低剂量螺内酯治疗对射血分数保留型心力衰竭心室结构及预后的影响与血浆晚期糖基化终末产物的关系

Effect of low dose spironolactone treatment on ventricular structure and prognosis in heart failure with preserved ejection fraction associated with advanced glycation end products in plasma

目的探讨低剂量螺内酯治疗对射血分数保留型心力衰竭(HFpEF)心室结构及预后的影响,并分析其与血浆可溶性晚期糖基化终末产物受体(sRAGE)的关系。方法选取2017年1月~2019年1月于联勤保障部队第970医院心内科收治的116例HFpEF患者作为研究对象,根据入院时间分为对照组和观察组,各58例;其中对照组给予常规治疗,观察组治疗方案同对照组,但螺内酯为低剂量治疗;对比两组治疗前后心室重构相关指标和血浆sRAGE差异。以入院开始计算,随访18个月,记录并统计各组终点事件发生情况,绘制Kaplan-Meier曲线,并用Log-rank检验对比分析;对比不同终点事件发生者心室重构相关指标和血浆sRAGE差异。结果与治疗前比较,治疗后两组舒张早期血流峰速度减速时间(DT)、左房容积指数(LAVI)和左房质量指数(LVMI)及血浆sRAGE减低,而舒张早期二尖瓣血流速度与舒张晚期二尖瓣血流速度的比值(E/A)升高,差异均有统计学意义(P<0.05),且与对照组比较,观察组DT、LAVI、LVMI和血浆sRAGE降低,E/A升高,差异均有统计学意义(P<0.05)。观察组临床总有效率高于对照组,差异均有统计学意义(P<0.05)。与临床无效组比较,临床有效组DT、LAVI、LVMI及血浆sRAGE减低,而E/A升高,差异均有统计学意义(P<0.05)。截至随访结束,116例HFPEF患者共32例发生了终点事件,绘制Kaplan-Meier曲线分析发现:对照组终点事件未发生率明显低于观察组(Log-rank=4.732,P=0.030)。与终点事件组比较,无终点事件组DT、LAVI、LVMI及血浆sRAGE减低,而E/A升高,差异均有统计学意义(P<0.05)。结论低剂量螺内酯不仅可改善射血分数保留型心力衰竭心功能和心脏结构,还可降低远期不良事件发生率,与血浆sRAGE相关。

Objective To investigate the effect of low-dose spironolactone treatment on ventricular structure and prognosis in heart failure with preserved ejection fraction(HFpEF),and to analyze its relationship with plasma soluble advanced glycation end product receptor(sRAGE).Methods A total of 116 HFpEF patients who were admitted to the Department of Cardiology of the 970 th Hospital of the joint service and safety force of Chinese PLA between January 2017 and January 2019 were selected as the study subjects and randomly divided into control(58 patients)and observation(58 patients)groups according to the admission time.In which the control group was given conventional treatment,and the treatment regimen of the observation group was the same as the control group,but spironolactone was a low-dose treatment.Ventricular remodeling related indexes and plasma sRAGE differences before and after treatment in the two groups were compared.Calculated from admission,with a total follow-up of 18 months,the occurrence of endpoint events in each group was recorded and counted,Kaplan Meier curves were plotted and analyzed by log rank test for comparison.To contrast the differences in ventricular remodeling related indexes and plasma sRAGE among patients with different endpoints.Results Compared with before treatment,peak diastolic flow velocity deceleration time(DT),left atrial volume index(Lavi),and left atrial mass index(LVMI)and plasma sRAGE were decreased in the two groups after treatment,whereas the ratio of early diastolic to late diastolic mitral flow velocity(E/a)was increased,with significant differences(P<0.05).DT,Lavi,LVMI,and plasma sRAGE were decreased while E/A was increased in the observation group compared with the control group(all P<0.05).The clinical overall response rate of the observation group was higher than that of the control group,and all the differences were statistically significant(P<0.05).Compared with the clinical inactive group,DT,Lavi,LVMI,and plasma sRAGE were decreased in the clinical effective group,whereas E/A was increased and the differences were statistically significant(P<0.05).By the end of follow-up,a total of 32 out of 116 HFpEF patients had developed endpoint events and Kaplan Meier curve analysis was performed:the endpoint events in the control group were not significantly less frequent than those in the observation group(log rank=4.732,P=0.030).Compared with the end-point event group,DT,Lavi,LVMI,and plasma sRAGE were decreased in the group without end-point events,whereas E/A was increased and the differences were statistically significant(P<0.05).Conclusion Low dose spironolactone not only improves cardiac function and cardiac structure in heart failure with preserved ejection fraction,but also reduces long-term adverse event rates,associated with plasma sRAGE.