左西孟旦对冠心病心力衰竭患者血流动力学和HIF-1α活化水平的影响

Levosimendan improves hemodynamics and reduces the activation of HIF-1α in CHD patients with heart failure

目的探讨非洋地黄类正性肌力药左西孟旦对于冠心病心力衰竭患者血流动力学和HIF-1α活化水平的影响。方法随机将80例心功能(NYHA)III-IV冠心病患者平均分为两组,即常规治疗组(对照组)和左西孟旦联合常规治疗组(治疗组)。在治疗前和治疗7天时,记录和监测患者血流动力学指标(LVEF、SV、CO和CI值)和血浆NTpro-BNP水平,同时使用western blot法检测血细胞HIF-1α活化水平。结果两组患者在给予治疗7天后,血流动力学指标(LVEF、SV、CO和CI值)、血浆NTpro-BNP水平和血细胞HIF-1α活化水平均较治疗前有明显改善,差异均有显著统计学意义(P均<0.05)。同时,与对照组相比较治疗组血流动力学指标(LVEF、SV、CO和CI值)、血NTproBNP水平和血细胞HIF-1α活化水平改善更加显著,差异有显著统计学意义(P均<0.05)。在临床研究期间患者均未出现与药物相关的严重不良反应。结论非洋地黄类正性肌力药左西孟旦可以有效改善冠心病心力衰竭患者血流动力学异常和降低血NTpro-BNP水平,并可能与抑制HIF-1α活化水平密切相关。

Objective To investigate the effects of levosimendan on hemodynamics and the activation of HIF-1αin coronary heart disease （CHD） patients with heart failure. Methods 80 CHD patients with heart failure （NYHA, III-IV grade） were randomly divided regular treatment group （control group） and levosimendan plus regular treatment group （treatment group）, with 40 in each. Before and after 7 day treatments, hemodynamics indexes （LVEF, SV, CO and CI）, serum level of NTpro-BNP and the expression of HIF-1α in blood cells were measured. Results After 7d treat- ments, hemodynamics indexes （LVEF, SV, CO and CI）, serum level of NTpro-BNP and the expression of HIF-1α in blood cells were all improved in both two groups （P〈0.05 in all）. Moreover, the improvements in treatment group were more significantly than that in control group （P〈0.05 in all）. Conclusion Levosimendan effectively improves hemody- namics indexes （LVEF, SV, CO and CI）, serum level of NTpro-BNP and the expression of HIF-1α in CHD patients with heart failure.