依普利酮治疗轻度症状收缩性心力衰竭患者的临床观察

Eplerenone in the treatment of patients with mild symptoms systolic heart failure

目的:评价依普利酮在轻度症状收缩性心力衰竭患者的疗效。方法:选取我院2013年2月至2015年10月收治的NYHA分级Ⅱ级的收缩性心力衰竭患者,随机分为对照组(41例,常规心衰治疗)与观察组(42例,加依普利酮治疗)。治疗6个月后,观察、分析2组间患者治疗前后症状、体征、超声指标、脑钠肽(brain natriuretic peptide,BNP)、转化生长因子-β1(transforming growth factor-β1,TGF-β1)、6 min步行试验(6 min walking test,6MWT)、生活质量评分变化。结果:2组患者血浆BNP与TGF-β1水平均较治疗前降低,左室射血分数(left ventricular shoot ejection fraction,LVEF)、左心室收缩末期内径(left ventricular contraction end systolic diameter,LVESD)、室间隔厚度(interventricular septal thickness,IVS)、6MWT、生活质量评分均较治疗前有所改善,差异有统计学意义(P<0.05)。治疗后2组间对比,观察组患者血浆BNP与TGF-β1水平分别为(274.08±175.90)pg/m L和(114.28±39.50)ng/L,均低于对照组的(452.85±128.52)pg/m L和(255.08±41.05)ng/L,观察组患者LVEF(49.02%±7.41%)和6MWT[(710.57±158.25)m]高于对照组,LVESD[(38.54±8.05)mm]和生活质量评分(41.54±10.59)低于对照组,差异均有统计学意义(P<0.05)。2组间不良反应发生率差异无统计学意义。观察组治疗总有效率高于对照组(69.08%vs.39.02%,P<0.05)。结论:在常规治疗基础上,依普利酮作为新型高选择性醛固酮受体阻滞剂,能够降低轻度症状收缩性心力衰竭患者血浆TGF-β1水平,在逆转心肌重构、改善心功能中发挥重要作用。

Objective：To evaluate the clinical efficacy of eplerenone in the treatment of patients with mild symptoms systolic heart failure. Methods：A total of 83 patients with systolic heart failure in grade NYHA Ⅱ from February 2013 to December 2015 in our hospital were enrolled in the study,and were divided into 2 group randomly. Patients in the control group（41 cases） were treated with routine anti systolic heart failure,on this basis, the observaiion group was treated with eplerenone 25 mg/d,if no significant adverse reactions after 1 month, then increased to 50 mg/d. After 6 months of treatment, the symptoms, signs, brain natriuretic peptide （BNP）, plasma transformation growth factor-β1 （TGF-β1）,left ventricular shoot ejection fraction（LVEF）,left ventrictilar contraction end sys- tolic diameter （LVESD）, interventricular septal thickness （IVS）, 6 min walking test （6MWT）, quality of life score changes of the two groups before and after treatment were recorded and compared. Results：After receiving different treatments, the plasma levels of BNP and TGF-βin two groups were significantly lower than those before treatment; LVEF, LVESD, IVS, 6MWT, quality of life scores were improved compared with those before treatment（P〈0.05）. After the treatment,plasma TGF-β（274.08 ± 175.90） pg/mL and BNP level （114.28 ± 39.50） ng/L in observation group was lower than those of control group;the LVEF（49.02 ± 7.41 ）% and 6MWT [（710.57 ±158.25） m] were higher,the LVESD[（38.54 ± 8.05） mm] and the quality of life scores（41.54 ± 10.59） were lower in observation group than in those of control group（P〈0.05）. The adverse reaction rate between two groups showed no statistic significant. The total effective rate of the observation group was 69.08%, higher than that of the control group （P〈0.05）. Conclusion：As a new high selec- tive aldosterone receptor blocking agent, eplerenone can reduce plasma TGF-β1 level of patients with mild symptoms of systolic heartfailure and play a role in improving the heart function and re- verse myocardial remodeling on the basis of routine treatment.