厄贝沙坦氢氯噻嗪联合糖皮质激素治疗重症心力衰竭患者临床疗效的研究

Analysis of the effect of irbesartan and hydrochlorothiazide combined with glucocorticoids in patients with severe heart failure

目的探讨糖皮质激素辅助厄贝沙坦氢氯噻嗪治疗重症心力衰竭（CHF）患者的临床疗效及对神经内分泌因子的影响作用。方法选取69例重症CHF患者为研究对象，随机分为研究组（34例）和对照组（35例），两组均给予常规基础治疗及厄贝沙坦氢氯噻嗪，研究组加用糖皮质激素进行治疗。比较两组患者治疗前后心功能及实验室指标的差异。结果治疗前两组患者的左心室舒张末期内径（LVEDD）、收缩末期左室内径（LVESD）、左心室射血分数（LVEF）、左室舒张末期容量（LVEDV）和左室收缩末期容量（LVESV）测定值差异无统计学意义（P〉0．05）；治疗后研究组和对照组的上述指标较治疗前均明显好转（P〈0．05），治疗后研究组优于对照组（P〈0．05）。治疗后研究组的皮质醇（COR）、醛固酮（ALD）、内皮素（ET）和转化生长因子-β1（TGF-β1）、超敏C-反应蛋白（hs-CRP）测定值与对照组比较差异有统计学意义（P〈0．05），两组间心房钠尿肽（ANP）、β2-微球蛋白（β2-MG）测定值差异无统计学意义（P〉0．05）。治疗后研究组的6min步行距离（365．4±73．2）m明显长于对照组的（314．2±68．4）m，两组比较差异有统计学意义（P〈0．05）。治疗后研究组的总有效率91．18％明显高于对照组的71．43％，且差异有统计学意义（P〈0．05）。结论糖皮质激素辅助厄贝沙坦氢氯噻嗪治疗重症CHF患者能够明显改善心功能及神经内分泌因子的分泌，从而进一步提高临床治疗效果。

Objective To investigate the clinical efficacy of glucocorticoid auxiliary irbesartan hydrochlorothiazide in the treatment of severe heart failure patients and the effect on neuroendocrine factors. Methods Sixty - nine severe heart failure patients were selected and randomly divided into study group （34 cases） and control group （35 cases）. The two groups were given conventional treatment and irbesartan hydrochlorothiazide thiazide, and study group were additionally treated with corticosteroids. The differences of heart function and laboratory index between the two groups before and after treatment were compared. Results Before treatment the patients between the two groups showed no statistical differenced about the LVEDD, LVESD, LVEF, LVEDV, LVESV values （P 〉 0.05） ; after the treatment the above indicators of the study group and the control group were higher than those before treatment （ P 〈 0.05）, but after treatment the indicators were improved more significantly in the study group than those in the control group （P 〈0.05）. After treatment, COR, ALD, ET, TGF- 61, hsCRP value in the study group were obviously higher than those of the control group （P 〈 0.05 ）, but the ANP, 62 - MG value were not significantly different between the two groups （ P 〉 0.05）. After treatment the walking distance within 6 min in the study group of was longer than that in the control group [ （365.4 ± 73.2）m vs. （314.2 ± 68.4） m, P 〈 0.05 ]. The therapy efficiency in the study group was significantly higher than that in controlgroup （ 91. 18% vs. 71. 43%, P 〈 0. 05 ）. Conclusion Glucocorticoid assisted Eritrea hydrogen irbesartan hydrochlorothiazide in the treatment of severe heart failure patients can significantly improve cardiac function and neuroendocrine factor secretion, so as to further improve clinical effect.