丙丁酚改善缺血性心肌病心力衰竭患者心功能及机制研究

Effects and mechanism of probucol on cardic function in patients with ischemic cardiomyopathy heart failure

目的:探讨丙丁酚改善缺血性心肌病(is-chemic cardiomyopathy,ICM)心力衰竭患者心功能及其机制。方法:选择36例ICM心力衰竭患者,随机分为丙丁酚组和常规治疗组,各18例。两组患者均接受调脂、抗血小板和抗心肌缺血的基础治疗以及常规抗心衰治疗,丙丁酚组在常规治疗基础上加用丙丁酚片。治疗初及治疗6个月后观察两组患者下列指标的变化情况:NYHA心功能分级;血脂指标:TC、TG、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C);氧化应激指标:氧化低密度脂蛋白(ox-LDL)、丙二醛(MDA)、超氧化物岐化酶(SOD);炎症标志物:高敏C反应蛋白(hs-CRP)、红细胞沉降率(ESR);超声心动图指标:左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)和左室射血分数(LVEF)。结果:治疗6个月后,与常规治疗组比较,丙丁酚组患者MDA明显降低(P<0.05),ox-LDL明显降低(P<0.01),SOD明显增高(P<0.01),NYHA心功能分级有效率明显增加(P<0.05),LVEF有增加的趋向,但比较差异无统计学意义(P>0.05)。治疗6个月后,与常规治疗组比较,丙丁酚对于TG、HDL-C、LDL-C、hs-CRP、ESR、LVEDD和LVESD的改变无统计学意义。结论:丙丁酚改善ICM心力衰竭患者心衰的作用与其抗氧化作用有关,与其调脂作用无关。

AIM：To explore the effects and mechanism of probucol on cardic function in patients with ischemic cardiomyopathy（ICM） heart failure.METHODS： 36 patients with ICM heart failure were randomly divided into probucol group and conventional therapy group（n=18 in each group）.Both groups were given therapy of regulating blood lipid,antiplatelet,anti-ischemia and conventional anti-heart failure therapy.Probucol group was additionally given with probucol.The following changes of both groups were determined before and after treatment for six months respectively： cardiac function classification;blood lipids： total cholesterol（TC）,triglyceride（TG）,high density lipoprotein cholesterol（HDL-C）,low density lipoprotein cholesterol（LDL-C）;oxidative stress indices： oxidized low-density lipoproteins（ox-LDL）,malondialdehyde（MDA）,superoxide dismutase（SOD）;markers of inflammation： high sensitivity C-reactive protein（hs-CRP）,erythrocyte sedimentation rate（ESR）;echocardiography parameters： left ventricular end-diastolic dimension（LVEDD）,left ventricular end-systolic dimension（LVESD）,left ventricular ejection fraction（LVEF）.RESULTS：After six months of treatment,compared with the conventional therapy group,probucol decreased the levels of MDA（P0.05）,decreased the level of ox-LDL（P0.01）,increased the level of SOD（P0.01）,and increased the improving rate of cardiac function in observation group（P0.05）.Compared with the conventional therapy group,there was a growing trend towards LVEF in the observation group,but there was no significant difference between two groups.After six months of treatment,compared with the conventional therapy group,the changes of TG,HDL-C,LDL-C,hs-CRP,ESR,LVEDD and LVESD by Probucol had no statistical significance.CONCLUSION： The effect of probucol on ICM heart failure may be related with anti-oxidation and may not be related with lipid-lowering efficacies.