螺内酯联合阿托伐他汀钙治疗慢性心力衰竭的临床疗效及其对自主神经功能、瘦素和脂联素水平的影响

Clinical Effect of Spirolactone Combined with Atorvastatin Calcium in Treating Chronic Heart Failure and the Impact on Autonomic Nervous Function,Leptin and Adiponectin

目的观察螺内酯联合阿托伐他汀钙治疗慢性心力衰竭(CHF)的临床疗效,并探讨其对自主神经功能、瘦素和脂联素水平的影响。方法选取2013年5月—2015年5月新疆医科大学附属中医医院收治的CHF患者96例,采用随机数字表法分为对照组和观察组,每组48例。对照组患者在对症治疗基础上给予阿托伐他汀钙片,观察组患者在对照组基础上给予螺内酯;两组患者均持续治疗3个月。比较两组患者临床疗效,治疗前后心功能指标[包括射血分数(EF)和6分钟步行距离]、自主神经功能指标[包括5 min RR间期平均值的标准差(SDANN)、RR间期的标准差(SDNN)、相邻RR间期差值的均方根(RMSSD)、5 min RR间期标准差的平均值(SDNNindex)、相邻RR间期相差≥50 ms的百分数(PNN50)]、瘦素及脂联素水平,并观察两组患者治疗期间不良反应发生情况。结果 (1)观察组患者临床疗效优于对照组(P<0.05)。(2)治疗前两组患者EF、6分钟步行距离及治疗后EF比较,差异无统计学意义(P>0.05);治疗后观察组患者6分钟步行距离长于对照组(P<0.05)。(3)两组患者治疗前SDANN、SDNN、RMSSD、SDNNindex、PNN50比较,差异无统计学意义(P>0.05);治疗后观察组患者SDANN、SDNN、RMSSD、SDNNindex、PNN50高于对照组(P<0.05)。(4)治疗前两组患者瘦素、脂联素水平比较,差异无统计学意义(P>0.05);治疗后观察组患者瘦素、脂联素水平低于对照组(P<0.05)。(5)两组患者治疗期间不良反应发生率比较,差异无统计学意义(P>0.05)。结论螺内酯联合阿托伐他汀钙治疗CHF的临床疗效确切,可有效改善患者心功能和自主神经功能,降低瘦素和脂联素水平,且安全性较高。

Objective To observe the clinical effect of spirolactone combined with atorvastatin calcium in treating chronic heart failure(CHF),to investigate the impact on autonomic nervous function,leptin and adiponectin.Methods A total of 96 patients with CHF were selected in the Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University from May 2013 to May 2015,and they were divided into control group and observation group according to random number table,each of 48 cases.Patients in control group received atorvastatin calcium tablets based on symptomatic treatment,while patients in observation group received spirolactone combined with atorvastatin calcium tablets;both groups continuously treated for 3 months.Clinical effect,index of hearty function(including EF and 6-minute walking distance)and autonomic nervous function(including SDANN,SDNN,RMSSD,SDNNindex and PNN50),leptin and adiponectin before and after treatment were compared between the two groups,and incidence of adverse reactions was observed during treatment.Results (1)Clinical effect in observation group was statistically significantly better than that in control group(P<0.05).(2)No statistically significant difference of EF or 6-minute walking distance was found between the two groups before treatment,nor was EF after treatment(P>0.05),while 6-minute walking distance in observation group was statistically significantly longer than that in control group(P<0.05).(3)No statistically significant difference of SDANN,SDNN,RMSSD,SDNNindex or PNN50 was found between the two groups before treatment(P>0.05),while SDANN,SDNN,RMSSD,SDNNindex and PNN50 in observation group were statistically significantly higher than those in control group after treatment(P<0.05).(4)No statistically significant difference of leptin or adiponectin was found between the two groups before treatment(P>0.05),while leptin and adiponectin in observation group were statistically significantly lower than those in control group after treatment(P<0.05).(5)No statistically significant difference of incidence of adverse reactions was found between the two groups during treatment(P>0.05).Conclusion Spirolactone combined with atorvastatin calcium has certain clinical effect in treating CHF,can effectively improve the cardiac function and autonomic nervous function,reduce the leptin and adiponectin,with relatively high safety.