左西孟旦对AHF患者心功能、血浆BNP与血清细胞因子水平的影响

Impact of levosimendan on cardiac function,plasma BNP and serum cytokine levels in AHF patients

目的:观察左西孟旦对急性心力衰竭(AHF)的疗效及对患者心功能、脑钠肽(BNP)、超敏C反应蛋白(hsCRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平的影响。方法:本院2016年1月~2018年1月收治的148例AHF患者被随机均分为多巴酚丁胺组和左西孟旦组,两组均在常规治疗基础上接受相应药物治疗21d。观察比较两组治疗前后心功能指标、血浆BNP、血清hsCRP、TNF-α、IL-6水平、6min步行距离(6MWD)、治疗总有效率和不良反应。结果:左西孟旦组总有效率显著高于多巴酚丁胺组(83.78%比68.92%),P=0.033。与多巴酚丁胺组比较,左西孟旦组治疗后LVEF[(49.98±3.68)%比(52.17±3.82)%]、每搏输出量[SV,(67.52±5.79)ml比(69.48±5.83)ml]和6MWD[(328.46±31.62)m比(396.75±31.89)m]显著升高,左室收缩末内径[(54.12±8.64)mm比(51.31±8.26)mm]、左室舒张末内径[(65.25±8.86)mm比(62.14±8.57)mm]、血浆BNP[(572.59±89.62)mg/ml比(351.78±81.41)mg/ml]、血清TNF-α[(24.68±5.83)ng/L比(21.05±5.39)ng/L]、IL-6[(21.36±4.51)ng/L比(18.29±4.34)ng/L]、hsCRP[(4.89±2.15)ng/L比(3.06±1.47)ng/L]水平显著降低,P<0.05或<0.01。两组不良反应发生率无显著差异,P=0.690。结论:与多巴酚丁胺比较,左西孟旦治疗AHF疗效更显著,能够更显著地改善患者心功能、运动耐力,降低细胞因子的水平。

Objective:To observe therapeutic effect of levosimendan on acute heart failure(AHF)and its impact on cardiac function,levels of brain natriuretic peptide(BNP),high sensitive C reactive protein(hsCRP),tumor necrosis factor(TNF)-αand interleukin(IL)-6.Methods:A total of 148 AHF patients treated in our hospital from Jan 2016 to Jan 2018 were randomly and equally divided into dobutamine group and levosimendan group,both groups received corresponding medication based on routine treatment for 21d.Cardiac function,levels of plasma BNP,serum hsCRP,TNF-αand IL-6,6min walking distance(6MWD)before and after treatment,total effective rate and incidence of adverse reactions were observed and compared between two groups.Results:Total effective rate of levosimendan group was significantly higher than that of dobutamine group(83.78%vs.68.92%),P=0.033.Compared with dobutamine group after treatment,there were significant rise in LVEF[(49.98±3.68)%vs.(52.17±3.82)%],stroke volume[SV,(67.52±5.79)ml vs.(69.48±5.83)ml]and 6MWD[(328.46±31.62)m vs.(396.75±31.89)m],and significant reductions in left ventricular end systolic dimension[(54.12±8.64)mm vs.(51.31±8.26)mm],left ventricular end diastolic dimension[(65.25±8.86)mm vs.(62.14±8.57)mm],levels of plasma BNP[(572.59±89.62)mg/ml vs.(351.78±81.41)mg/ml],serum TNF-α[(24.68±5.83)ng/L vs.(21.05±5.39)ng/L],IL-6[(21.36±4.51)ng/L vs.(18.29±4.34)ng/L]and hsCRP[(4.89±2.15)ng/L vs.(3.06±1.47)ng/L]in levosimendan group,P<0.05 or<0.01.There was no significant difference in incidence rate of adverse reactions during treatment between two groups,P=0.690.Conclusion:Compared with dobutamine,levosimendan possesses more significant therapeutic effect on AHF.It can more significantly improve cardiac function,exercise capacity and reduce cytokine levels in these patients.