2.8735.78±3.36*58.03±8.1566.03±7.27*328.3±34.8384.8±35.7*
t值-1.6043.181-1.4592.277-0.8561.949-1.1052.032
P值0.1110.0020.1470.0250.3940.0540.2720.044
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联合组和西医组冠心病并发衰弱患者治疗前后营养学指标比较（±s）

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组别例数Hb/（g/L）ALB/（g/L）TP/（g/L）PA/（mg/L）
治疗前治疗后治疗前治疗后治疗前治疗后治疗前治疗后
联合组6096.61±5.17109.42±6.61*32.54±2.9137.11±3.03*56.81±7.4468.40±5.99*321.5±32.6398.5±38.1*
西医组6098.22±5.81105.76±5.98*33.31±2.8735.78±3.36*58.03±8.1566.03±7.27*328.3±34.8384.8±35.7*
t值-1.6043.181-1.4592.277-0.8561.949-1.1052.032
P值0.1110.0020.1470.0250.3940.0540.2720.044
), ArticleFig(id=1322926186900365780, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926175030485375, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数握力/（kg）TUG/（s）FTSS/（s）
治疗前治疗后治疗前治疗后治疗前治疗后
联合组6014.58±1.7415.80±1.9018.51±2.0216.24±1.5119.56±2.3817.13±1.82
西医组6014.90±1.6015.12±1.6818.94±1.9517.44±1.6319.15±2.1517.87±2.34
t值-1.0492.077-1.186-4.1830.990-1.934
P值0.2970.0400.2380.0000.3240.056
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联合组和西医组冠心病并发衰弱患者治疗前后握力、TUG、FTSS水平比较（±s）

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组别例数握力/（kg）TUG/（s）FTSS/（s）
治疗前治疗后治疗前治疗后治疗前治疗后
联合组6014.58±1.7415.80±1.9018.51±2.0216.24±1.5119.56±2.3817.13±1.82
西医组6014.90±1.6015.12±1.6818.94±1.9517.44±1.6319.15±2.1517.87±2.34
t值-1.0492.077-1.186-4.1830.990-1.934
P值0.2970.0400.2380.0000.3240.056
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老年冠心病并发衰弱的相关因素及甘草泻心汤加李可肾四味增减治疗效果
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李茹 , 马树灿 , 肖红 , 英俊岐 , 刘智芬
中华中医药学刊 | 省级项目平台 2025,43(7): 225-228
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中华中医药学刊 |省级项目平台 2025 , 43 (7) : 225 -228
老年冠心病并发衰弱的相关因素及甘草泻心汤加李可肾四味增减治疗效果
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李茹, 马树灿, 肖红, 英俊岐, 刘智芬
作者信息
  • 衡水市人民医院，河北 衡水 053000
通讯作者:
刘智芬（1972-），女，衡水景县人，副主任医师，学士，研究方向：老年心血管、老年综合评估。E-mail：。
作者简介:

李茹（1985-），女，河北武邑人，主治医师，硕士，研究方向：老年心脑血管病、老年综合评估。

Related Factors of Senile CHD Patients Complicated with Weakness and The Effect of Gancao Xiexin Decoction（甘草泻心汤）and Modified LI Ke’ s Shensiwei（李可肾四味加减）
Ru LI, Shucan MA, Hong XIAO, Junqi YING, Zhifen LIU
Affiliations
  • Hengshui People's Hospital，Hengshui 053000，Hebei，China
出版时间: 2025-07-10 doi: 10.13193/j.issn.1673-7717.2025.07.045
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摘要
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目的

探讨老年冠心病（Coronary heart disease，CHD）患者并发衰弱的危险因素及采取中医甘草泻心汤加李可肾四味增减治疗的效果。

方法

选取2020年2月—2021年2月在医院接受治疗的老年CHD且合并衰弱患者120例作为衰弱组、另外选取120例不合并衰弱的老年CHD患者作为非衰弱组，分析引起CHD患者发生衰弱的危险因素；将衰弱组患者采用随机数字表分为联合组和西医组各60例，西医组采用常规西医治疗方案，联合组在西医组基础上加用中医甘草泻心汤加李可肾四味增减治疗，疗程均为12周，对比两组治疗效果差异。

结果

（1）经Logistic回归模型分析，体质量指数（Body mass index，BMI）降低、合并急性冠脉综合征、微营养评估（Mini Nutritional Assessment Short Form，MNASF）评分增高、Charlson共病指数增高是老年CHD患者发生衰弱的独立危险因素（P<0.05），白蛋白（Albumin，ALB）、总蛋白（Total protein，TP）水平升高可有效降低老年CHD患者发生衰弱的风险，属于保护性因素（P<0.05）。（2）治疗前，西医组和联合组两组患者的血红蛋白（Hemoglobin，Hb）、ALB、TP、前白蛋白（Prealbumin，PA）水平差异无统计学意义（P>0.05）；治疗后，两组患者的血清Hb、ALB、TP、PA水平与治疗之前对比均显著提高（P<0.05），联合组患者的血清Hb、ALB、PA水平高于西医组（P<0.05）；治疗前，西医组和联合组两组患者的握力、起立-行走计时测试（Timed Up and Go test，TUG）、重复坐站测试（Functional Sit-to-Stand Test，FTSS）水平差异无统计学意义（P>0.05）；治疗后，两组患者的握力与治疗之前对比均显著提高，TUG、FTSS水平显著降低（P<0.05），联合组患者的握力高于西医组，TUG小于西医组（P<0.05）。

结论

营养不良和共病是老年CHD患者并发衰弱的危险因素；在西医基础治疗方案的基础上加用中医甘草泻心汤加李可肾四味增减治疗能显著提升治疗效果。

老年  /  冠心病  /  衰弱  /  危险因素  /  中医  /  甘草泻心汤
Objective

To explore the risk factors of elderly patients with coronary heart disease（CHD）and weakness and the effect of using traditional Chinese medicine Gancao Xiexin Decoction（甘草泻心汤）combined with Modified LI Ke’s Shensiwei（李可肾四味加减）.

Methods

A total of 120 elderly CHD patients complicated with weakness who received the treatment in the hospital from February 2020 to February 2021 were as the weakness group，and another 120 elderly CHD patients without weakness were as the non weakness group to analyze the risk factors that caused weakness. The weakness group was randomly divided into a combination group and a Western medicine group，with 60 cases in each. The Western medicine group received conventional Western medicine treatment，while the combination group received additional treatment with Gancao Xiexin Decoction combined with Modified LI Ke’s Shensiwei on the basis of the Western medicine group. The treatment courses were both 12 weeks，and the differences in treatment effects between the two groups were compared.

Results

（1）According to Logistic regression model analysis，decreased body mass index（BMI），complicated with acute coronary syndrome，increased Mini Nutritional Assessment Short Form（MNA-SF）score and Charlson comorbidity index were independent risk factors for weakness in elderly CHD patients（P<0.05）. Increased Charlson comorbidity index was an independent risk factor for weakness in elderly CHD patients（P<0.05）. The elevated levels of albumin（ALB）and total protein（TP）can effectively reduce the risk of weakness in elderly CHD patients and were protective factors（P<0.05）.（2）Before treatment，there was no significant difference in serum hemoglobin（Hb），ALB，TP or prealbumin（PA）between the Western medicine group and the combination group（P>0.05）. After treatment，the serum levels of Hb，ALB，TP and PA of the two groups were significantly increased compared to those before treatment（P<0.05），while the serum levels of Hb，ALBand PA of the combination group were higher than those of the Western medicine group（P<0.05）. Before treatment，the grip strength，the levels of Timed Up and Go Test（TUG）and Functional Sit-to-Stand Test（FTSS）between the western and combination groups were not significant（P>0.05）. After treatment，the grip strength of both groups was significantly improved and the levels of TUG and FTSS were significantly reduced（P<0.05）. The grip strength in the combination group was higher than that in the Western medicine group，and the TUGwas lower than that in the Western medicine group（P<0.05）.

Conclusion

Malnutrition and comorbidities are risk factors for concurrent weakness in elderly CHD patients. On the basis of the basic treatment plan of Western medicine，the addition of traditional Chinese medicine Gancao Xiexin Decoction combined with Modified LI Ke’s Shensiwei can significantly improve the treatment effect.

elderly  /  coronary heart disease  /  weakness  /  risk factors  /  traditional Chinese medicine  /  Gancao Xiexin Decoction（甘草泻心汤）
李茹, 马树灿, 肖红, 英俊岐, 刘智芬. 老年冠心病并发衰弱的相关因素及甘草泻心汤加李可肾四味增减治疗效果. 中华中医药学刊, 2025 , 43 (7) : 225 -228 . DOI: 10.13193/j.issn.1673-7717.2025.07.045
Ru LI, Shucan MA, Hong XIAO, Junqi YING, Zhifen LIU. Related Factors of Senile CHD Patients Complicated with Weakness and The Effect of Gancao Xiexin Decoction（甘草泻心汤）and Modified LI Ke’ s Shensiwei（李可肾四味加减）[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (7) : 225 -228 . DOI: 10.13193/j.issn.1673-7717.2025.07.045
正文
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衰弱是一种机体易损性增加、抗应激能力减退的非特异性状态，好发于老年人，与老年人群神经肌肉、代谢及免疫系统等生理储备下降有关。冠心病（Coronary heart disease，CHD）同样好发于老年人，老年CHD患者合并衰弱可增加失能、功能下降、住院和死亡的风险[1]。目前临床对于老年虚弱的研究刚刚起步，西医临床对此并无理想的治疗方法，多围绕运动锻炼、营养干预、共病和多重用药管理、多学科协作医护模式、减少医疗伤害、药物治疗等6个方面[2]。
老年衰弱并无确切的中医病名，根据其症状可将其归纳于“虚劳”之范畴，正气亏损、气血阴阳不足是其基本病机，多为脾胃不和、肾精亏虚共存。治则以益气补肾为法[3]。甘草泻心汤出自《伤寒杂病论》，脾胃不和、寒热错杂之痞证[4]。“肾四味”出自《李可老中医急危重症疑难病经验专辑》，功擅补肾益精[5]。本研究探讨老年CHD患者并发衰弱的危险因素及采取中医甘草泻心汤加李可肾四味增减治疗的效果。
1　材料与方法
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1.1　一般资料
（1）选取2020年2月—2021年2月在我院接受治疗的老年CHD且合并衰弱患者120例作为衰弱组，另外选取120例不合并衰弱的老年CHD患者作为非衰弱组，研究方案经医学伦理学委员会批准（LYSQ 2019-0012-041）。
纳入标准：①年龄≥60岁；②临床症状、心电图结果符合2014版美国心脏病学院/美国心脏协会（ACC/AHA）发布的冠心病的诊断和治疗指南；③选择性冠状动脉造影明确有1支或1支以上主要冠状动脉血管狭窄≥50%；④典型心绞痛症状或既往有明确陈旧心肌梗死病史；⑤衰弱患者的诊断标准参考2017版《老年患者衰弱评估与干预中国专家共识》[6]中的标准，Fried衰弱综合征评价为阳性。
排除标准：①患者拒绝接受衰弱筛查；②患者无法进行交流或现有临床资料无法获得有效信息来判断患者是否衰弱；③严重认知障碍、重度抑郁、重度焦虑患者；④慢性心功能不全Ⅳ级（NYHA分级）、急性心肌梗死、骨折等需卧床休息的患者。
（2）将衰弱组120例患者采用随机数字表分为联合组和西医组各60例，西医组采用常规西医治疗方案，联合组在西医组基础上加用中医甘草泻心汤加李可肾四味增减治疗，对比两组治疗效果差异。
1.2　并发衰弱相关因素分析的资料收集方法
所有研究对象入院后均进行问诊，包括年龄、性别、身高、体质量、是否吸烟、是否饮酒、是否合并高血压病、糖尿病、血脂异常、是否发生急性冠脉综合征，计算体质量指数（Body mass index，BMI）＝体质量/身高2。采用冠脉造影技术检测患者冠脉病变支数。对患者进行NYHA心功能、微营养评估（Mini Nutritional Assessment Short Form，MNA-SF）评分[7]、Charlson共病指数[8]测评。取血检测营养学指标以及血脂指标。
1.3　治疗方法
西医组采用常规西医治疗方案，包括指导患者进行康复锻炼、营养干预、用药指导、共病管理。
联合组在西医组基础上加用中医甘草泻心汤加李可肾四味增减治疗，药用：炙甘草15 g，姜半夏15 g，黄芩12 g，黄连4 g，干姜6 g，党参15 g，黄菖蒲10 g，白芷10 g，莪术15 g，大枣5枚，补骨脂15 g，菟丝子15 g，枸杞子15 g，淫羊藿15 g。上药1剂/d，水煎取汁300 mL，分两次早晚温服。疗程均为12周。
1.4　治疗相关观察指标及检测方法
对比西医组和联合组两组患者治疗前后的躯体活动能力［起立-行走计时测试（Timed Up and Go test，TUG）、重复坐站测试（Functional Sitto-Stand Test，FTSS）］、握力、营养学指标［血清白蛋白（Albumin，ALB）、血红蛋白（Hemoglobin，Hb）、总蛋白（Total protein，TP）、前白蛋白（Prealbumin，PA）］。
于治疗前、治疗12周后抽取西医组和联合组两组患者外周静脉血2 mL，室温静置半小时后离心处理，3000 r/min、10 min，取血清采用贝克曼AU5800全自动生化分析仪检测ALB、TP、PA。另取一份血标本，采用希森美康XN-2800全自动模块式血液体液分析仪检测Hb。
1.5　统计学方法
数据使用统计软件SPSS 21.0进行分析，本研究收集的ALB、TP、PA、Hb等计量资料采用均数±标准差（）进行描述，组间比较采用t检验；计数资料采用率（%）描述，数据比较采用χ2检验；多因素分析采用Logistic回归模型；P<0.05则认为差异有统计学意义。
2　结果
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2.1　老年CHD患者发生衰弱的单因素分析
经单因素分析，衰弱组和非衰弱组患者的BMI、糖尿病合并率、NYHA心功能分级、急性冠脉综合征、MNA-SF评分、Charlson共病指数、ALB、TP、PA、Hb水平比较，差异具有统计学意义（P<0.05）。见表1。
2.2　老年CHD患者发生衰弱的多因素分析
经Logistic回归模型分析，BMI降低、合并急性冠脉综合征、MNA-SF评分增高、Charlson共病指数增高是老年CHD患者发生衰弱的独立危险因素（P<0.05），ALB、TP水平升高可有效降低老年CHD患者发生衰弱的风险，属于保护性因素（P<0.05）。见表2。
2.3　一般资料对比
对比联合组和西医组的基线资料，两组患者具有较好的可比性和均衡性（P>0.05）。见表3。
2.4　治疗前后营养学指标比较
治疗前，两组患者的血清Hb、ALB、TP、PA水平差异无统计学意义（P>0.05）；治疗后，两组患者的血清Hb、ALB、TP、PA水平与治疗之前对比均显著提高（P<0.05），联合组患者的血清Hb、ALB、PA水平高于西医组（P<0.05）。见表4。
2.5　治疗前后握力、TUG、FTSS水平比较
治疗前，两组患者的握力、TUG、FTSS水平差异无统计学意义（P>0.05）；治疗后，两组患者的握力与治疗之前对比均显著提高，TUG、FTSS水平显著降低（P<0.05），联合组患者的握力高于西医组，TUG小于西医组（P<0.05）。见表5。
3　讨论
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随着老龄化社会的到来，CHD等心血管系统疾病的发生风险越来越高，严重威胁患者的健康和生命安全。老年CHD严重影响患者的功能状态，其中相当一部分患者合并衰弱，而衰弱对CHD患者的预后不利[9]。衰弱的发生机制比较复杂，已有的研究认为，衰弱与遗传、增龄、不良生活方式、老年综合征、肌少症、多病共存、多重用药、睡眠障碍、焦虑和抑郁、经济条件差、教育程度低、活动能力差有关[10]。目前西医临床对于老年冠心病并发衰弱的治疗手段有限。
经Logistic回归模型分析，BMI降低、合并急性冠脉综合征、MNA-SF评分增高、Charlson共病指数增高是老年CHD患者发生衰弱的独立危险因素，ALB、TP水平升高可有效降低老年CHD患者发生衰弱的风险，属于保护性因素。这一结果提示，营养不良和共病是老年CHD患者并发衰弱的危险因素。这是由于多种疾病共存时可导致多系统生理储备的加速下降，营养不良时体内平衡失调而导致衰弱[11]。在今后的临床工作中应将营养不良共病的老年CHD患者作为并发衰弱的高危人群，给予积极的营养干预和共病管理，以改善患者的预后。
中医学理论认为，衰弱是由气血、阴阳虚损所致，其病变在脏腑，以虚证为主。《中藏经》有云：“真气自失，使人肌肉消，神气弱，饮食减，行步艰难”。《景岳全书》认为：“五脏之虚，穷必及肾”。根据中医虚则补之的治则，应给予健脾益肾之法治疗[12]。甘草泻心汤加李可肾四味增减方中以甘草为君药，功擅补中缓急、健脾益气。人参、大枣共为臣药，善补脾胃之虚。佐以黄芩、黄连苦寒泄热；半夏、干姜温以散寒。补骨脂、淫羊藿、菟丝子善补肾阳，枸杞子善补肾阴，四药合用，善补肾中阴阳。诸药共奏健脾益肾之功[13-14]。
本研究发现，治疗后，两组患者的握力与治疗之前对比均显著提高，TUG、FTSS水平显著降低，联合组患者的握力高于西医组，TUG低于西医组。上述结果提示，在西医基础治疗方案的基础上加用中医甘草泻心汤加李可肾四味增减治疗能显著提升治疗效果，改善患者的虚弱状态。这是由于中药人参所含的皂苷类成分可增强机体免疫功能、抗疲劳、抗衰老、促进造血功能、调节内分泌及代谢[15]。具体而言，大枣富含多糖、维生素，可调节免疫功能、改善脾胃功能[16]。黄芩所含的黄芩苷、黄连所含的生物碱均具有良好的抗菌、抗病毒作用，可降低患者机体的病原体负荷，抑制炎症反应，改善机体健康状况[17]。研究显示，菟丝子水提取物可增加实验动物的体质量、胸腺质量，并提高白细胞、红细胞、血红蛋白、超氧化物歧化酶水平[18]。淫羊藿所含的淫羊藿苷可调节内分泌功能和免疫功能，抑制破骨细胞活性、促进成骨细胞生长[19-20]。
本研究还尝试通过检测营养指标血清Hb、ALB、TP、PA水平来评估疗效，发现治疗后，两组患者的血清Hb、ALB、TP、PA水平与治疗之前对比均显著提高，联合组患者的血清Hb、ALB、PA水平高于西医组。这一结果提示，在西医基础治疗方案的基础上加用中医甘草泻心汤加李可肾四味增减治疗老年CHD可更好地改善患者的营养状况，这是其纠正虚弱的重要机制。这与人参、大枣、补骨脂、淫羊藿、菟丝子、枸杞子等补益类中药提高免疫力、改善营养代谢等药理作用有关[21-26]。
综上所述，营养不良和共病是老年CHD患者并发衰弱的危险因素，在西医基础治疗方案的基础上加用中医甘草泻心汤加李可肾四味增减治疗能显著提升治疗效果。
基金
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  • 河北省中医药管理局科研计划项目(2020540)
文献
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2025年第43卷第7期
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doi: 10.13193/j.issn.1673-7717.2025.07.045
  • 首发时间：2026-10-30
  • 出版时间：2025-07-10
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基金
河北省中医药管理局科研计划项目(2020540)
作者信息
    衡水市人民医院，河北 衡水 053000

通讯作者:

刘智芬（1972-），女，衡水景县人，副主任医师，学士，研究方向：老年心血管、老年综合评估。E-mail：。
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https://castjournals.cast.org.cn/joweb/zhzyyxk/CN/10.13193/j.issn.1673-7717.2025.07.045
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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