左西孟旦联合多巴胺治疗重症心脏瓣膜病患者的临床疗效及其对血浆内脂素及基质金属蛋白酶的影响研究

Clinical Efficacy of Levosimendan Combined with Dopamine in the Treatment of Severe Valvular Heart Disease and Its Impact on Plasma Visfatin and Matrix Metalloproteinase

背景目前,临床上治疗重症心脏瓣膜病多采用心脏瓣膜置换术,但手术并发症较多,且患者易发生脱机困难,因此开展重症心脏瓣膜病患者药物治疗研究具有重要意义。目的观察左西孟旦联合多巴胺治疗重症心脏瓣膜病患者的临床疗效及其对血浆内脂素及基质金属蛋白酶(MMP)的影响。方法选取2019年2月—2020年2月潜江市中心医院心内科收治的100例重症心脏瓣膜病患者,采用随机数字表法分为对照组和观察组,每组50例。对照组患者在基础治疗的同时给予多巴胺治疗,观察组在基础治疗的同时给予左西孟旦联合多巴胺治疗。比较两组患者治疗前和治疗5 d后血流动力学指标〔包括心率、平均动脉压(MAP)、中心静脉压(CVP)、血管外肺水指数(EVLWI)〕、心功能指标〔包括左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)〕、血清炎性因子〔包括白介素6(IL-6)、肿瘤坏死因子α(TNF-α)、超敏C反应蛋白(hs-CRP)〕及血浆内脂素、MMP-9、MMP-2水平,并观察两组患者治疗期间不良反应发生情况。结果观察组患者治疗5 d后心率、MAP、CVP、EVLWI低于对照组(P<0.05);两组患者治疗5 d后心率、MAP、CVP、EVLWI分别低于本组治疗前(P<0.05)。观察组患者治疗5 d后LVEF高于对照组,LVESD和LVEDD小于对照组(P<0.05);两组患者治疗5 d后LVEF分别高于本组治疗前,LVESD和LVEDD分别小于本组治疗前(P<0.05)。观察组患者治疗5 d后血清IL-6、TNF-α、hs-CRP水平低于对照组(P<0.05);两组患者治疗5 d后血清IL-6、TNF-α、hs-CRP水平分别低于本组治疗前(P<0.05)。观察组患者治疗5 d后血浆内脂素、MMP-9、MMP-2水平低于对照组(P<0.05);两组患者治疗5 d后血浆内脂素、MMP-9、MMP-2水平分别低于本组治疗前(P<0.05)。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)。结论左西孟旦联合多巴胺可有效改善重症心脏瓣膜病患者血流动力学及心功能,减轻炎性反应,降低血浆内脂素、MMP-9、MMP-2水平,且未增加药物相关不良反应,安全性较高。

Background At present,the heart valve replacement is widely used in the treatment of severe valvular heart disease,but there are many surgical complications,and the patients had difficulty in off-line.Therefore,it is of great significance to carry out drug treatment research for patients with severe valvular heart disease.Objective To observe the clinical efficacy of levosimendan combined with dopamine in the treatment of severe valvular heart disease and its impact on plasma visfatin and matrix metalloproteinase(MMP).Methods From February 2019 to February 2020,a total of 100 patients with severe valvular heart disease admitted to the Department of Cardiology,Qianjiang Central Hospital were selected,and they were divided into the control group and the observation group according to random number table method,50 cases in each group.On the basis of basic treatment,the control group was treated with dopamine,while the observation group was treated withlevosimendan combined with dopamine.The hemodynamic indexes〔including heart rate,mean arterial pressure(MAP),central venous pressure(CVP),extravascular lung water index(EVLWI)〕,cardiac function indexes〔including leftventricular ejection fraction(LVEF),left ventricular end systolic diameter(LVESD),left ventricular end diastolic diameter(LVEDD)〕,serum inflammatory markers〔including interleukin-6,tumor necrosis factor-alpha(TNF-α),highsensitive C-reaction protein(hs-CRP)〕and plasma levels of visfatin,MMP-9 and MMP-2 between the two groups beforetreatment and five-day after treatment;the adverse reactions of the two groups were observed during the treatment.Results Theheart rate,MAP,CVP and EVLWI in the observation group were lower than those in the control group five-day after treatment(P < 0.05);the heart rate,MAP,CVP and EVLWI in the two groups five-day after treatment were lower than those beforetreatment,respectively(P < 0.05).Five-day after treatment,LVEF in the observation group was higher than that in controlgroup,while LVESD and LVEDD in the observation group were lower than those in the control group(P < 0.05);LVEF inthe two groups five-day after treatment was higher than that before treatment,while LVESD and LVEDD were lower than thosebefore treatment(P < 0.05). The serum levels of interleukin-6,TNF-α and hs-CRP in the observation group five-day aftertreatment were lower than those in the control group(P < 0.05);the serum levels of interleukin-6,TNF-α and hs-CRPin the two groups five-day after treatment were lower than those before treatment,respectively(P < 0.05).The plasma levelsof visfatin,MMP-9 and MMP-2 in the observation group five-day after treatment were lower than those in the control group(P < 0.05);the plasma levels of visfatin,MMP-9 and MMP-2 in the two groups five-day after treatment were lowerthan those before treatment,respectively (P < 0.05).There was no significant difference in the incidence of adversereactions between the two groups(P > 0.05).Conclusion Levosimendan combined with dopamine can effectively improvehemodynamics and cardiac function in patients with severe valvular heart disease,alleviate inflammatory response,reduce theplasma levels of visfatin,MMP-9 and MMP-2,and have no increased drug-related adverse reactions,and the safety is higher.