盐酸曲美他嗪联合托伐普坦对CHD伴难治性HF患者sCD146、NT-proBNP水平及心功能的影响

Effects of trimetazidine hydrochloride combined with toraputam on CD146,NT-proBNP levels and Cardiac function in patients with coronary heart disease with refractory heart failur

目的:分析盐酸曲美他嗪联合托伐普坦对冠心病(CHD)伴难治性心力衰竭(HF)患者可溶性CD146(sCD146)、氨基末端脑钠肽前体(NT-proBNP)水平及心功能的影响。方法:2019年02月~2020年06月我院收治的CHD伴难治性HF患者80例,采用随机数字表法分为对照组和观察组,各40例。对照组采用口服托伐普坦进行治疗;观察组在对照组的基础上口服盐酸曲美他嗪进行治疗,两组均治疗3个月。比较两组治疗前后炎症因子水平,治疗前后可溶性CD40(sCD40)、sCD146、NT-proBNP、血肌酐(SCR)、血尿酸(BUA)水平,治疗前后心功能指标和治疗后不良反应发生率。结果:治疗后两组肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、白介素-8(IL-8)、sCD40、sCD146水平较治疗前均显著降低,观察组显著低于对照组。治疗后较治疗前比较,两组NT-proBNP水平均下降,对照组SCR水平下降;治疗后,观察组NT-proBNP和SCR水平均低于对照组。治疗后两组左心室射血分数(LVEF)显著高于治疗前,观察组高于对照组;治疗后,两组左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)低于治疗前,观察组低于对照组。对照组不良反应发生率为7.50%;观察组不良反应发生率为5.00%,差异无统计学意义。结论:与托伐普坦单独使用相比,加用盐酸曲美他嗪能降低CHD伴难治性HF患者机体炎症反应、促进机体利尿作用从而降低NT-proBNP和sCD146水平,改善心功能,同时不会增加患者不良反应,值得在临床推广。

Objective To analyze the effects of trimetazidine hydrochloride combined with toraputam on soluble CD146(sCD146),amino-terminal brain natriuretic peptide(NT-proBNP)level and Cardiac function in patients with coronary heart disease(CHD)with refractory heart failure(HF).Methods Between February 2019 and June 2020,80 patients with CHD with refractory HF admitted to our hospital were divided into control group and observation group by random number table method,with 40 cases each.The control group was treated with oral torwaptan.The observation group was treated orally with trimetazidine hydrochloride on the basis of the control group,and both groups were treated for for 3 months.The levels of inflammatory cytokines before and after treatment,soluble CD40(sCD40),sCD146,NT-proBNP,serum creatinine(SCR),blood uric acid(BUC),Cardiac function indicators before and after treatment and the incidence of adverse reactions after treatment were compared between the two groups.Results After treatment,the levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-8(IL-8),sCD40 and sCD146 in the two groups were significantly lower than before treatment,the observation group was significantly lower than the control group.After treatment,compared with before treatment,the level of nt-probnp in the two groups increased,while the level of SCR in the control group increased.After treatment,the levels of nt-probnp and SCR in the observation group were lower than those in the control group.After treatment,the left ventricular ejection fraction(LVEF)of the two groups was significantly higher than before treatment,and that of the observation group was higher than that of the control group.After treatment,LVEDD and LVESD were lower in the two groups than before treatment,and lower in the observation group than in the control group.After treatment,the incidence of adverse reactions in the control group was 7.50%.The incidence of adverse reactions in the observation group was 5.00%,with no statistically significant difference between the two groups.Conclusion Compared with torwaputam alone,the addition of trimetazidine hydrochloride can reduce the inflammatory response of CHD patients with refractory HF,promote diuretic effect of the body,thus reduce NT-proBNP and sCD146 levels,improve Cardiac function,and do not increase adverse reactions in patients,which is worthy of clinical promotion.