结缔组织病并发难治性心力衰竭患者联用糖皮质激素的疗效

Curative effect of combined glucocorticoid in patients with connective tissue diseases complicated by refractory heart failure

目的探讨常规抗心力衰竭治疗联用糖皮质激素治疗结缔组织病并发难治性心力衰竭患者的疗效。方法回顾性分析江苏省淮安市第一人民医院于2009年1月~2015年12月住院的结缔组织病并发难治性心力衰竭患者18例的临床资料,其中男性2例,女性16例,年龄48~67岁,平均年龄(51±11)岁。所有患者均常规抗心力衰竭治疗联合应用糖皮质激素。比较治疗前后心排血量(CO)、心排血指数(CI)、左室射血分数(LVEF)、N末端脑钠肽前体(NT-pro BNP)、6分钟步行距离(6MWT)、心率(HR)。结果与治疗前比较,治疗后患者的NT-pro BNP、6MWT、CO、CI、LVEF、HR均改善,(1588.0±45.6)pg/ml vs.(455.7±22.3)pg/ml,(98.9±25.4)m vs.(404.6±85.3)m,(3.78±0.24)L/min vs.(4.50±0.71)L/min,(1.82±0.38)L·min^(-1)·m^(-2) vs.(2.73±0.34)L·min^(-1)·m^(-2),(37±6)%vs.(56±14)%,(108±12)次/min vs.(74±21)次/min,差异有统计学意义(P均<0.05)。结论结缔组织病并发难治性心力衰竭患者常规抗心力衰竭治疗联合糖皮质激素治疗疗效显著。但本研究样本量较小,有待进一步扩大样本研究证实。

Objective To discuss the curative effect of routine anti-heart failure therapy combining glucocorticoid（GC） in patients with connective tissue diseases complicated by refractory heart failure（RHF）. Methods The clinical materials from the patients（n=18, male 2, female 16, aged from 48 to 67 and average age=51±11） in the First People＇s Hospital of Huai＇an City of Jiangsu Province were retrospectively analyzed from Jan. 2009 to Dec. 2015. All patients were given routine anti-heart failure therapy combining GC. The cardiac output（CO）, cardiac output index（CI）, left ventricular ejection fraction（LVEF）, N-terminal pro-brain natriuretic peptide（NT-pro BNP）, 6-minute walk distance（6 MWD） and heart rate（HR） were compared before and after treatment. Results NT-pro BNP [（1588.0±45.6） pg/m L vs.（455.7±22.3） pg/m L], 6 MWT [（98.9±25.4） m vs.（404.6±85.3） m], CO [（3.78±0.24） L/min vs.（4.50±0.71） L/min], CI [（1.82±0.38） L·min^（-1）·m^（-2） vs.（2.73±0.34） L·min^（-1） ·m^（-2）], LVEF [（37±6） % vs.（56±14） %] and HR [（108±12） time/min vs.（74±21） time/min] were improved after treatment compared with before treatment（all P〈0.05）. Conclusion The curative effect of anti-heart failure therapy combining GC is significant in patients with connective tissue diseases complicated by RHF. As the sample size is small, the further large-sample study is needed to confirm the conclusion.