小剂量地高辛联合氢氯噻嗪及螺内酯治疗老年心力衰竭的疗效

Efficacy of low-dose digoxin combined with hydrochlorothiazide and spironolactone in the treatment of elderly patients with heart failure

目的 探讨小剂量地高辛联合氢氯噻嗪及螺内酯治疗老年心力衰竭疗效及对心肌肌钙蛋白(cTnT)、心肌酶学、N-末端B型利钠肽原(NT-proBNP)和炎症因子水平的影响。方法 选取2017年6月~2020年7月我院收治的168例老年心力衰竭患者,按随机数表法分为观察组(小剂量地高辛联合氢氯噻嗪及螺内酯)、地高辛组(正常剂量地高辛联合氢氯噻嗪及螺内酯)、对照组(安慰剂联合氢氯噻嗪及螺内酯治疗),每组各56例。比较3组疗效、治疗前及治疗10 d后心功能[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)]、心肌酶学[肌酸磷酸激酶(CK)、肌酸磷酸激酶同工酶(CK-MB)、羟丁酸脱氢酶(HBDH)]、疾病相关因子[cTnT、NT-proBNP、白细胞介素-6(IL-6)]、生活质量[明尼苏达心力衰竭生活质量问卷(MLHFQ)]水平。结果 3组总有效率比较差异有统计学意义,观察组和地高辛组总有效率均明显高于对照组(P<0.05)。治疗10 d后,观察组、地高辛组LVEDD、LVESD水平明显低于治疗前及同期对照组,LVEF水平明显高于治疗前及同期对照组(P<0.05)。治疗10 d后,观察组、地高辛组心肌酶学(CK、CK-MB、HBDH)、疾病相关因子(cTnT、NT-proBNP、IL-6)、MLHFQ水平明显低于治疗前及同期对照组(P<0.05)。治疗前后观察组和地高辛组心功能(LVEDD、LVESD、LVEF)、心肌酶学(CK、CK-MB、HBDH)、疾病相关因子(cTnT、NT-proBNP、IL-6)、MLHFQ水平比较差异无统计学意义(P>0.05)。结论 小剂量地高辛联合氢氯噻嗪及螺内酯治疗老年心力衰竭能够改善患者心功能及心肌损伤程度,提高生活质量,与正常剂量地高辛有相同的良好疗效。

Objective To study the efficacy of low-dose digoxin combined with hydrochlorothiazide and spironolactone in the treatment of elderly patients with heart failure and its influence on levels of cardiac troponin(cTnT),myocardial enzymology,N-terminal pro-B-type natriuretic peptide(NT-proBNP)and inflammatory factors.Methods A total of 168 elderly patients with heart failure who were treated in the hospital were selected from June 2017 to July 2020 and were randomly divided into the observation group(low-dose digoxin combined with hydrochlorothiazide and spironolactone),the digoxin group(normal-dose digoxin combined with hydrochlorothiazide and spironolactone)and the control group(placebo combined with hydrochlorothiazide and spironolactone treatment),with 56 cases in each group.The efficacy of the three groups was compared,and the cardiac function[left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),left ventricular ejection fraction(LVEF)],myocardial enzymology[creatine phosphokinase(CK),creatine phosphokinase isoenzyme(CK-MB),hydroxybutyrate dehydrogenase(HBDH)],disease-related factors[cTnT,NT-proBNP,interleukin-6(IL-6)]and quality of life[Minnesota Living with Heart Failure Questionnaire(MLHFQ)]were compared among the three groups before treatment and after 10 d of treatment.Results There was a statistically significant difference in the total effective rate among the three groups,and the total effective rate of observation group and digoxin group was significantly higher than that of the control group(P<0.05).After 10 d of treatment,the levels of LVEDD and LVESD in the observation group and the digoxin group were significantly lower than those before treatment and those in the control group during the same period while the level of LVEF was significantly higher than that before treatment and that in the control group during the same period(P<0.05).After 10 d of treatment,the levels of myocardial enzymology(CK,CK-MB,HBDH),disease-related factors(cTnT,NT-proBNP,IL-6)and MLHFQ in observation group and digoxin group were significantly lower than those before treatment and those in the control group during the same period(P<0.05).There were no statistical differences in cardiac function(LVEDD,LVESD,LVEF),myocardial enzymology(CK,CK-MB,HBDH),disease-related factors(cTnT,NT-probNP,IL-6)and MLHFQ between the observation group and the digoxin group before and after treatment(P>0.05).Conclusion Low-dose digoxin combined with hydrochlorothiazide and spironolactone in the treatment of elderly heart failure can improve the cardiac function and myocardial injury degree and enhance the quality of life,and has the same good efficacy as normal-dose digoxin.