丹参粉针联合左卡尼汀对缺血性心力衰竭的疗效及其对肾功能损害的影响

Effects of levocarnitine combined with Salvia miltiorrhiza powder on ischemic heart failure and kidney damage

目的 探讨注射用丹参粉针联合左卡尼汀对缺血性心力衰竭的治疗作用及对早期肾损害的防治作用.方法 选择2011年6月～2013年6月于河北省廊坊市安次区医院心内科符合条件的缺血性心力衰竭患者随机106例,分为治疗组和对照组,对照组给予常规抗心力衰竭治疗,治疗组在常规抗心力衰竭的治疗基础上加用注射用丹参粉针1 200 mg和左卡尼汀注射液3 g静脉滴注,一日一次,疗程为14 d.治疗前后分别通过测定左室射血分数（LVEF％）、6 min步行试验、NT-proBNP指标评估心功能,通过测定血尿酸（UA）、尿素氮（BUN）、肌酐（Cr）、尿微量蛋白（mAlb）、转蛋白（TRF）、NAG酶,并计算肌酐清除率（Ccr）等临床指标评估肾功能损害.结果 治疗后治疗组有效率90.57％,显著高于对照组,79.24％,P＜0.05.治疗组与对照组比较左室射血分数明显改善,P ＜0.05,活动耐量提高,P＜0.05,NT-proBNP明显下降,P＜0.05;治疗组较的尿微量蛋白（mAlb）、NAG酶低于对照组,P＜0.05.结论 注射用丹参粉针联合左卡尼汀可显著改善缺血性心力衰竭的心功能,增加活动耐量,同时可改善肾功能损害.

Objective To assess the effects of levocarnitine combined with Salvia mihiorrhiza powder on ischemic heart failure with kidney damage. Methods 106 ischemic heart failure patients, aged 50-80, with history of heart infarction and NYHA grade Ⅱ-Ⅲ, were randomly divided into 2 groups： control group which underwent conventional anti-heart failure therapy, and treatment group which received intravenous injection of Salvia mihiorrhiza powder 1200 mg and levocarnitine 3 g once a day in addition to the conventional therapy for a period of 14 days. Then their heart function were assessed by measuring the left ventricular ejection fraction （LVEF）, 6-minute walk test, and N-terminal pro-brain natirretic peptide （NT-proBNP） level; and the renal function was evaluated by measuring the levels of uric acid （UA）, urea nitrogen （BUN）, creatinine （Cr）, urine protein microalbumin （mAlb）, transferrin （TRF）, N-acety [3 D amino glycosidase （NAG）, and creatinine clearance （Ccr）. Results The effective rate of the treatment group was 90.57%, significantly higher than that of the control group,79.24%, P 〈0.05. The LVEF% of the treatment group was significantly higher than that of the control group; the distance of 6-minute walk of the treatment was significantly longer than that of the control group, the levels of NT-proBNP, mAlb and NAG enzyme of the treatment group were all significantly lower than those of the control group,all P 〈0.05. Conclusion Intravenous injection of Salvia miltiorrhiza powder combined with levocarnitine is considered being effective in improving heart function, raising exercise tolerance, as well as reducing renal damage in the patients with ischemic heart failure.