“金三角”药物强化治疗对收缩功能保留型心力衰竭的临床疗效观察

Comparison on effects of intensive versus routine treatment in patients with heart failure with preserved ejection fraction

目的比较心力衰竭"金三角"药物强化治疗与常规治疗对收缩功能保留型心力衰竭(HFpEF)的临床疗效。方法按入排标准,入组合并至少2种心血管危险因素的HFpEF患者90例,随机分为强化治疗组(n=45)和常规治疗组(n=45)。强化治疗组除利尿剂外尚联用心力衰竭"金三角"药物强化治疗;常规治疗以利尿剂治疗为主,按需选用其他药物。两组疗程均为1年。结果较之常规治疗,强化治疗可显著地降低血压、心率、胆固醇、B-型脑钠肽、NYHA心功能分级、超声左室舒张功能分级,而对空腹血糖、肌酐、左室射血分数(LVEF)无明显影响;随访1年,强化治疗可显著减少主要终点(主要不良心血管事件)及次要终点(心力衰竭住院),但不降低死亡、心血管并发症及恶性心律失常的发生率。结论对于合并多种危险因素的HFpEF患者,强化治疗比常规治疗可更有效地改善心功能,降低主要不良心血管事件的发生率,获益主要来自减少心衰住院。

Objective To compare the clinical efficacy of intensive therapy with"golden triangle"drug versus and conventional treatment in patients with HFpEF.Methods A total of 90 patients with HFpEF accompanying with at least two cardiovascular risk factors were randomly divided into intensive treatment group(n=45)and conventional treatment group(n=45)according to the inclusion and exclusion criteria.In the intensive treatment group,diuretics were used in combination with"golden triangle"drugs for heart failure,while in the conventional treatment group diuretics were the main treatment and other drugs could be used as needed.Both groups were followed up for one year.Results Compared with conventional treatment,intensive treatment significantly reduced blood pressure,heart rate,cholesterol,B-type brain natriuretic peptide,percentage of NYHA grading≥3,and percentage of echocardiographic diastolic function grading=3,but had no significant effect on fasting blood glucose,creatinine and LVEF.At 1-year follow-up,intensive treatment significantly reduced the primary endpoint(major adverse cardiovascular events)and secondary endpoint(hospitalization for heart failure),but did not reduce the incidence of death,cardiovascular complications,and malignant arrhythmias.Conclusion For HFpEF patients with multiple risk factors,intensive treatment is more effective than conventional one in reducing the incidence of major adverse cardiovascular events.The benefits mainly come from reducing hospitalization for heart failure.