培哚普利联合卡维地洛对老年充血性心力衰竭患者心功能及炎性指标的影响

Effects of perindopril combined with carvedilol on cardiac function and inflammatory indexes in elderly patients with congestive heart failure

目的探讨培哚普利联合卡维地洛治疗老年充血性心力衰竭患者的临床效果。方法将2016年5月至2018年5月中国人民解放军联勤保障部队第九八一部队收治的97例老年充血性心力衰竭患者随机分成2组,联合组(培哚普利联合卡维地洛)49例和对照组(卡维地洛)48例。比较2组患者治疗前后的临床疗效;比较2组患者治疗前后左心室射血分数(left ventricular ejection fraction,LVEF)、左心室舒张末期内径(left ventricular end-diastolic diameter,LVEDD)、左心室收缩末期内径(left ventricular end-systolic diameter,LVESD)、左心室后壁厚度(left ventricular posterior wall depth,LVPWD);比较2组治疗前后血清脑钠肽(brain natriuretic peptide,BNP)浓度、6 min步行距离(6-minute walking distance,6MWT)、心率;比较2组患者治疗前后同型半胱氨酸(homocysteine,Hcy)、高敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)、血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)浓度;统计2组治疗期间出现的不良反应。结果治疗后,联合组患者总有效率明显高于对照组总有效率,差异有统计学意义[93.88%(46/49)vs. 79.17%(38/48),P<0.05]。治疗后,联合组患者的LVEDD、LVESD、LVPWD为(56.19±1.16)mm、(46.41±2.25)mm、(10.01±0.32)mm,低于对照组的(60.52±1.14)mm、(49.25±2.13)mm、(11.20±0.17)mm,差异有统计学意义(P<0.05);联合组患者的LVEF高于对照组,差异有统计学意义(53.86%±8.91%vs. 45.24%±7.57%,P<0.05)。联合组患者治疗后血清BNP浓度、心率低于对照组,6MWT比对照组明显升高,差异有统计学意义(P<0.05)。治疗后,联合组患者的血清Hcy、hsCRP和TNF-α浓度明显低于对照组,差异有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论培哚普利联合卡维地洛治疗老年充血性心力衰竭的效果显著,其不但在改善心功能方面有积极作用,还能降低心血管疾病发生风险,并在此基础上减轻炎性反应,且具有较高的安全性。

Objectives To explore the clinical curative effect of perindopril combined with carvedilol in elderly patients with congestive heart failure(CHF).Methods Totally 97 elderly patients with CHF who were admitted to 981 Unit of the Joint Logistics Support Force of PLA from May 2016 to May 2018 were randomly divided into combination group(49 cases,perindopril combined with carvedilol)and control group(48 cases,carvedilol).The clinical curative effect before and after treatment was compared between the two groups.The left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),left ventricular posterior wall depth(LVPWD)were compared between the two groups.Serum concentration of brain natriuretic peptide(BNP),6-minute walking distance(6 MWT),heart rate(HR)before and after treatment were compared between the two groups.Serum concentrations of homocysteine(Hcy),high-sensitivity C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α)before and after treatment were compared between the two groups.The adverse reactions during treatment were compared between the two groups.Results After treatment,total response rate of combination group was significantly higher than that of control group[93.88%(46/49)vs.79.17%(38/48),P<0.05].After treatment,LVEDD,LVESD and LVPWD in combination group were(56.19±1.16)mm,(46.41±2.25)mm,(10.01±0.32)mm and they were significantly lower than those in control group which were(60.52±1.14)mm,(49.25±2.13)mm,(11.20±0.17)mm(P<0.05);and LVEF in combination group was significantly higher than that in control group(53.86%±8.91%vs.45.24%±7.57%,P<0.05).After treatment,BNP and HR in combination group were significantly lower than those in control group,while 6 MWT was significantly higher than that in control group(P<0.05).After treatment,serum concentrations of Hcy,hs-CRP and TNF-αin combination group were significantly lower than those in control group(P<0.05).There was no significant difference in incidence of adverse reactions between the two groups(P>0.05).Conclusions The curative effect of perindopril combined with carvedilol is significant in elderly patients with CHF.It can not only play positive roles in improving cardiac function,but also reduce risk of cardiovascular diseases,reduce inflammatory response on this basis,with relatively higher safety.