左西孟旦联合冻干重组人脑利钠肽对缺血性心肌病患者心室重构改善作用的研究

茅焕豪; 叶剑飞; 郑伟峰; 杨莹

doi:10.16766/j.cnki.issn.1674-4152.002186

左西孟旦联合冻干重组人脑利钠肽对缺血性心肌病患者心室重构改善作用的研究

doi: 10.16766/j.cnki.issn.1674-4152.002186

1.
宁波市第四医院心内科，浙江宁波 315700
2.
浙江大学附属邵逸夫医院心内科，浙江杭州 310000

基金项目:

浙江省医药卫生科技计划项目 2018KY492

详细信息

通讯作者:
茅焕豪，E-mail：kind_1998@163.com

中图分类号: R542.2 R541.4
计量
- 文章访问数: 268
- HTML全文浏览量: 162
- PDF下载量: 11
- 被引次数: 0
出版历程
- 收稿日期: 2021-04-19

Effect of levosimendan combined with lyophilised recombinant human brain natriuretic peptide on ventricular remodelling in patients with ischemic cardiomyopathy

1.
Department of Cardiology, the Fourth Hospital of Ningbo City, Ningbo, Zhejiang 315700, China

摘要

摘要: 目的观察左西孟旦联合冻干重组人脑利钠肽治疗缺血性心肌病的临床疗效及对心功能损伤和心室重构的改善作用。方法选择2018年6月—2021年2月宁波市第四医院心内科收治的240例缺血性心肌病心力衰竭患者为研究对象，按照随机数字表法分为对照组(120例)和研究组(120例)。对照组患者予以常规治疗，研究组患者增加左西孟旦联合冻干重组人脑利钠肽治疗。检测2组患者治疗前后血清转化生长因子β1(TGF-β1)、核因子-κB(NF-κB)、成纤维细胞生长因23(FGF23)、胱抑素C(CysC)、肌酸激酶同工酶(CK-MB)、N末端原脑利钠肽(NT-proBNP)和超敏C反应蛋白(hs-CRP)等血清生化指标水平，统计左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左室收缩末期容积(LVEDV)、左室收缩末期容积(LVESV)及左心室射血分数(LVEF)等心脏超声指标变化，评价患者治疗后临床疗效，进行6分钟步行试验，观察治疗期间药物不良反应。结果治疗后，研究组患者血清NF-κB、CysC、CK-MB、NT-proBNP和hs-CRP含量均显著低于对照组(均P < 0.05)；研究组LVEDV和LVESV均显著低于对照组(均P < 0.05)，而LVEF[(54.18±4.94)%]显著高于对照组[(49.62±4.61)%, P < 0.05]；研究组治疗总体有效率为90.83%，显著高于对照组(76.67%，P < 0.05)；研究组治疗后6分钟步行试验结果为(436.51±33.82)m，对照组为(392.74±28.61)m，2组比较差异有统计学意义(P < 0.05)。2组均未出现药物不良反应。结论给予缺血性心肌病心力衰竭患者左西孟旦及冻干重组人脑利钠肽联合用药治疗，可有效减轻心室重构和心肌损伤程度，增强心肌功能，提高疗效水平，安全性高。
- 左西孟旦 /
- 冻干重组人脑利钠肽 /
- 缺血性心肌病 /
- 心力衰竭 /
- 心功能 /
- 心室重构 /
- 临床疗效
Abstract: Objective To observe the clinical efficacy of levosimendan combined with lyophilised recombinant human brain natriuretic peptide (neoactivin) in the treatment of ischemic cardiomyopathy and the improvement of cardiac function damage and ventricular remodelling. Methods A total of 240 patients with ischemic cardiomyopathy heart failure admitted to the Department of Cardiology in Ningbo Fourth Hospital from June 2018 to February 2021 were selected as the research objects. The patients were randomly divided into the control group (120 cases) and study group (120 cases) according to the random number table method. The patients in the control group were given conventional treatment, whilst those in the study group were treated with levosimendan combined with neoactivin. The serum levels of TGF-β1, NF-κB, FGF23, CysC, CK-MB, NT-proBNP and hs-CRP in both groups before and after treatment were detected. The changes in LVEDD, LVESD, LVEDV, LVESV and LVEF were statistically analysed. The clinical efficacy of heart failure after treatment was evaluated. The 6-min walk test was conducted. The incidence of adverse drug reactions during treatment was observed. Results After treatment, serum levels of NF-κB, CysC, CK-MB, NT-proBNP and hs-CRP in the study group were significantly lower than those in the control group (all P < 0.05). The detection values of LVEDV and LVESV in the study group were significantly lower than those in the control group, whilst LVEF (54.18±4.94) % was significantly higher than that in the control group (49.62±4.61) % (all P < 0.05). The total effective rate of the study group (90.83%) was significantly higher than that of the control group (76.67%, P < 0.05). The results of the 6-min walk test in the study group [(436.51±33.82) m] was significantly better than that in the control group [(392.74±28.61) m, P < 0.05]. No adverse drug reactions were observed in both groups during treatment. Conclusion Levosimendan combined with neoactivin can effectively alleviate ventricular remodelling, inhibit myocardial injury, improve myocardial function, improve the level of curative effect and has high safety.
- Levosimendan /
- Lyophilised recombinant human brain natriuretic peptide /
- Ischemic cardiomyopathy /
- Heart failure /
- Cardiac function /
- Ventricular remodelling /
- Clinical efficacy
利益冲突 无

HTML全文

表 1 2组缺血性心肌病心力衰竭患者治疗前后血清生化指标比较 (x ±s)

组别	例数	TGF-β1(ng/mL)			NF-κB(pg/mL)		FGF23(pg/mL)			CysC(μg/mL)
组别	例数	治疗前	治疗后		治疗前	治疗后	治疗前	治疗后		治疗前	治疗后
对照组	120	52.37±6.51	41.16±5.74^a		80.52±9.41	54.46±6.13^a	671.09±78.73	487.23±49.26^a		2.98±0.37	1.87±0.24^a
研究组	120	53.49±6.74	39.93±5.17^a		81.67±9.72	48.74±5.63^a	682.42±71.42	479.64±42.53^a		3.04±0.35	1.24±0.19^a
t值		1.314	1.745		0.931	7.577	1.167	1.318		1.341	22.241
P值		0.190	0.082		0.353	＜0.001	0.224	0.189		0.181	＜0.001

组别	例数	CK-MB(U/L)				NT-proBNP(pg/mL)			hs-CRP(μg/mL)
组别	例数	治疗前		治疗后		治疗前	治疗后		治疗前		治疗后
对照组	120	158.62±16.53		74.62±6.31^a		3 516.45±259.62	2 064.74±141.63^a		6.82±0.79		2.93±0.31^a
研究组	120	157.41±16.21		65.86±5.93^a		3 530.27±263.35	1 498.39±126.37^a		6.75±0.74		2.65±0.27^a
t值		0.575		11.081		0.410	32.653		0.711		7.361
P值		0.566		＜0.001		0.682	＜0.001		0.478		＜0.001
注：与治疗前比较，^aP＜0.001。TGF-β1为血清转化生长因子β1，NF-κB为核因子-κB，FGF23为成纤维细胞生长因23，CysC为胱抑素C，CK-MB为肌酸激酶同工酶，NT-proBNP为N末端原脑利钠肽，hs-CRP为超敏C反应蛋白。

下载: 导出CSV

表 2 2组缺血性心肌病心力衰竭患者治疗前后心脏超声指标比较 (x ±s)

组别	例数	LVEDD(mm)		LVESD(mm)		LVEDV(mL)		LVESV(mL)		LVEF(%)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	120	66.52±5.63	53.19±4.96^a	45.63±6.63	38.25±4.49^a	117.69±12.84	98.62±8.47^a	63.84±7.26	49.59±5.47^a	38.93±3.67	49.62±4.61^a
研究组	120	65.93±5.83	52.64±4.83^a	44.29±6.84	37.41±4.27^a	118.27±12.23	91.48±7.83^a	64.45±7.51	44.63±5.21^a	39.07±3.56	54.18±4.94^a
t值		0.793	0.870	1.542	1.485	0.363	6.779	0.645	7.192	0.300	7.388
P值		0.428	0.385	0.124	0.139	0.717	＜0.001	0.519	＜0.001	0.765	＜0.001
注：与治疗前比较，^aP＜0.001。LVEDD为左心室舒张末期内径，LVESD为左心室收缩末期内径，LVEDV为左室收缩末期容积，LVESV为左室收缩末期容积，LVEF为左心室射血分数。

下载: 导出CSV

表 3 2组缺血性心肌病心力衰竭患者临床总有效率比较 [例(%)]

组别	例数	显效	有效	无效	总有效
对照组	120	25(20.83)	67(55.83)	28(23.33)	92(76.67)
研究组	120	45(37.50)	64(53.33)	11(9.17)	109(90.83)
注：2组总有效率比较，χ²=8.848，P=0.003。

下载: 导出CSV

参考文献(17)

[1]	姜丹.心肌梗死后缺血性心肌病的相关危险因素分析[J].中西医结合心血管病电子杂志,2018,6(5):100,102. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXJH201805068.htm
[2]	薛彦博,郑小璞.缺血性心肌病的诊断与治疗现状:局限与展望[J].中华临床医师杂志(电子版),2016,10(6):763-765. doi: 10.3877/cma.j.issn.1674-0785.2016.06.002
[3]	张莉,郑颜磊,程飞.细胞凋亡在缺血性心肌病中作用的研究进展[J].中国中西医结合急救杂志,2018,25(5):558-560. doi: 10.3969/j.issn.1008-9691.2018.05.029
[4]	安雅芳,马娜.缺血性心肌病的临床研究进展[J].中国处方药,2017,15(10):16-17. doi: 10.3969/j.issn.1671-945X.2017.10.012
[5]	李静.冠状动脉硬化性缺血性心肌病的临床特点[J].中西医结合心血管病电子杂志,2020,8(9):71,90. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXJH202009054.htm
[6]	龙竞伟,李平.曲美他嗪联合比索洛尔对缺血性心肌病患者NT-proBNP水平及心功能的影响[J].中华全科医学,2020,18(5):766-768. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY202005018.htm
[7]	潘春奇,菅颖,倪斌,等.沙库巴曲缬沙坦对射血分数降低的缺血性心肌病患者心肌损伤和炎症因子的影响[J].中华全科医学,2020,18(11):1848-1850,1945. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY202011016.htm
[8]	李玮,穆少丽.冻干重组人脑利钠肽对缺血性心肌病合并心力衰竭患者神经内分泌激素及心室重构的影响[J].广西医科大学学报,2018,35(7):947-951. https://www.cnki.com.cn/Article/CJFDTOTAL-GXYD201807014.htm
[9]	陈如杰,郭献阳,程碧环,等.左西孟旦对应激性心肌病患者的心脏保护作用[J].中华危重症医学杂志(电子版),2017,10(6):381-385. doi: 10.3877/cma.j.issn.1674-6880.2017.06.004
[10]	顾方方,程震锋.左西孟旦联合中药治疗扩张型心肌病伴心力衰竭临床研究[J].中华中医药学刊,2017,35(10):2634-2637. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYHS201710042.htm
[11]	王江友,鄢华.左西孟旦在心血管疾病中的多效性研究进展[J].中华老年心脑血管病杂志,2018,20(3):312-313. doi: 10.3969/j.issn.1009-0126.2018.03.025
[12]	吴刚,周宇.左西孟旦对老年慢性心力衰竭心室重构及相关指标的影响[J].中华老年心脑血管病杂志,2020,22(4):393-396. doi: 10.3969/j.issn.1009-0126.2020.04.015
[13]	颜成敏,葛赟,周瑜,等.重组人脑利钠肽对急性失代偿性心功能衰竭合并急性肾功能损伤的临床疗效观察[J].中华急诊医学杂志,2018,27(9):1041-1043. doi: 10.3760/cma.j.issn.1671-0282.2018.09.018
[14]	魏立业,夏岳,张晓婵,等.重组人脑利钠肽对行直接介入治疗的急性心肌梗死患者心肾保护作用[J].中华老年心脑血管病杂志,2017,19(2):156-159. doi: 10.3969/j.issn.1009-0126.2017.02.012
[15]	吴琼,陈还珍,盖婉丽.重组人脑利钠肽治疗急性心肌梗死合并心力衰竭的效果[J].中国心血管杂志,2019,24(3):250-253. https://www.cnki.com.cn/Article/CJFDTOTAL-XIXG201903016.htm
[16]	付文科,孙玉发,郝卫军,等.左西孟旦治疗老年缺血性心肌病所致急性失代偿性心力衰竭的疗效和安全性分析[J].中华老年心脑血管病杂志,2017,19(2):153-155. doi: 10.3969/j.issn.1009-0126.2017.02.011
[17]	傅涛,荆忱,徐佳,等.冻干重组人脑利钠肽治疗缺血性心肌病室性心律失常和急性心力衰竭的疗效和安全性评价[J].北京医学,2017,39(6):607-610,614. https://www.cnki.com.cn/Article/CJFDTOTAL-BJYX201706024.htm