小剂量螺内酯治疗NYHAI～Ⅱ级收缩性心力衰竭效果分析

Low dose spironolactone alleviates cardiac remolding in patients with NYHA class I - II heart failure

目的评价螺内酯在NYHAI-Ⅱ级收缩性心力衰竭治疗中的有效性与安全性。方法2009年入选本院NYHAI-Ⅱ级慢性收缩性心力衰竭患者88例，随机分为螺内酯组和对照绀。对照组采用常规治疗，螺内酯组在常规治疗基础上加用螺内酯片20mg／d，疗程6个月。检测治疗前后的超声心动图、6min步行试验、血浆醛固酮、N末端B型利钠肽原（NT—proBNP）。整个研究过程中监测血钾、肌酐。结果治疗后螺内酯组二尖瓣舒张早期充盈速度（E）／二尖瓣舒张晚期充盈速度、E／心肌舒张早期速度显著低于对照组，分别为（1．2±0．7）比（1．7±0．6），P=0．007；（15．2±2．3）比（17．7±3．0），P=0．000。两组左室舒张末期内径、左室射血分数差异无统计学意义。螺内酯组左室质量指数较治疗前显著减少[（112±19）g／m2比（117±27）g／m2，P=0．044]。治疗后螺内酯组血浆醛同酮明显低于对照组[（157±16）ng／L比（165±16）ng/L，P=0．021]。两组间NT—proBNP水平差异无统计学意义，但螺内酯组NT-proBNP水平较治疗前明显降低（P=0．000）。治疗前后两组患者收缩压、舒张压、心率、血钾浓度、血肌酐浓度及6min步行试验差异无统计学意义。螺内酯组血肌酐水平、血钾浓度均较治疗前升高，分别为（87±22）umol／L比（83±18）umol／L，P=0．047；（4．5±0．6）mmol／L比（4．4±0．4）mmol／L，P=0．012。螺内酯组血钾浓度≥5．0mmol／L的发生率明显高于对照绀（19．6％、5．4％，P=0．050）。两组间再住院率差异无统计学意义。结论螺内酯可以改善NYHAI～Ⅱ级收缩性心力衰竭患者的心脏重塑和舒张功能。

Objective To evaluate the efficacy and safety of spironolactone in treatment NYHA （ New York Heart Association ） class I - II heart failure patients. Methods Eighty eight patients with NYHA class I - II heart failure were randomized to sprionolaetone or placebo groups. Patients were assessed by echocardiography and 6-minute walking test （6MWT） ,plasma aldosterone and NT-proBNP were measured before and 6 months after treatment; serum potassium and creatinine were monitored through the study. Results The E/A and E/E＇ in spironolactone group were significantly lower than those of control group （ 1.2 ± 0. 7 vs. 1.7 ± 0. 6, P = 0. 007 ; 15.2 ± 2. 3 vs. 17.7 ± 3.0, P = 0. 000）. No differences were observed in left ventricular end-diastofic diameter （LVEDD） and left ventricular ejection fraction （LVEF） between two groups after treatment. Left ventrieular mass index （LVMI） in spironolactone group decreased after theatment [ （ 117 ± 27） g/m2 vs. （ 112 ± 19） g/m2, P = 0.044]. Plasma aldosterone level in spironolactone group after treatment was significantly lower than that of control group [ （ 157 ± 16） ng/L vs. （ 165 ± 16） ng/L, P =0. 021 ]. Although there were no differences in plasma NT-proBNP level between two groups after treatment, it decreased significantly comparing with that of before treatment （ P = 0. 000）. No differences were observed in serum potassium and creatinine between two groups after treatment. However serum potassium and creatinine in spironolactone group increased significantly after treatment [ （ 83 ± 18 ） umol/L vs. （87 ± 22） umol/L, P =0.047; （4.4 ±0.4） mmol/L vs. （4.5 ±0.6） mmol/L, P = 0. 012 ]. Conclusion Spironolaetone can alleviate eardiae remolding and diastolie funetion in NYHA elass I - II heart failure patients.