应用cTnT和NT-proBNP水平综合评价左西孟旦治疗老年慢性心力衰竭的疗效

Evaluation of the efficacy in chronic heart failure treated with levosimendan by detecting blood c Tn T and NT-pro BNP

目的采用心肌钙蛋白T（cardiac troponin T,c Tn T）和N-末端B型利尿钠肽前体（N-terminal pro-B-type natriuretic peptide,NT-pro BNP）水平结合超声心动图指标,评价经常规抗心力衰竭药物治疗效果欠佳的患者应用左西孟旦注射液的疗效及其安全性。方法选取2012年6月—2014年10月开封市第二人民医院心内科的慢性心力衰竭住院患者96例,随机分为常规组和左西孟旦组各48例,2组患者的心功能为Ⅲ~Ⅳ级,基线资料均衡。常规组患者采用β受体拮抗药、利尿药、洋地黄类药物和血管紧张素转换酶抑制药等药物治疗,左西孟旦组在常规组基础上加用左西孟旦。观察用药前和用药后24 h,2组患者血清标志物NT-pro BNP、c Tn T及左心室射血分数（left ventricular ejection fraction,LVEF）、每搏输出量（stroke volume,SV）和左心室舒张末期内径（left ventricular end diastolic,LVED）的变化情况。结果 2组用药前NT-pro BNP、c Tn T水平比较差异无统计学意义（P〉0.05）,用药后左西孟旦组NT-pro BNP和c Tn T水平较治疗前显著降低,LVEF、SV较治疗前显著增高,差异均有统计学意义（P〈0.05）,LVED在用药前后差异无统计学意义（P〉0.05）。而常规治疗组用药前后NT-pro BNP、c Tn T水平及LVEF、SV、LVED比较差异均无统计学意义（P〉0.05）。左西孟旦组患者用药后的有效率为39.6%（19/48）,常规组为20.8%（10/48）,2组比较差异有统计学意义（P〈0.05）。结论应用c Tn T和NT-pro BNP水平评价左西孟旦注射液治疗老年慢性心力衰竭效果具有一定的临床价值。

Objective To evaluate the efficacy and safety of levosimendan injections by detecting the levels of cTnT and NTproBNP combined with echocardiography index for patients which had poor outcomes with anti-heart failure drugs.Methods From June 2012 to October 2014,96 patients with chronic heart failure in department of cardiology,Kaifeng second people＇s hospital,were randomly divided into two groups with 48 patients in each group.The patients with NYHA heart function class IV in two groups had a baseline information balance.Patients in routine group were treated with beta receptor antagonist,diuretics,digitalis drugs and angiotensin converting enzyme inhibitors.Patients in levosimendan group were treated with levosimendan based on routine treatment.Before and after medication of 24 hours,the changing of NT-proBNP,cTnT,left ventricular ejection fraction（LVEF）,stroke volume（SV） and left ventricular end diastolic diameter（LVED） were measured.Results There was no significant difference in the levels of NT-proBNP,cTnT between two groups before treatment（P〈0.05）.After treatment with levosimendan,the levels of NT-proBNP and cTnT significantly lower than that before treatment,LVEF and SV increased,there were significant differences（P〈0.05）,LVED had no significant difference before and after treatment（P〈0.05）.While in the control group,levels of NT-proBNP,cTnT and LVEF,SV,LVED had no statistically significant differences before and after treatment.The effective rate was 39.6%（19/48） in levosimendan group after treatment,and 20.8%（10/48） in routine group,there was a statistically significant difference between two groups（P〈0.05）.Conclusion It had clinical application value in evaluation of the efficacy in senile chronic heart failure treated with levosimendan by detecting levels of cTnT and NT-proBNP.