CAJ | 학술논문

目的：评价醛固酮受体拮抗剂螺内酯对围生期心肌病（ PPCM）的治疗价值。方法收集72例病情相对稳定的PPCM患者，随机分为2组，对照组和干预组各36例，均给予ACEI／ARB、β-受体阻滞剂、曲美他嗪、阿司匹林等抗心力衰竭治疗，对照组维持以上治疗，干预组在以上治疗基础上加用螺内酯20 mg，每天1次，治疗6个月后，测定心率、血压、左室舒张末内径（LVEDD）、左室射血分数（LVEF）、N末端脑钠肽前体（NT-proBNP）、电解质及心功能NYHA分级。结果治疗6个月后，2组患者心功能分级和LVEF都有改善，心率及NT-proBNP水平下降，无死亡患者。与对照组相比，干预组LVEF明显提高（ P ＜0[．05），心功能分级、血压、心率、NT-proBNP均有改善但差异无统计学意义（ P ＞0．05），血钾水平未见异常升高，干预组无症状生存率高于对照组，但不具有统计学意义（85．2％ vs．69．1％，Log-rank χ2＝1．79， P ＝0．18）。结论对于病情较稳定的以心功能NYHA II级为主的PPCM患者，在标准抗心力衰竭治疗基础上加用螺内酯可进一步获益，提高了心脏收缩功能，减少了心力衰竭事件，未引起血钾异常升高。
목적：평개철고동수체길항제라내지대위생기심기병（ PPCM）적치료개치。방법수집72례병정상대은정적PPCM환자，수궤분위2조，대조조화간예조각36례，균급여ACEI／ARB、β-수체조체제、곡미타진、아사필림등항심력쇠갈치료，대조조유지이상치료，간예조재이상치료기출상가용라내지20 mg，매천1차，치료6개월후，측정심솔、혈압、좌실서장말내경（LVEDD）、좌실사혈분수（LVEF）、N말단뇌납태전체（NT-proBNP）、전해질급심공능NYHA분급。결과치료6개월후，2조환자심공능분급화LVEF도유개선，심솔급NT-proBNP수평하강，무사망환자。여대조조상비，간예조LVEF명현제고（ P ＜0[．05），심공능분급、혈압、심솔、NT-proBNP균유개선단차이무통계학의의（ P ＞0．05），혈갑수평미견이상승고，간예조무증상생존솔고우대조조，단불구유통계학의의（85．2％ vs．69．1％，Log-rank χ2＝1．79， P ＝0．18）。결론대우병정교은정적이심공능NYHA II급위주적PPCM환자，재표준항심력쇠갈치료기출상가용라내지가진일보획익，제고료심장수축공능，감소료심력쇠갈사건，미인기혈갑이상승고。
Objective To evaluate the effect of aldosterone receptor antagonist spironolactone in the treatment of peri -partum cardiomyopathy (PPCM).Method Collected 72 cases of relatively stable PPCM patients, they were randomly divided into 2 groups, control group and treatment group with 36 cases in each group , they were treated with ACEI/ARB, beta bloc-kers, and trimetazidine, aspirin and other anti-heart failure treatment, the control group maintained the above treatment , treat-ment group based on the above treatment , also used of spironolactone 20 mg, 1 times a day , after 6 months of treatment , the heart rate, blood pressure, left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), N ter-minal brain precursor , electrolyte and heart function of natriuretic peptide NYHA classification were measured .Results After 6 months of treatment , 2 groups of patients ’ cardiac functional and LVEF have improved , heart rate and NT-proBNP level were decreased , and no death patients were recorded .Compared with the control group , the treatment group ’ s LVEF was in-creased ( P <0.05), heart function, blood pressure, heart rate, NT-proBNP were improved, but the difference was not sta-tistically significant ( P >0.05), and no abnormal increase of blood potassium levels were found , the treatment group’s a-symptomatic survival rate was higher than the control group , but the difference did not reach with statistical significance (85.2%vs.69.1%, Log rank χ2 =1.79, P =0.18).Conclusion Apart from standard anti heart failure drugs , aldoste-rone receptor antagonist give benefit to NYHA class II PPCM whose heart failure are relative steady .Aldosterone receptor an-tagonist enhanced cardiac systolic function , decreased onset of heart failure and do not bring serum potassium abnormal .