左西孟旦联合螺内酯对慢性心力衰竭患者血清炎症因子水平及心室重构的影响研究

Effects of Levosimendan Combined Spironolactone on the Serum Inflammatory Factors Levels and Ventricular Remodeling in Patients with Chronic Heart Failure

目的:研究左西孟旦联合螺内酯对慢性心力衰竭患者血清炎症因子水平及心室重构的影响。方法:选择2015年1月-2017年12月我院干部病房收治的88例慢性心力衰竭患者,将其随机分为两组。对照组单纯口服螺内酯,每次20 mg,每天1次;观察组联合采取左西孟旦治疗。观察和比较两组治疗前后的心功能指标(左心室舒张期末内径、6 min步行试验、左心室射血分数以及左心室收缩期末内径),血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白介素-6 (interleukin-6,IL-6)、高敏C-反应蛋白(high sensitivity C-reactive protein,hs-CRP)、N端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)水平的变化情况。结果:治疗后,观察组的有效率明显高于对照组(90.91%vs. 72.73%,P<0.05);两组治疗后左心室舒张期末内径、左心室收缩期末内径、血清hs-CRP、TNF-α、IL-6和NT-proBNP水平均较治疗前显著降低,而左心室射血分数及6 min步行试验均较治疗前明显增加(P<0.05),且观察组左心室舒张期末内径、左心室收缩期末内径、血清hs-CRP、TNF-α、IL-6和NT-proBNP水平明显低于对照组,左心室射血分数及6 min步行试验显著高于对照组(P<0.05)。结论:左西孟旦联合螺内酯治疗慢性心力衰竭患者可能显著提高其临床疗效,可能与其有效改善患者的心功能以及心室重构、减轻机体炎症反应有关。

Objective: To study the effect of levosimendan combined spironolactone on the serum inflammatory factors levels and ventricular remodeling in patients with chronic heart failure. Methods: 88 cases of patients with chronic heart failure who were treated in our hospital from January 2015 to December 2017 were selected and randomly divided into two groups. The control group was treated with spironolactone alone, while the observation group was treated with levosimendan. The cardiac function indexes(left ventricular end-diastolic diameter, 6-minute walking test, left ventricular ejection fraction and left ventricular end-systolic diameter), serum tumor necrosis factor-α(TNF-α), interleukin-6(IL-6), high sensitivity C-reactive protein(hs-CRP) and N-terminal pro-brain natriuretic peptide(NT-proBNP) levels were observed and compared between the two groups before and after treatment. Results: After treatment, the effective rate of observation group was significantly higher than that of the control group(90.91% vs. 72.73%, P<0.05). After treatment,left ventricular end diastolic diameter, left ventricular end systolic diameter, serum hs-CRP, TNF-α, IL-6 and NT-proBNP levels were significantly lower than those before treatment, while the left ventricular ejection fraction and 6-minute walking test were significantly increased(P<0.05), and the left ventricular end diastolic diameter, left ventricular end systolic diameter, serum levels of hs-CRP, TNF-α,IL-6 and NT-proBNP were significantly lower than those in the control group. The left ventricular ejection fraction and 6-minute walking test were significantly higher than those in the control group(P<0.05). Conclusion: Levosimendan combined with spironolactone may significantly improve its clinical efficacy in the treatment of chronic heart failure, which may be related to the effective improvement of cardiac function, ventricular remodeling and alleviating inflammation.