CAJ | 학술논문

目的：探讨不同剂量螺内酯对肾功能正常的收缩性心力衰竭患者的疗效和安全性。方法入选2011年12月—2012年12月肾功能正常的收缩性心力衰竭患者148例，在常规治疗的基础上随机分为每天螺内酯20 mg组72例、60 mg组76例。所有患者在入选前及用药12个月后检测B型脑钠肽（ BNP）水平，同时行超声心动图检查评估左室舒张末期容积指数（LVEDVI）、左室收缩末期容积指数（LVESVI）、左室质量指数（LVMI）和左室射血分数（ LVEF）的变化。并监测血钾、肾功能及不良事件发生情况。结果治疗12个月时，2组 LVEDVI、LVESVI、 LVMI、LVEF和BNP均较治疗前有明显改善（ P ＜0?．05），60 mg组较20 mg 组改善更明显，差异均有统计学意义（ P ＜0．05）。60 mg组较20 mg组高钾血症（血钾≥5．5 mmol／L）的发生率升高不明显（7．9％ vs．2．8％），无统计学差异（P ＞0．05）。2组中均末发生严重高钾血症（血钾≥6．0 mmol／L）。20 mg组较60 mg组低钾血症的发生率明显增加（2．6％vs．11．1％），且差异有统计学意义（ P ＜0．05）。60 mg组较20 mg组乳房发育及乳房疼痛的发生率明显升高（13．2％vs．2．8％），且差异有统计学意义（ P ＜0．05）。2组各有2例血肌酐增长较上次检验值＞50％的患者，差异无统计学意义（ P ＞0．05），均无血肌酐增长＞180μmol／L者。结论肾功能正常的收缩性心力衰竭患者在常规治疗的基础上应用每日60 mg螺内酯可进一步改善患者的心室重构，降低BNP水平，减少低钾血症的发生，在密切监测下应用是安全的。
목적：탐토불동제량라내지대신공능정상적수축성심력쇠갈환자적료효화안전성。방법입선2011년12월—2012년12월신공능정상적수축성심력쇠갈환자148례，재상규치료적기출상수궤분위매천라내지20 mg조72례、60 mg조76례。소유환자재입선전급용약12개월후검측B형뇌납태（ BNP）수평，동시행초성심동도검사평고좌실서장말기용적지수（LVEDVI）、좌실수축말기용적지수（LVESVI）、좌실질량지수（LVMI）화좌실사혈분수（ LVEF）적변화。병감측혈갑、신공능급불량사건발생정황。결과치료12개월시，2조 LVEDVI、LVESVI、 LVMI、LVEF화BNP균교치료전유명현개선（ P ＜0?．05），60 mg조교20 mg 조개선경명현，차이균유통계학의의（ P ＜0．05）。60 mg조교20 mg조고갑혈증（혈갑≥5．5 mmol／L）적발생솔승고불명현（7．9％ vs．2．8％），무통계학차이（P ＞0．05）。2조중균말발생엄중고갑혈증（혈갑≥6．0 mmol／L）。20 mg조교60 mg조저갑혈증적발생솔명현증가（2．6％vs．11．1％），차차이유통계학의의（ P ＜0．05）。60 mg조교20 mg조유방발육급유방동통적발생솔명현승고（13．2％vs．2．8％），차차이유통계학의의（ P ＜0．05）。2조각유2례혈기항증장교상차검험치＞50％적환자，차이무통계학의의（ P ＞0．05），균무혈기항증장＞180μmol／L자。결론신공능정상적수축성심력쇠갈환자재상규치료적기출상응용매일60 mg라내지가진일보개선환자적심실중구，강저BNP수평，감소저갑혈증적발생，재밀절감측하응용시안전적。
Objective To evaluate the efficacy and safety of different dosage of spironolactone on normal renal func -tion in patients with congestive heart failure .Methods From 2011 December to 2012 December , 148 patients with systolic heart failure and normal renal function were enrolled , on the basis of conventional therapy , they were randomly divided into spironolactone 20 mg group with 72 cases, spironolactone 60 mg group with 76 cases.B-type natriuretic peptide (BNP) level were measured in all patients before and after 12 months of treatment , and ultrasound were performed to assess the change of left ventricular end diastolic volume index (LVEDVI), left ventricular end systolic volume index (LVESVI), left ventricular mass index (LVMI) and left ventricular ejection fraction (LVEF).And the serum potassium, renal function and adverse events were monitored in all of these patients .Results After 12 months of treatment, 2 groups of LVEDVI, LVESVI, LVMI, LVEF and BNP were significantly improved than before treatment ( P <0.05), 60 mg group were more significant than the 20 mg group, the difference was statistically significant ( P <0.05).The increase of hyperkalemia (potassium is more than or equal to 5.5 mmol/L) in the 60 mg group was not significant as in the 20 mg group (7.9%vs.2.8%), no significant diffe-rence was found ( P >0.05).Severe hyperkalemia (potassium is more than or equal to 6 mmol/L) were not detected in both of the 2 groups.The incidence of hypokalemia in 20 mg group was significantly than in 60 mg group (2.6% vs.11.1%), and the difference was statistically significant ( P <0.05).Breast development and breast pain were significantly higher in 60 mg group than in 20 mg group (13.2%vs.2.8%), and the difference was statistically significant ( P <0.05).2 cases with serum creatinine increased >50%than previous test were found in each of the 2 group, no significant difference were found ( P >0.05), there was no serum creatinine increase >180 μmol/L case was found in both of the two gruops .Conclusion On the basis of conventional therapy , spironolactone 60 mg under close monitoring is safe and can further improve ventricular remodeling , reduce the level of BNP and reduce the hypokalemia occurred in patients with congestive heart failure and normal renal function .