托伐普坦对急性心衰患者的疗效评价

The effect of Tolvaptan on the levels of hs-CRP and brain natriuretic peptides in end-stage heart failure

目的评价托伐普坦对急性心力衰竭的治疗效果及其对超敏C反应蛋白（hs—CRP）及脑钠肽（BNP）等心衰标记物水平的影响。方法选取急性心衰患者50例，心功能分级Ⅲ级或Ⅳ级（NYHA分级）。检测hs—CRP、BNP水平，心脏彩超测定左心室射血分数（LVEF）及左心室舒张末期内径（LVEDD）。随机分为对照组25例和治疗组25例，两组均予标准抗心衰治疗，治疗组在常规治疗基础上联用托伐普坦。在接受托伐普坦治疗7d后，两组再检测hs—CRP、BNP和LVEF、LVEDD。结果两组心功能疗效比较，治疗组总有效率优于对照组（96％比76％，P〈0．01）；两组心脏彩超测定LVEDD治疗组改善程度优于对照组[（57．8±5．1）mm比（60．5±4．1）mm，P〈0．05]，LVEF治疗组改善程度优于对照组[（41．0±5．6）％比（37．4±4．5）％，P〈0．05]；两组治疗后hs—CRP明显下降，治疗组下降较对照组显著[（4．81±1．57）mg／L比（5．32±1．43）mg／L，P〈0．05]；两组治疗后BNP显著下降，治疗组下降较对照组显著[（316±146）pg／ml比（512±116）pg／ml，P〈0．05]。结论托伐普坦治疗终末期心衰疗效肯定，可在常规治疗基础上进一步降低急性心衰患者C反应蛋白和BNP水平，改善左室功能，可作为急性心衰的治疗药物。

Objective To evaluate the effect of Tolvaptan on level of hs-CRP and plasma brain natri- uretic peptide （BNP） in patients with acute heart failure and the therapeutic effect. Methods 50 patients whith NYHA Ⅲ-Ⅳ were enrolled in the study. All patients were divided into Tolvaptan treatment group （25 cases ） and control group （25 cases）. The levels of hs-CRP and plasma BNP were evaluated, and left ventrieular ejection function （LVEF） and left ventricular end-diastolic diameter （LVEDD） was detected by cardiography. The indexes were reevaluated in 7 days after treatment. Results After treatment, the totally therapeutic effect was better in treatment group than control group （96% vs 76%, P〈0.05）. In treatment group, the LVEF increased obviously [ （41.0±5.6）% vs （37.4±4.5）%, P〈0.05 ]and the LVEDD decreased significantly[ （57.8±5.1）mm vs （60.5±4.1） mm, P〈0.05 ]. The level of plasma BNP decreased in both two groups, although the treatment group was more sig- nificant than control group [（316±146）pg/ml vs （512±116）pg/ml, P〈0.05], as well as the level of hs-CRP [（4.81±1.57）mg/L vs （5.32±1.43）mg/L, P〈0.05]. Conclusion Tolvaptan shows positive effect on treatment of acute heart failure, and Tolvaptan can be one of short-term therapeutic drug for acute heart failure.