CAJ | 학술논문

目的：观察左卡尼汀对糖尿病合并心力衰竭老年患者的临床疗效。方法选取糖尿病合并心力衰竭老年患者48例，随机分为两组。对照组采取常规抗心力衰竭治疗14 d，治疗组在此基础上静脉滴注左卡尼汀3.0 g，每日1次，共14 d。治疗前及治疗后分别检查两组患者的6 min 步行试验、心脏超声心动图及血浆钠尿肽（BNP）、血糖、血脂、胰岛素水平。结果治疗后，两组患者的心功能指标6 min 步行试验、左室舒张末期内径（LVEDD）、左室收缩末期内径（LVESD）、左室射血分数（LVEF）、左室缩短分数（FS）和舒张功能指标 E 峰与 A 峰的比值（E/ A）均较治疗前显著改善（ P ﹤0.05）。且治疗组6 min 步行试验、LVEF、E/ A 改善程度较对照组更为明显（ P ﹤0.05）。对照组治疗后 BNP、空腹血糖（FBG）、胰岛素抵抗指数（HOMA - IR）较治疗前有改善（ P ﹤0.05），治疗组治疗后 BNP、FBG、三酰甘油（TG）、总胆固醇（TC）、高密度脂蛋白（HDL）、HOMA - IR 较治疗前有显著改善（ P ﹤0.05），且治疗组 BNP、FBG、TC 及 HOMA - IR 改善程度较对照组更为显著，差异有统计学意义（ P ﹤0.05）。治疗组治疗后临床疗效总有效率明显高于对照组（ P ﹤0.05）。结论左卡尼汀可明显纠正糖尿病合并心力衰竭老年患者的心肌能量代谢障碍，调节心肌的舒张及收缩功能，改善胰岛素抵抗，从而改善患者的临床症状和预后，延缓心力衰竭的进展。
목적：관찰좌잡니정대당뇨병합병심력쇠갈노년환자적림상료효。방법선취당뇨병합병심력쇠갈노년환자48례，수궤분위량조。대조조채취상규항심력쇠갈치료14 d，치료조재차기출상정맥적주좌잡니정3.0 g，매일1차，공14 d。치료전급치료후분별검사량조환자적6 min 보행시험、심장초성심동도급혈장납뇨태（BNP）、혈당、혈지、이도소수평。결과치료후，량조환자적심공능지표6 min 보행시험、좌실서장말기내경（LVEDD）、좌실수축말기내경（LVESD）、좌실사혈분수（LVEF）、좌실축단분수（FS）화서장공능지표 E 봉여 A 봉적비치（E/ A）균교치료전현저개선（ P ﹤0.05）。차치료조6 min 보행시험、LVEF、E/ A 개선정도교대조조경위명현（ P ﹤0.05）。대조조치료후 BNP、공복혈당（FBG）、이도소저항지수（HOMA - IR）교치료전유개선（ P ﹤0.05），치료조치료후 BNP、FBG、삼선감유（TG）、총담고순（TC）、고밀도지단백（HDL）、HOMA - IR 교치료전유현저개선（ P ﹤0.05），차치료조 BNP、FBG、TC 급 HOMA - IR 개선정도교대조조경위현저，차이유통계학의의（ P ﹤0.05）。치료조치료후림상료효총유효솔명현고우대조조（ P ﹤0.05）。결론좌잡니정가명현규정당뇨병합병심력쇠갈노년환자적심기능량대사장애，조절심기적서장급수축공능，개선이도소저항，종이개선환자적림상증상화예후，연완심력쇠갈적진전。
Objective To investigate the clinical efficacy of levocarnitine for elderly diabetic patients with heart failure. Methods Forty- eight elderly diabetic patients with heart failure were randomly divided into two groups. The control group was treated with conventional therapy for 14 days,the treatment group was treated with conventional therapy plus intravenous infusion of 3. 0 g of levocarnitine per day for 14 days. The 6min walk test,echocardiography and plasma natriuretic peptide,glucose,lipids,and insulin levels were examined in two groups of patients be-fore and after treatment. Results The 6min walk test,left ventricular end - diastolic diameter(LVEDD),left ventricular end - systolic diameter (LVESD),left ventricular ejection fraction(LVEF),fractional shortening(FS)and E / A ratio significantly improved( P ﹤ 0. 05)after treat-ment in both groups,and the improvements of 6min walk test,LVEF and E / A ratio of treatment group were more significant than control group( P ﹤ 0. 05). The BNP,FBG and HOMA - IR improved over the treatment in the both groups,they were more significant( P ﹤ 0. 05)in the treat-ment group;the improvements of BNP,FBG,TC and HOMA - IR were significant compared with the control group( P ﹤ 0. 05). The clinical effi-cacy of the treatment group was significantly higher than control group( P ﹤ 0. 05). Conclusion Levocarnitine can significantly correct myocardi-al energy metabolism in elderly diabetic patients with heart failure,regulate myocardial diastolic and systolic function,improve insulin resistance, thereby improve the clinical symptoms and the prognosis of patients,slow the progression of heart failure.