左西孟旦治疗急性非ST段抬高型心肌梗死致心力衰竭的临床研究

Clinical study of levosimendan in the treatment of heart failure caused by acute non-ST-segment elevation myocardial infarction

目的探讨左西孟旦治疗急性非ST段抬高型心肌梗死(NSTEMI)致心力衰竭(HF)的临床价值。方法将60例急性NSTEMI致HF患者随机分为常规组30例和左西孟旦组30例。两组患者均按照急性冠脉综合征及HF指南给予常规治疗,左西孟旦组加用左西孟旦注射液。比较两组患者入组第1 d、3 d、7 d心脏指数(CI)、左心室射血分数(LVEF)、血浆氨基末端脑钠肽前体(NT-proBNP)、心肌肌钙蛋白T(cTNT)、血清C反应蛋白(CRP)和白细胞介素(IL)-6水平。随访住院期间和出院后3个月内主要不良心血管事件(MACE)的发生情况。结果与同组入组第1 d比较,入组第3 d、7 d两组患者CI和LVEF均逐渐升高,血浆NT-proBNP、cTNT及血清CRP、IL-6水平均逐渐降低(P<0.05);入组第3 d、7 d左西孟旦组CI及LVEF均高于同期常规组,血浆NT-proBNP、cTNT及血清CRP、IL-6水平均低于同期常规组(P<0.05)。两组随访期间发生非致死性再发心肌梗死、恶性心律失常、急性HF(AHF)发作或再入院及全因死亡患者比例比较差异均无统计学意义(P>0.05)。结论左西孟旦可改善急性NSTEMI所致HF患者近期多项血流动力学指标并下调炎症反应程度,对住院期间和出院3个月的MACE无显著影响。

Objective To study the clinical value of levosimendan in the treatment of heart failure(HF)caused by acute non-ST-segment elevation myocardial infarction(NSTEMI).Methods A total of 60 patients with HF caused by acute NSTEMI were randomly divided into conventional treatment group(30 cases)and levosimendan group(30 cases).Patients in two groups were given conventional therapy according to the guideline of acute coronary syndrome and HF,and patients in levosimendan group were additionally given levosimendan injection.Cardiac index(CI),left ventricular ejection fraction(LVEF),plasma amino-terminal precursor brain natriuretic peptide(NT-proBNP),cardiac troponin T(cTNT),serum C-reactive protein(CRP)and interleukin(IL)-6 levels at 1st,3rd and 7th day of enrollment were compared in two groups.Patients were followed up for major adverse cardiovascular events(MACE)during hospitalization and within 3 months after discharge from hospital.Results Compared with the 1st day of enrollment in the same group,CI and LVEF in two groups were gradually increased at the 3rd and 7th day of enrollment,and plasma NT-proBNP,cTNT,serum CRP and IL-6 levels were gradually decreased;CI and LVEF in levosimendan group were higher than those in conventional treatment group at the same time,and plasma NT-proBNP,cTNT,serum CRP and IL-6 levels were lower than those in conventional treatment group at the same time at 3rd and 7th day of enrollment(P<0.05).There were no significant differences of proportion of patients with non-fatal recurrent myocardial infarction,malignant arrhythmia,acute HF(AHF)attack or readmission and all-cause death between two groups duringfollow-up period(P>0.05).Conclusion Levosimendan can improve several recent hemodynamic indexes and down-regulate the degree of inflammatory response in patients with HF caused by acute NSTEMI,but has no significant effect on MACE during hospitalization and 3 months after discharge from hospital.