左旋卡尼汀治疗缺血性心肌病慢性心力衰竭患者的临床疗效观察

Clinical investigation of L-carnitine in the treatment of chronic congestive heart failure of the patients with ischemic cardiomyopathy

目的观察左旋卡尼汀治疗缺血性心肌病慢性心力衰竭（CHF）患者的临床疗效。方法选择缺血性心肌病慢性心力衰竭患者76例，随机分为两组：对照组42例常规给予洋地黄、利尿剂、血管扩张剂、ACEI或ARB、B受体阻滞剂等药物；左旋卡尼汀组34例，在常规药物治疗的基础上加用国产左旋卡尼汀3g／d治疗10～14d。结果（1）治疗后，两组心率和心肌耗氧量两组均较治疗前明显降低（P〈0.01），而左旋卡尼汀治疗组心率和心肌耗氧量显著低于常规治疗组（P〈O．05）；（2）治疗后，左旋卡尼汀治疗组左室射血分数（LVEF）显著上升（P〈0．05），而常规组无统计学差异（P〉0．05）．两组心功能Ⅰ-Ⅱ级患者百分比明显增加，Ⅲ-Ⅳ级患者百分比明显减少（P〈0．01），而左旋卡尼汀治疗组Ⅲ-Ⅳ级患者百分比明显低于常规治疗组（P〈0．05）。结论左旋卡尼汀组治疗心力衰竭患者可降低患者心肌耗氧量．改善心功能。

Objective To observe the cardiac functional effect of L-carnitine（L-CN） on the congestive heart failure（CHF） of patients with ischemic cardiomyopathy. Methods 76 cases of chronic CHF randomly received routine treatment （digitalis, diuretics, vasodilator, ACEI or ARB, β-blocker） or on the basis of routine therapy or with the addition of L-CN（3.0 g/d ,10-14 d）. Results （1） There was significant decrease in heart rats and myocardial volume of oxygen consumptions in two groups after treatment than those before treatment （P 〈 0. 01）, and the heart rats and myocardial volume of oxygen consumptions in L-CN group were lower than those of controls （P〈0.05）. （2） The left ventricular ejection fraction （LVEF） in L-CN group after treatment were higher than those before treatment （P〈0.05）, and there were not different in LVEF in control group between before and after treatment. Conclusion Routine therapy with the addition of L-CN might be an effective treatment for the CHF patients with ischemic cardiomyopathy.