左西孟旦和米力农治疗对心力衰竭患者血管内皮因子、心室重构及心功能的影响
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摘要
目的探讨并对比左西孟旦和米力农对心力衰竭患者血管内皮因子、心室重构及心功能的影响。方法将2016年6月至2018年6月医院收治的80例急性失代偿期心力衰竭患者随机分为左西孟旦组和米力农组,每组各40例。治疗前和治疗7d采用超声心动图检测心功能参数[左心室收缩末期内径(left ventricular end systolic diameter,LVESD)、左心室舒张末期内径(left ventricular end diastolic diameter,LVEDD)、左心室射血分数(left ventricular ejection fractions,LVEF)],检测血清N-末端前体脑钠肽(N-terminal pro-B-type natriuretic peptid,NT-pro BNP)、血管内皮生长因子(vascular endothelial growth factor,VEGF)、白介素6(Interleukin-6,IL-6)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α),治疗结束后2个月行6min步行实验(6-minute walk test,6MWT),记录两组不良反应。结果左西孟旦组治疗后LVESD值低于米力农组,LVEF值高于米力农组,差异有统计学意义(P <0.05),但两组治疗后LVEDD值比较,差异无统计学意义(P>0.05);左西孟旦组治疗后NT-pro BNP水平低于米力农组,6MWT距离长于米力农组,差异有统计学意义(P<0.05);左西孟旦组治疗后VEGF水平高于米力农组,IL-6、TNF-α水平低于米力农组,差异有统计学意义(P<0. 05),两组不良反应发生率比较,差异无统计学意义(P>0. 05)。结论左西孟旦、米力农均可用于治疗心力衰竭患者心室重构,改善心功能,但短期效果而言,左西孟旦优于米力农。
Objective To investigate and compare the effect of levosimendan and mirinone on vascular endothelial factors,ventricular remodeling and cardiac function in patients with heart failure. Methods A total of eighty patients with acute decompensated heart failure admitted to the hospital from June 2016 to June 2018 were randomly divided into the levosimendan group and the mirinone group,with 40 cases in each group. The cardiac function parameters [ left ventricular end-systolic diameter(LVESD), left ventricular end-diastolic dimension(LVEDD),left ventricular ejection fraction(LVEF) ] were detected by echocardiography before the treatment and after 7 days of treatment. The serum N-terminal pro-brain natriuretic peptide(NT-pro BNP), vascular endothelial growth factor(VEGF), vascular endothelial growth factor(VEGF), interleukin 6(IL-6)and tumor necrosis factor-alpha(TNF-α) were also detected. The 6-minute walking test(6 MWT) was performed at 2 months after the treatment and adverse reactions in both groups were recorded. Results The LVESD value was lower and the LVEF value was higher in the levosimendan group than in the mirinone group after the treatment(P <0.05). However,there was no significant difference in the LVEDD between the two groups after the treatment(P>0. 05). The NT-pro BNP level was lower and the 6 MWT distance was longer in the levosimendan group than in the mirinone group after the treatment(P <0.05). The VEGF level was higher while levels of IL-6 and TNF-a were lower in the levosimendan group than in the mirinone group(P <0.05). There was no significant difference in the incidence of adverse reactions between the two groups(P >0. 05). Conclusion In terms of short-term effects,levosimendan is better than milinon in the treatment of ventricular remodeling in patients with heart failure,as well as the improvement of cardiac function.
Objective To investigate and compare the effect of levosimendan and mirinone on vascular endothelial factors,ventricular remodeling and cardiac function in patients with heart failure. Methods A total of eighty patients with acute decompensated heart failure admitted to the hospital from June 2016 to June 2018 were randomly divided into the levosimendan group and the mirinone group,with 40 cases in each group. The cardiac function parameters [ left ventricular end-systolic diameter(LVESD), left ventricular end-diastolic dimension(LVEDD),left ventricular ejection fraction(LVEF) ] were detected by echocardiography before the treatment and after 7 days of treatment. The serum N-terminal pro-brain natriuretic peptide(NT-pro BNP), vascular endothelial growth factor(VEGF), vascular endothelial growth factor(VEGF), interleukin 6(IL-6)and tumor necrosis factor-alpha(TNF-α) were also detected. The 6-minute walking test(6 MWT) was performed at 2 months after the treatment and adverse reactions in both groups were recorded. Results The LVESD value was lower and the LVEF value was higher in the levosimendan group than in the mirinone group after the treatment(P <0.05). However,there was no significant difference in the LVEDD between the two groups after the treatment(P>0. 05). The NT-pro BNP level was lower and the 6 MWT distance was longer in the levosimendan group than in the mirinone group after the treatment(P <0.05). The VEGF level was higher while levels of IL-6 and TNF-a were lower in the levosimendan group than in the mirinone group(P <0.05). There was no significant difference in the incidence of adverse reactions between the two groups(P >0. 05). Conclusion In terms of short-term effects,levosimendan is better than milinon in the treatment of ventricular remodeling in patients with heart failure,as well as the improvement of cardiac function.
引文
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[3]边圆,王甲莉,程凯.等.2016年欧洲心脏病学会急性心力衰竭指南解读[J].中华急诊医学杂志,2016,25(7):849-853.
[4]刘波,郭莉,程波,等.曲美他嗪联合运动疗法对冠心病经皮冠状动脉介人术后患者心脏康复的影响[J].中国医院药学杂志,2017,37(4):376-379.
[5]许天一,吴萍,王爱玲,等.米力农雾化治疗小儿重症肺炎合并心力衰竭的疗效[J].山东大学学报:医学版.2016,54(7):88-90.
[6] PALMERINI E,S(O|¨)DERBERG S, MONDILLO S,et al. Effects of levosimendan on heart failure in normotensive patients:Does loading dose matter?[J]. Acute Card Care,2015,17(1):14-19.
[7]何芳,杨国杰.左西孟旦对心力衰竭危重患者死亡率影响的Meta分析[J].中国循环杂志,2015,30(5):422-427.
[8]曹俊雄,朱志军,吴丹宁.冻干重组人脑利钠肽联合左西孟旦治疗急性心力衰竭的临床观察[J].中国药房,2016,27(8):1091-1093.
[9]邬涛,吴清华,吴丹,等.慢性心力衰竭患者外周血NF-κB、血清TGF-β1与心室重构的相关性[J].重庆医学,2016,45(24):3408-3411.
[10]王晓琳,周元丽,孙伟,等.托伐普坦联合左西孟旦治疗顽固性心力衰竭的疗效观察[J].中国药房,2016,27(8):1074-1077.
[11]黄洁,刘国红,杨海英.血清CA125与慢性心力衰竭严重程度及近期预后相关性分析[J].标记免疫分析与临床,2017,24(7):754-758.
[12]林绍侠,刘志兵,蔡铁海,等.血清sST2联合NT-proBNP检测对心力衰竭患者预后的预测价值[J].山东医药,2016,56(26):61-62.
[13]曹新营,杨文琦,邢彩耐,等.阿托伐他汀联合美托洛尔应用于慢性心功能衰竭患者对其T细胞功能及临床预后的研究[J].标记免疫分析与临床,2017,24(7):738-742.
[14]解娜,刘景委,尚花娣,等.hs-CRP、cystatin C、NT-proBNP在慢性心力衰竭发展过程中的意义[J].广东医学,2016,37(12):1839-1842.
[15]咸慧霞,米娜,王同成.左西孟旦联合芪苈强心胶囊治疗充血性心力衰竭临床观察[J].山东医药,2015,55(41):53-54.
[16]吴曾繁,陈卫卫,刘先霞.心脉隆注射液对冠心病心力衰竭病人血清BNP、hsCRP、VEGF的影响[J].中华中医药学刊,2017,35(9):2433-2435.
[17]宋孟仙,刘华,王雯霞,等.体外心脏震波治疗对缺血性心力衰竭患者的疗效及其机制研究[J].临床心血管病杂志,2016,32(9):938-942.
[18]宁国强,项志雄,汪炜,等.心力衰竭合并肺部感染患者血清炎症因子水平变化及其与心肌功能的关系研究[J].中华医院感染学杂志,2016,26(24):5599-5600.
[19]郭衍楷,徐洁,曹桂秋,等.射血分数保留的心力衰竭患者血清IL-6、TNF-α、CRP水平变化及其相关性分析[J].疑难病杂志,2018,17(3):217-220.
[2] ALTENBERGER J, GUSTAFSSON F, HARJOLA V P, et al.Levosimendan in acute and advanced heart failure:an appraisal of the clinical dabase and evaluation of its therapeutic applications[J]. J Cardiovasc Pharmacol,2018,71(3):129-136.
[3]边圆,王甲莉,程凯.等.2016年欧洲心脏病学会急性心力衰竭指南解读[J].中华急诊医学杂志,2016,25(7):849-853.
[4]刘波,郭莉,程波,等.曲美他嗪联合运动疗法对冠心病经皮冠状动脉介人术后患者心脏康复的影响[J].中国医院药学杂志,2017,37(4):376-379.
[5]许天一,吴萍,王爱玲,等.米力农雾化治疗小儿重症肺炎合并心力衰竭的疗效[J].山东大学学报:医学版.2016,54(7):88-90.
[6] PALMERINI E,S(O|¨)DERBERG S, MONDILLO S,et al. Effects of levosimendan on heart failure in normotensive patients:Does loading dose matter?[J]. Acute Card Care,2015,17(1):14-19.
[7]何芳,杨国杰.左西孟旦对心力衰竭危重患者死亡率影响的Meta分析[J].中国循环杂志,2015,30(5):422-427.
[8]曹俊雄,朱志军,吴丹宁.冻干重组人脑利钠肽联合左西孟旦治疗急性心力衰竭的临床观察[J].中国药房,2016,27(8):1091-1093.
[9]邬涛,吴清华,吴丹,等.慢性心力衰竭患者外周血NF-κB、血清TGF-β1与心室重构的相关性[J].重庆医学,2016,45(24):3408-3411.
[10]王晓琳,周元丽,孙伟,等.托伐普坦联合左西孟旦治疗顽固性心力衰竭的疗效观察[J].中国药房,2016,27(8):1074-1077.
[11]黄洁,刘国红,杨海英.血清CA125与慢性心力衰竭严重程度及近期预后相关性分析[J].标记免疫分析与临床,2017,24(7):754-758.
[12]林绍侠,刘志兵,蔡铁海,等.血清sST2联合NT-proBNP检测对心力衰竭患者预后的预测价值[J].山东医药,2016,56(26):61-62.
[13]曹新营,杨文琦,邢彩耐,等.阿托伐他汀联合美托洛尔应用于慢性心功能衰竭患者对其T细胞功能及临床预后的研究[J].标记免疫分析与临床,2017,24(7):738-742.
[14]解娜,刘景委,尚花娣,等.hs-CRP、cystatin C、NT-proBNP在慢性心力衰竭发展过程中的意义[J].广东医学,2016,37(12):1839-1842.
[15]咸慧霞,米娜,王同成.左西孟旦联合芪苈强心胶囊治疗充血性心力衰竭临床观察[J].山东医药,2015,55(41):53-54.
[16]吴曾繁,陈卫卫,刘先霞.心脉隆注射液对冠心病心力衰竭病人血清BNP、hsCRP、VEGF的影响[J].中华中医药学刊,2017,35(9):2433-2435.
[17]宋孟仙,刘华,王雯霞,等.体外心脏震波治疗对缺血性心力衰竭患者的疗效及其机制研究[J].临床心血管病杂志,2016,32(9):938-942.
[18]宁国强,项志雄,汪炜,等.心力衰竭合并肺部感染患者血清炎症因子水平变化及其与心肌功能的关系研究[J].中华医院感染学杂志,2016,26(24):5599-5600.
[19]郭衍楷,徐洁,曹桂秋,等.射血分数保留的心力衰竭患者血清IL-6、TNF-α、CRP水平变化及其相关性分析[J].疑难病杂志,2018,17(3):217-220.