肾上腺皮质功能变化在顽固性充血性心力衰竭患者中的临床意义

Clinical significance of the function of adrenal cortex in refractory congestive heart failure

目的 :探讨通过小剂量糖皮质激素替代治疗提高顽固性充血性心力衰竭 (心衰 )患者机体细胞应激反应的能力以改善药物的疗效。方法 :38例顽固性充血性心衰患者随机分为常规治疗对照组 (17例 )和激素治疗组 (2 1例 ) ,治疗组患者在强心、利尿、扩血管的基础上给予小剂量糖皮质激素治疗。用 Swan Ganz导管和心脏超声监测心功能和血流动力学变化。结果 :所有入选患者循环血中皮质醇浓度均低下 ,对照组患者对强心、利尿、扩血管治疗效果较差 ;而治疗组患者在糖皮质激素治疗后 1周 ,血中皮质醇水平明显升高 ,其心排指数和左室射血分数显著提高 ,尿量明显增加 ,全身水肿消退。病死率治疗组较对照组明显降低 (2 3.8%比 70 .6 % ,P<0 .0 1) ;而两组患者院内感染的发生率无显著差异 (38.1% ,8/ 2 1比 5 8.8% ,10 / 17)。结论 :顽固性充血性心衰患者使用小剂量糖皮质激素替代治疗可提高机体细胞应激反应能力 ,改善药物疗效 ,提高患者存活率。

Objective: To investigate the function of adrenal cortex in refractory congestive heart failure and to testify the hypothesis that glucocorticosteroid can improve the effectiveness of medicine on this disease. Methods: Thirtyeight patients with refractory congestive heart failure (men 23 and women 15) were enrolled in this study and randomly divided into two groups, control group and treatment group. The cardiac index and ejection fraction were applied to evaluate the cardiac function and the level of blood cortisol was used to estimate the adrenal cortex function. Results: The level of blood cortisol was low at the time of hospitalization in all studied patients. Moreover, the digoxin, diuretic and vasodilating had little effectiveness in those patients . However, the glucocorticosteroid at a low dosage was able to improve the effectiveness of those medicines on congestive heart failure. The cardiac index, left ventricular ejection fraction and urine output dramatically increased after glucocorticosteroid treatment. There was a significant difference between the treatment group and control group (23 8 percent vs. 70 6 percent, P <0 01). In addition, the mortality in treatment group was also lower than that in control group (38 1 percent vs. 58 8 percent, P >0 05). Conclusion : Glucocorticosteroid at a low dosage obviously improved the effectiveness of medicines on congestive heart failure, and increased the survival rate in the patients.