CAJ | 학술논문

目的观察静脉注射左卡尼汀治疗肺动脉高压导致右心功能障碍的疗效.方法入选66例WHO心功能分级Ⅲ～Ⅳ级的特发性肺动脉高压14例、先天性心脏病相关性肺动脉高压36例及结缔组织病相关性肺动脉高压16例患者,分为左卡尼汀治疗组40例和对照组26例.左卡尼汀治疗组在常规治疗基础上给予左卡尼汀5 g/d,静脉滴注,连用7 d.分别于研究开始及7 d后进行6min步行距离、WHO心功能分级、体格检查及血清标记物检查,评价两组疗效和记录不良反应.结果治疗前后比较,左卡尼汀组患者的6 min步行距离增加75 m,对照组增加45 m(P=0.04).左卡尼汀组16例心功能改善2级,13例改善1级,6例无变化,5例恶化一级以上;对照则分别为心功能改善2级3例,改善1级8例,无变化9例和恶化一级以上6例(P=0.04).左卡尼汀组B型利钠肽水平下降58.16 ng/L,而对照组下降33.29 ng/L(P=0.01).左卡尼汀组收缩压升高8.1 mm Hg(1 mm Hg=0.133 kPa),对照组升高2.4 mm Hg(P=0.03).无患者因严重不良反应退出研究.结论常规治疗的基础上联合应用左卡尼汀,可改善肺动脉高压所导致的右心功能障碍患者的运动耐量和心功能分级,并且安全性、耐受性良好.
목적 관찰정맥주사좌잡니정치료폐동맥고압도치우심공능장애적료효.방법 입선66례WHO심공능분급Ⅲ～Ⅳ급적특발성폐동맥고압14례、선천성심장병상관성폐동맥고압36례급결체조직병상관성폐동맥고압16례환자,분위좌잡니정치료조40례화대조조26례.좌잡니정치료조재상규치료기출상급여좌잡니정5 g/d,정맥적주,련용7 d.분별우연구개시급7 d후진행6min보행거리、WHO심공능분급、체격검사급혈청표기물검사,평개량조료효화기록불량반응.결과 치료전후비교,좌잡니정조환자적6 min보행거리증가75 m,대조조증가45 m(P=0.04).좌잡니정조16례심공능개선2급,13례개선1급,6례무변화,5례악화일급이상;대조칙분별위심공능개선2급3례,개선1급8례,무변화9례화악화일급이상6례(P=0.04).좌잡니정조B형리납태수평하강58.16 ng/L,이대조조하강33.29 ng/L(P=0.01).좌잡니정조수축압승고8.1 mm Hg(1 mm Hg=0.133 kPa),대조조승고2.4 mm Hg(P=0.03).무환자인엄중불량반응퇴출연구.결론 상규치료적기출상연합응용좌잡니정,가개선폐동맥고압소도치적우심공능장애환자적운동내량화심공능분급,병차안전성、내수성량호.
Objective To investigate tlle efficacy of L-carnitine in patients with right-sided heart failure induced by pulmonary arterial hypertension(PAH).Methods A total of 66 pulmonary arterial hypertension patients(14 idiopathic,36 congenital heart disease associated and 16 connective-tissue disease associated PAH,WHO heart functional class Ⅲ,n=38 or IV,n=28)were enrolled in this study and divided into control group(26 cases)and L-carnitine group(40 cases).All patients received conventional treatment according to guideline for treatment of right-sided heart failure.The patients in L-carnitine group received 5 g/d L-carnitine intravenously for seven days.Six-minute walking distance,WHO heart functional class,physical examination,and serum markers were evaluated at baseline and 7 days after enrollment.Results Compared to the baseline,six-minute walking distance was significantly increased(75m vs.45 m,P＜0.05).WHO heart functional class significantly improved(impmved 2 classes in 16 patients,impmved 1 class in 13,no improved in 6,worsen in 5 vs.3,8,9,6 respectively in the control,P=0.04),BNP level significant decreased(58.16 ng/L vs.33.29 ng/L,P=0.01)and systolic blood pressure significantly increased[8.1 mm Hg vs.2.4 mm Hg(1 mm Hg=0.133 kPa),P=0.03]in Lcarnitine group compared with those in control group.No patient was withdrawn from this study for safety reasons.Conclusions L-carnitine could improve short-term exercise capacity and WHO heart functional class in right-sided heart failure patients induced by PAH.