吡非尼酮辅助治疗慢性心力衰竭对心肌纤维化的影响

Effect of Pirfenidone in Adjuvant Treatment of Chronic Heart Failure on Myocardial Fibrosis

目的探讨吡非尼酮辅助治疗慢性心力衰竭(CHF)的临床疗效,以及对患者心肌纤维化(MF)的影响。方法选取医院2018年12月至2020年12月收治的CHF患者94例,按简单随机化法分为观察组和对照组,各47例。两组患者均予常规抗心力衰竭药物治疗,观察组患者加用吡非尼酮,均连续治疗1个月。结果观察组总有效率为93.62%,显著高于对照组的76.60%(P<0.05)。治疗后,观察组患者的心功能指标[左室射血分数(LVEF)、心输出量(CO)、每搏输出量(SV)、二尖瓣血流最大流速和心房收缩期二尖瓣血流最大流速比值(E/A)]均显著高于对照组(P<0.05);观察组患者的血清MF指标[Ⅰ型前胶原(PCⅠ)、Ⅲ型前胶原(PCⅢ)、层粘连蛋白(LN)、透明质酸(HA)]水平均显著低于对照组(P<0.05);观察组患者的血清过氧化物酶体增殖物激活受体α(PPARα)水平显著高于对照组,转化生长因子β1(TGF-β1)水平显著低于对照组(P<0.05);观察组患者的血清炎性因子[肿瘤坏死因子-α(TNF-α)、白细胞介素1β(IL-1β)、核转录因子κB(NF-κB)]水平均显著低于对照组(P<0.05)。观察组和对照组患者治疗期间药品不良反应发生率相当(10.64%比8.51%,P>0.05)。结论吡非尼酮辅助治疗CHF安全有效,可减轻患者的MF,改善心功能,其作用机制可能与调节血清炎性因子TNF-α,IL-1β,NF-κB的水平及TGF-β1和PPARα的表达有关。

Objective To investigate the clinical efficacy of pirfenidone in the adjuvant treatment of chronic heart failure(CHF),and its effect on the myocardial fibrosis(MF)of patients.Methods A total of 94 patients with CHF admitted to the hospitalfrom December 2018 to December 2020 were selected and divided into the observation group and the control group according tothe simple randomization method,with 47 cases in each group.The patients in the two groups were treated with conventional anti-heart failure drugs,on this basis,the patients in the observation group were treated with pirfenidone.Both groups were treatedcontinuously for one month.Results The total effective rate in the observation group was 93.62%,which was significantly higherthan 76.60%in the control group(P<0.05).After treatment,the cardiac function indexes such as left ventricular ejectionfraction(LVEF),cardiac output(CO),stroke volume(SV)and ratio of the maximum flow velocity of the mitral valve to themaximum flow velocity of the mitral valve during atrial systole(E/A)in the observation group were significantly higher thanthose in the control group(P<0.05).After treatment,the MF indexes in serum such as typeⅠprocollagen(PCⅠ),typeⅢprocollagen(PCⅢ),laminin(LN)and hyaluronic acid(HA)in the observation group were significantly lower than those in thecontrol group(P<0.05).After treatment,the level of serum peroxisome proliferator-activated receptorα(PPARα)in theobservation group was significantly higher than that in the control group,while the level of transforming growth factor-β1(TGF-β1)in the observation group was significantly lower than that in the control group(P<0.05).After treatment,the levels of seruminflammatory factors such as tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β)and nuclear transcription factor-κB(NF-κB)in the observation group were significantly lower than those in the control group(P<0.05).The incidence of adverse drugreactions in the observation group was similar to that in the control group(10.64%vs.8.51%,P>0.05).Conclusion Pirfenidoneis safe and effective in the adjuvant treatment of CHF,which can reduce the MF and improve the cardiac function of patients.Itsmechanism may be related to the regulation of the levels of serum inflammatory factors such as TNF-α,IL-1β,NF-κB and theexpression of TGF-β1and PPARα.