左西孟旦联合丹参川芎嗪注射液治疗慢性难治性心衰的临床研究

Clinical study of levosimendan combined with Danshen Chuanxiongqin injectionin treatment of chronic refractory heart failure

目的 探讨左西孟旦注射液联合丹参川芎嗪注射液治疗慢性难治性心力衰竭的疗效及对患者脑钠肽(BNP)、心功能、微小RNA-423-5P(miR-423-5P)等的影响。方法 采用随机数字表法将2018年1月至2020年1月西安市北方医院收治的160例慢性难治性心力衰竭患者分为左西孟旦组和联合组,每组80例。左西孟旦组采用左西孟旦注射液治疗,联合组采用左西孟旦注射液联合丹参川芎嗪注射液治疗。比较两组治疗后总有效率、心功能指标[左室射血分数(LVEF)、心脏指数(CI)、每搏输出量(SV)、左室舒张末期内径(LVEDD)、收缩末期内径(LVESD)、舒张早期二尖瓣血流速度/舒张晚期二尖瓣血流速度(E/A)]、心力衰竭标志物[BNP、微管连接蛋白(Nexilin)、心型脂肪酸结合蛋白(H-FABP)]、血管内皮功能指标[内皮素-1(ET-1)、一氧化氮(NO)]、miR-423-5P mRNA水平及不良反应。结果 联合组总有效率(95.00%)高于左西孟旦组(83.75%),差异有统计学意义(P<0.05)。联合组治疗后LVEF、CI、SV、E/A高于左西孟旦组,LVEDD、LVESD低于左西孟旦组,差异均有统计学意义(P<0.05)。联合组治疗后BNP、Nexilin、H-FABP水平低于左西孟旦组(P<0.05)。联合组治疗后ET-1水平低于左西孟旦组,NO水平高于左西孟旦组,差异均有统计学意义(P<0.05)。联合组治疗后miR-423-5P mRNA水平低于左西孟旦组(P<0.05)。联合组不良反应发生率(2.50%)与左西孟旦组(5.00%)相比,差异无统计学意义(P>0.05)。结论 左西孟旦注射液联合丹参川芎嗪注射液治疗慢性难治性心力衰竭,能有效改善患者心功能,保护心肌细胞,缓解内皮功能障碍,安全、可靠,其疗效机制可能与下调miR-423-5P mRNA表达有关。

Objective To investigate the efficacy of levosimendan injection combined with Danshen Chuanxiongqin injection in the treatment of chronic refractory heart failure and its effects on brain natriuretic peptide(BNP),cardiac function and microRNA-423-5P(miR-423-5P)in the patients.Methods A total of 160 patients with chronic refractory heart failure admitted and treated in the Xi′an Municipal North Hospital from January 2018 to January 2020 were divided into the levosimendan group and combined group by the random number table method,80 cases in each group.The levonimendan group was treated with levonimendan injection,and the combined group was treated with levonimendan injection combined with Danshen Chuanxiongqin injection.The total effective rate,cardiac function indicators[left ventricular ejection fraction(LVEF),heart index(CI),stroke output(SV),left ventricular end-diastolic diameter(LVEDD),end-systolic diameter(LVESD),early diastolic mitral valve flow velocity/late diastolic mitral valve flow velocity(E/A)]and heart failure[BNP,Nexilin,cardiac fatty acid binding protein(H-FABP)],and vascular endothelial function indexes[endothelin-1(ET-1),nitric oxide(NO)],miR-423-5P mRNA level after treatment and adverse reactions were compared between the two groups.Results The total effective rate of the combined group was higher than that of the levosimendan group,and the difference was statistically significant(95.00%vs.83.75%,P<0.05).After treatment,the LVEF,CI,SV and E/A levels of the combined group were higher than those of the levosimendan group,while LVEDD and LVESD were lower than those of the levosimendan group,and the differences were statistical significant(P<0.05).After treatment,the levels of BNP,Nexilin and H-FABP in the combined group were lower than those in the levosimendan group(P<0.05).After treatment,the ET-1 level in the combined group was lower than that in the left simondan group,and the NO level was higher than that in the levosimendan group,and the differences were statistically significant(P<0.05).After treatment,the miR-423-5P mRNA level in the combined group was lower than that in the levosimendan group(P<0.05).There was no statistically significant difference in the incidence rate of adverse reactions between the combination group andlevosimendan group(2.50%vs.5.00%,P>0.05).Conclusion Levosimendan injection combined with Danshen Chuanxiongqin injection could effectively improve the cardiac function,protect the cardiomyocytes and alleviate the endothelial dysfunction in the patients with chronic refractory heart failure,which is safe and reliable,and its efficacy mechanism may be related to the downregulation of miR-423-5P mRNA expression.