地高辛低血浓度与慢性心力衰竭的疗效

Lower serum digoxin concentration and therapeutic effect on chronic heart failure

目的探讨中国人地高辛治疗心衰的有效血药浓度。方法心力衰竭患者口服地高辛0.125~0.25 mg/d,3 d后改为0.0625~0.125 mg/d维持,依据服药1周后地高辛血药浓度(SDC)分组,低浓度组(SDC≤0.4μg/L)57例,中浓度组(0.4μg/L<SDC<0.9μg/L)56例,高浓度组(SDC≥0.9μg/L)52例。观察终点:出现心律失常、死亡或口服地高辛6个月,前两者测即刻SDC,后者清晨空腹测SDC。同时观察用药前后症状改善情况、心率及心脏左室射血分数(LVEF)变化。结果3组患者口服地高辛1周和6个月所测SDC值无统计学差异,低、中和高浓度组6个月所测SDC值分别为:(0.31±0.03)μg/L,(0.62±0.16)μg/L和(1.54±0.62)μg/L。入院时心率明显偏快[低、中、高浓度组:(117±9)次/min,(108±11)次/min和(115±15)次/min],地高辛治疗后,在改善症状同时,心率保持于较低水平[低、中、高浓度组:(73±7)次/min,(77±6)次/min和(87±5)次/min]。与治疗前相比3组均有显著性差异(P<0.05)。用药后心率值3组之间无显著性差异。口服地高辛6个月后,LVEF 3组间无显著性差异,治疗后的LVEF均明显提高。地高辛治疗后,低浓度组致心律失常发生率明显低于中、高浓度组(P<0.05)。结论SDC(0.31±0.03)μg/L仍具有与较高浓度相同的治疗效果,同时心律失常发生率和病死率明显降低。

AIM To investigate the effects of lower serum digoxin concentration （SDC, SDC 〈 0.4 μg/L） on heart failure （HF） in Chinese population. METHODS Patients with HF took digoxin： 0. 125 - 0.25 mg daily for three days and then 0. 125 mg or 0. 0625 mg once a day. All the patients were divided into three groups according to the SDC one week after taking digoxin： the low SDC group （SDC ≤0. 4 μg/L）, middle SDC group （0.4 μg/L 〈 SDC 〈0. 9 μg/L） and high SDC group （SDC≥0. 9 μg/L） （57,56,52 patients respectively）. Investigation termination： arrhythmia, cardiac death or digoxin therapy for 6 months. Blood samples for SDC were taken in the meantime of companied arrhythmia and cardiac death, and at the end of 6-month administration of digoxin. Symptoms, heart rate and left ventricular ejection fraction （LVEF） were recorded from all patients before and after oral digoxin. RESULTS No significant difference was found in the SDC value detected at one-week and six-month between the three groups. The SDC after six months was respectively（0. 31 ±0.08） I^g/L, （0. 62 ±0. 16） μg/L and （ 1.54 ± 0. 62） I^g/L in low, middle and high SDC groups. Slowed heart rate after taking digoxin for 6 months was found in all three groups （P 〈0. 05） ： low SDC group： （73 ±7） bps vs （117 ±9） bps; middle SDC group： （77 ±6） bps vs （108 ±11） bps; high SDC group： （87 ±5） bps vs （115 ±15） bps. LVEF was markedly enhanced after 6-month administration of digoxin （P 〈 0. 05） but no difference between the three groups （P 〉 0. 05）. The arrhythmia rate in the high and middle SDC groups was significantly higher than that in the low SDC group （P 〈 0. 05）. CONCLUSION Mortality rate and arrhythmia rate were higher in high SDC group compared with those in middle and low groups. The low SDC （0. 31 ±0. 08） μg/L is safer but as effective as middle and high SDC in HF in chinese population.