免疫球蛋白联合左西孟旦治疗老年扩张型心肌病的疗效及对血清sSema4D、sTWEAK的影响

Curative effect of immunoglobulin combined with levosimendan on senile dilated cardiomyopathy and its influence on serum soluble Sema4D and sTWEAK

目的探讨免疫球蛋白联合左西孟旦治疗老年扩张型心肌病的疗效及对血清可溶性Sema4D(sSema4D)、可溶性肿瘤坏死因子样弱凋亡诱导因子(sTWEAK)的影响。方法选择2016年4月～2018年4月于昆明理工大学附属西双版纳傣族自治州人民医院接诊的90例老年扩张型心肌病患者为研究对象,随机分为观察组50例和对照组40例,在常规治疗基础上,对照组给予左西孟旦治疗,观察组联合免疫球蛋白治疗,连续治疗4周。比较两组在临床疗效、心功能、血清sSema4D、sTWEAK的变化及不良反应。结果治疗后,观察组临床疗效总有效率明显高于对照组[94.00%(47/50)vs. 77.50%(31/40)](P<0.05);观察组左室射血分数(LVEF)明显高于对照组,左室收缩末期内径(LVEDD)、左室舒张末期内径(LVESD)均明显低于对照组(P<0.05);观察组血清sSema4D、sTWEAK明显低于对照组(P<0.05);两组治疗期间不良反应比较差异无统计学意义(P>0.05)。结论在老年扩张型心肌病患者中使用免疫球蛋白联合左西孟旦可有效改善心功能,其内在机制可能和降低血清sSema4D、sTWEAK的表达,逆转左室重构相关。

Objective To investigate the curative effect of immunoglobulin combined with levosimendan on senile dilated cardiomyopathy(DCM)and its influence on serum soluble Sema4D(sSema4D)and sTWEAK.Methods The elderly DCM patients(n=90)were chosen from People's Hospital of Xishuangbanna Dai Autonomous Prefecture from Apr.2016 to Apr.2018,and then divided randomly into observation group(n=50)and control group(n=40).On the base of routine treatment,control group was given levosimendan and observation group was given immunoglobulin combined with levosimendan for 4 weeks continuously.The clinical efficacy,heart function,changes of serum sSema4D and sTWEAK and adverse reactions were compared between 2 groups.Results The total effective rate was significantly higher in observation group than that in control group[94.00%(47/50)vs.77.50%(31/40),P<0.05].LVEF was significantly higher,LVEDD and LVESD significantly lower in observation group than those in control group(P<0.05).The expressions of sSema4D and sTWEAK were significantly lower in observation group than those in control group(P<0.05).The difference in adverse reactions during treatment had no statistical significance between 2 groups(P>0.05).Conclusion Immunoglobulin combined with levosimendan can effectively improve heart function in elderly DCM patients,and the internal mechanism may be related to reducing expressions of sSema4D and sTWEAK and reversing left ventricular remodeling.