左西孟旦联合认知行为疗法对扩张型心肌病合并慢性心力衰竭的效果分析

The clinical efficacy of levosimendan combined with cognitive behavior therapy for patients with dilated cardiomyopathy complicated by chronic heart failure

目的观察左西孟旦联合认知行为疗法在扩张型心肌病合并慢性心力衰竭患者中的应用效果。方法选取2020年2月至2021年2月收治的扩张型心肌病合并慢性心力衰竭患者60例为研究对象,随机分为2组,每组30例。对照组给予常规治疗,治疗组在对照组基础上给予左西孟旦联合认知行为疗法治疗。比较2组心功能指标[左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室射血分数(LVEF)、心脏指数(CI)]、心室重构指标[基质金属蛋白酶9(MMP-9)、层粘蛋白(LN)、Ⅲ型胶原前肽(PⅢP)]、神经内分泌因子[去甲肾上腺素(NE)、血管紧张素Ⅱ(AngⅡ)]、炎性因子[肿瘤坏死因子α(TNF-α)、超敏C-反应蛋白(hs-CRP)]、T淋巴细胞亚群(CD_(3)^(+)、CD_(4)^(+)、CD_(8)^(+)、CD_(4)^(+)/CD_(8)^(+))、心理状态、自我效能及生活质量。结果治疗前2组LVEDD、LVESD、LVEF、CI、MMP-9、LN、PⅢP、NE、AngⅡ、TNF-α、hs-CRP、CD_(3)^(+)、CD_(4)^(+)、CD_(8)^(+)、CD_(4)^(+)/CD_(8)^(+)、SAS评分、SDS评分、GSES评分、WHOQOL-BREF评分比较差异无统计学意义(P>0.05);治疗后2组LVEDD、LVESD、MMP-9、LN、PⅢP、CD_(8)^(+)、SAS评分、SDS评分均显著低于治疗前,LVEF、CI、CD_(3)^(+)、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)、GSES评分、WHOQOL-BREF评分均显著高于治疗前,差异有统计学意义(P<0.05),且治疗组LVEDD、LVESD、MMP-9、LN、PⅢP、CD_(8)^(+)、SAS评分、SDS评分低于对照组,LVEF、CI、CD_(3)^(+)、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)、GSES评分、WHOQOL-BREF评分高于对照组,差异有统计学意义(P<0.05)。结论左西孟旦联合认知行为疗法治疗扩张型心肌病合并慢性心力衰竭能够有效改善患者心功能和心室重构,可能与抑制神经内分泌因子和炎性因子分泌,提高免疫功能有关。

Objective To investigate the clinical efficacy of levosimendan combined with cognitive behavior therapy for patients with dilated cardiomyopathy complicated by chronic heart failure.Methods A total of 60 patients with dilated cardiomyopathy complicated by chronic heart failure who were treated in our hospital from February 2020 to February 2021 were randomly divided into observation group and control group,with 30 cases in each group.The patients in control group were given conventional treatment,however,those in observation group treatment group,on the basis of control group,were treated by levosimendan combined with cognitive behavior therapy.The cardiac function indexes(LVEDD,LVESD,LVEF and CI),ventricular remodeling indexes(MMP-9,LN and PⅢP),neuroendocrine factors(NE and AngⅡ),inflammatory cytokines(TNF-αand hs-CRP),T lymphocyte subsets(CD_(3)^(+),CD_(4)^(+),CD_(8)^(+) and CD_(4)^(+)/CD_(8)^(+)),mental state,self efficacy and life quality of patients were observed and compared between the two groups.Results Before treatment,there were no significant differences in LVEDD,LVESD,LVEF,CI,MMP-9,LN,PⅢP,NE,AngⅡ,TNF-α,hs-CRP,CD_(3)^(+),CD_(4)^(+),CD_(8)^(+),CD_(4)^(+)/CD_(8)^(+),SAS scores,SDS scores,GSES scores and WHOQOL-BREF scores between the two groups(P>0.05).After treatment,LVEDD,LVESD,MMP-9,LN,PⅢP,CD_(8)^(+),SAS scores and SDS scores were significantly decreased in both groups,however,LVEF,CI,CD_(3)^(+),CD_(4)^(+),CD_(4)^(+)/CD_(8)^(+),GSES scores and WHOQOL-BREF scores were significantly increased(P<0.05),moreover,the decrease degree and increase degree in observation group were more significant than those in control group(P<0.05).Conclusion The levosimendan combined with cognitive behavior therapy in treatment of dilated cardiomyopathy complicated by chronic heart failure can effectively improve the cardiac function and ventricular remodeling,inhibit the expression of neuroendocrine factors and inflammatory cytokines,and improve the immune function of patients.