不同心功能水平的扩张型心肌病患者应用左西孟旦疗效研究

Effect of Levosimendan in Patients of Dilated Cardiomyopathy With Different Heart Function

目的:观察不同程度心力衰竭(心衰)的扩张型心肌病(DCM)患者应用左西孟旦后疗效。方法:入选DCM患者145例,根据左心室射血分数(LVEF)水平,分为轻度心衰组(LVEF≤45%,n=15)、中度心衰组(LVEF≤40%,n=58)及重度心衰组(LVEF≤30%,n=72)。对比分析各组应用左西孟旦治疗前及治疗7天后的LVEF、左心房前后内径(LAD)、左心室舒张期末内径(LVEDd)及B型利钠肽(BNP)水平。结果:与治疗前比,轻、中、重度心衰各组应用左西孟旦后LVEF均有提高,但只有重度心衰组差异有统计学意义[(24.79±2.81)%,(26.06±3.59)%,P<0.05)。3组LAD、LVEDd治疗前后均未见明显改善(P>0.05)。与治疗前比,左西孟旦治疗后轻、中、重心衰各组BNP水平均有显著降低[BNP水平(单位:pg/ml)轻度心衰组:1252.17±1435.39,604.80±631.87;中度心衰组:3206.90±2677.15,2369.78±2478.59;重度心衰组:6004.46±5041.59,4879.63±5302.42;P均<0.05],但各组治疗前后BNP差值及BNP治疗后下降比差异均无统计学意义(P>0.05)。结论:左西孟旦治疗DCM,短期内对轻、中、重度心衰患者心功能均有提高,且程度相当,但对心脏结构均无明显改善。

Objective： To study the effect of levosimendan treatment in patients of dilated cardiomyopathy （DCM） with different heart fraction. Methods： A total of 145 DCM patients were enrolled, based on left ventricular ejection fraction （LVEF）, the patients were divided into 3 groups： Mild heart failure （HF） group, the patients with LVEF≤45%,n=15, Moderate HF group, LVEF≤40%,n=58 and Severe HF group, LVEF≤30%,n=72. LVEF, left atrial diameter （LAD）, left ventricular end-diastolic diameter （LVEDD） and blood levels of BNP were examined and compared at prior and 7 days after levosimendan treatment respectively. Results： Compared with prior treatment, fater7 days of levosimendan medication, LVEF was elevated at certain degree in all 3 groups, while the statistic improvement was only found in Severe HF group （26.06±3.59） % vs （24.79±2.81） %,P〈0.05; LAD and LVEDD had no obvious changes with levosimendan medication in all 3 groups,P〉0.05. After levosimendan treatment, blood levels of BNP were decreased in all 3 groups as in Mild HF group （604.80±631.87） pg/ml vs （1252.17±1435.39） pg/ml, Moderate HF group （2369.78±2478.59） pg/ml vs （3206.90±2677.15） pg/ml and Severe HF group （4879.63±5302.42） pg/ml vs （6004.46±5041.59） pg/ml, allP〈0.05. The differences of BNP level between prior and after levosimendan treatment, the ratio for BNP reduction were similar among 3 groups, allP〉0.05. Conclusion： Levosimendan may, in short term, improve the cardiac function in DCM patients with mild, moderate and severe HF with similar degree; while it could not really change the cardiac structure.