不同剂量螺内酯对缺血性心肌病心力衰竭患者心脏结构和功能的影响

doi:10.3969/j.issn.10073205.2018.09.003

摘要/Abstract

摘要： ［摘要］〓
〖HTH〗目的〖HTSS〗〖KG*2〗观察不同剂量螺内酯对缺血性心肌病心力衰竭患者心脏结构和功能的影响。
〖HTH〗方法〖HTSS〗〖KG*2〗选取缺血性心肌病心力衰竭患者120例为研究对象，按照随机数字表法分为对照组、小剂量螺内酯组、中剂量螺内酯组和大剂量螺内酯组，每组30例，对照组给予常规治疗，小剂量螺内酯组加用10 mg螺内酯，中剂量螺内酯组加用20 mg螺内酯，大剂量螺内酯组加用40 mg螺内酯。比较各组治疗前后左心室射血分数（left ventricular ejection fraction，LVEF）、左心室收缩末径（left ventricular endsystolic diamete，LVESD）、左心室舒张末径（Left ventricular enddiastolic diameter，LVEDD）、纽约心脏学会（New York Heart Association，NYHA）心功能分级、N末端脑钠肽原（Nterminal proBtype natriuretic peptide，NTproBNP）、肌钙蛋白T（cardiac troponin T，cTnT）、超敏C反应蛋白（high sensitivity Creactive protein，hsCRP）、肿瘤坏死因子α（tumor necrosis factorα，TNFα）、Ⅲ型前胶原氨基端肽（procollagen type Ⅲ nitrogen terminal peptide，PⅢNP）、6 min步行距离及临床疗效。
〖HTH〗结果〖HTSS〗〖KG*2〗中剂量螺内酯组临床疗效优于对照组，治疗总有效率高于对照组（P＜005）。治疗后，4组NTproBNP、cTnT、hsCRP、TNFα、PⅢNP水平均低于治疗前，小剂量螺内酯组、中剂量螺内酯组及大剂量螺内酯组NTproBNP、hsCRP、TNFα、PⅢNP水平水平低于对照组，中剂量螺内酯组cTnT水平低于对照组，中剂量螺内酯组NTproBNP、hsCRP、TNFα及PⅢNP水平低于小剂量螺内酯组和大剂量螺内酯组（P＜005）；4组LVEF值、6 min步行距离大于治疗前，LVESD值、LVEDD值、NYHA心功能分级小于治疗前；小剂量螺内酯组、中剂量螺内酯组及大剂量螺内酯组LVEF值、6 min步行距离大于对照组，NYHA心功能分级小于对照组，中剂量螺内酯组LVEDD值小于对照组，中剂量螺内酯组NYHA心功能分级小于小剂量螺内酯组和大剂量螺内酯组，6 min步行距离大于小剂量螺内酯组和大剂量螺内酯组（P＜005）。
〖HTH〗结论〖HTSS〗〖KG*2〗与10 mg及40 mg剂量组比较，20 mg剂量螺内酯可有效控制缺血性心肌病心力衰竭患者心室重构，有利于患者心功能的改善，值得临床推广应用。

关键词: 心力衰竭, 螺内酯, 心室重构

Abstract: ［Abstract］〓Objective〖HTSS〗〓To observe the effects of different doses of spironolactone on cardiac structure and function in patients with heart failure of ischemic cardiomyopathy.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓The 120 patients with ischemic heart disease and heart failure were selected as study subjects. According to the random number table method, they were divided into control group, lowdose spironolactone group, middledose spironolactone group, and largedose spironolactone group, with 30 cases in each group. The control group given conventional treatment, lowdose spironolactone group plus 10 mg spironolactone, mediumdose spironolactone group with 20 mg spironolactone, highdose spironolactone group plus 40 mg spironolactone. The left ventricular ejection fraction(LVEF), left ventricular endsystolic diamete(LVESD), left ventricular enddiastolic diameter(LVEDD), nocardial function classificationin New York Heart Association(NYHA), Nterminal proBtype natriuretic peptide(NTproBNP), cardiac troponin T(cTnT), high sensitivity Creactive protein(hsCRP), tumor necrosis factorα(TNFα), procollagen type Ⅲ nitrogen terminal peptide(PⅢNP)， 6 min walking distance and clinical efficacy were compared among different groups.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓The clinical efficacy of the middledose spironolactone group was better than that of the control group, and the total treatment efficiency was higher than that of the control group(P＜005).After treatment, the levels of NTproBNP, cTnT, hsCRP, TNFα, and PⅢNP in the 4 groups were lower than before treatment.The levels of NTproBNP, hsCRP, TNFα, and PⅢNP in lowdose spironolactone group, middledose spironolactone group, and largedose spironolactone group were lower than those in the control group. The level of cTnT in the middledose spironolactone group was lower than that in the control group. The levels of NTproBNP, hsCRP, TNFα, and PⅢNP in the middledose spironolactone group were lower than those in the lowdose spironolactone group and the highdose spironolactone group(P＜005).The LVEF value and 6 min walking distance of the 4 groups were greater than before treatment. The LVESD value, LVEDD value and NYHA functional class were less than before treatment. The LVEF value and 6 min walking distance of smalldose spironolactone group, middledose spironolactone group, and largedose spironolactone group were greater than those of the control group. NYHA cardiac function was less than the control group. The LVEDD value of the middledose spironolactone group was lower than that of the control group, and the NYHA heart function of the middledose spironolactone group. The grading was smaller than that of the smalldose spironolactone group and the largedose spironolactone group, and 6 min walking distance was greater than that of the smalldose spironolactone group and the highdose spironolactone group(P＜005).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Compared with the 10 mg and 40 mg dose groups, the 20 mg dose of spironolactone can effectively control the ventricular remodeling in patients with ischemic cardiomyopathy heart failure, which will benefit the improvement of cardiac function and is worthy of clinical application.

Key words: heart failure, spironolactone, ventricular remodeling

鲁志科1，孙〓榕2*. 不同剂量螺内酯对缺血性心肌病心力衰竭患者心脏结构和功能的影响[J]. 河北医科大学学报, doi: 10.3969/j.issn.10073205.2018.09.003.

LU Zhike1， SUN Rong2*. Comparison of effects of different doses of spironolactone in treating heart failure of ischemic cardiomyopathy#br#[J]. Journal of Hebei Medical University, doi: 10.3969/j.issn.10073205.2018.09.003.

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不同剂量螺内酯对缺血性心肌病心力衰竭患者心脏结构和功能的影响

Comparison of effects of different doses of spironolactone in treating heart failure of ischemic cardiomyopathy#br#

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