间断利尿预防老年慢性心力衰竭患者利尿剂抵抗的机制研究

Study on Mechanism of Intermittent Diuresis in Preventing Diuretic Resistance in Elderly Patients with CHF

目的:探讨根据慢性心力衰竭患者液体潴留的情况给予固定日间断利尿治疗能否改善利尿剂抵抗的发生。方法:选取九江市第一人民医院确诊为慢性心力衰竭心功能Ⅲ、Ⅳ级(NYHA)住院患者194例,给予抗心力衰竭治疗病情达到稳定后,随机分为间断利尿组(n=92)与持续利尿组(n=102)。比较两组试验1年期间利尿剂抵抗发生率、再入院率、RAAS组分[肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)及醛固酮(ALD)]与NT-proBNP浓度变化、心脏结构与功能变化。结果:间断利尿组利尿剂抵抗率、再入院率较持续利尿组均显著下降(P<0.05)。试验6、12个月,间断利尿组的RAAS组分和NT-proBNP浓度明显低于试验起始、试验3个月,差异均有统计学意义(P<0.05);试验6、12个月,间断利尿组LVEF明显高于持续利尿组同时段,LVESD明显低于持续利尿组同时段,差异均有统计学意义(P<0.05);且间断利尿组试验不同时段LVEF均有上升趋势,试验12个月LVEF明显高于试验起始,差异有统计学意义(P<0.05)。结论:根据液体潴留情况给予慢性心力衰竭患者固定日间断利尿治疗后,利尿剂抵抗发生率下降,可能是通过降低RAAS系统激活介导的。

Objective:To explore whether fixed daily intermittent diuretic therapy can improve the occurrence of diuretic resistance according to the situation of fluid retention in patients with chronic heart failure.Method:A total of 194 hospitalized patients with chronic heart failure diagnosed as classⅢandⅣcardiac function(NYHA)in the First People’s Hospital of Jiujiang were selected,after giving anti heart failure treatment and reaching a stable condition,they were randomly divided into intermittent diuretic group(n=92)and continuous diuretic group(n=102).The incidence of diuretic resistance,the rate of readmission,the concentration changes of RAAS components(PRA,AngⅡand ALD)and NT-proBNP,and the changes of cardiac structure and function were analyzed in two groups during 1 year of trial.Result:The diuretic resistance rate and readmission rate in intermittent diuretic group were significantly lower than those in continuous diuretic group(P<0.05).At 6 and 12 months,the RAAS components and NT-proBNP concentration in the intermittent diuretic group were significantly lower than those at the start of the experiment and 3 months of the experiment,with statistical significance(P<0.05).At 6 and 12 months,LVEF in the intermittent diuretic group were significantly higher than those in the continuous diuretic group,LVESD were significantly lower than those in the continuous diuretic group,the differences were statistically significant(P<0.05).The LVEF in the intermittent diuretic group showed an upward trend at different time periods,and the LVEF at 12 months was significantly higher than that at the beginning of the experiment,with statistical significance(P<0.05).Conclusion:After fixed daily intermittent diuretic treatment according to fluid retention in patients with chronic heart failure,the decrease in the incidence of diuretic resistance may be mediated by reducing the activation of RAAS system.