CAJ | 학술논문

目的通过观察慢性充血性心力衰竭(CHF)患者血浆氨基末端B型钠利尿肽前体(NT-proBNP)浓度与心力衰竭严重程度的相关性,探讨环磷腺苷葡胺(MAC)联合培哚普利对CHF患者左心功能、血浆NT-proBNP浓度的影响,评估其临床疗效与安全性.方法选择2011年6月至2013年6月在普爱医院心内科心内科住院的126例慢性心力衰竭患者,随机(随机数字法)分为A组(42例,常规治疗)、B组(41例,常规治疗+培哚普利)、C组(43例,常规治疗+培哚普利+环磷腺苷葡胺),疗程为14 d.分别于给药前、给药14 d后测定左室射血分数(LVEF)、左室舒张末期内径(LVEDD)及血浆NT-proBNP浓度.结果 CHF患者血浆NT-proBNP浓度与纽约心脏病协会(NYHA)心功能分级及LVEDD呈正相关(r=0.617,P＜0.01;r=0.412,P＜0.01),与LVEF呈负相关(r=-0.372,P＜0.01).与A组比较,B、C两组治疗后LVEF、LVEDD均有更明显改善(P＜0.05),血浆NT-proBNP的浓度亦显著降低(P＜0.05);C组与B组相比血浆NT-proBNP浓度降低更明显(P＜0.05),但心功能参数两组则差异无统计学意义(P＞0.05).结论血浆NT-proBNP浓度与CHF患者的心衰严重程度密切相关,是心力衰竭诊断、治疗和预后评估的良好指标.培哚普利可降低CHF患者血浆NT-proBNP浓度并显著改善其心功能,MAC联合培哚普利虽不能进一步改善患者LVEF,但能使血浆NT-proBNP浓度进一步降低,且患者耐受性良好,治疗CHF疗效显著.
목적 통과관찰만성충혈성심력쇠갈(CHF)환자혈장안기말단B형납이뇨태전체(NT-proBNP)농도여심력쇠갈엄중정도적상관성,탐토배린선감포알(MAC)연합배타보리대CHF환자좌심공능、혈장NT-proBNP농도적영향,평고기림상료효여안전성.방법 선택2011년6월지2013년6월재보애의원심내과심내과주원적126례만성심력쇠갈환자,수궤(수궤수자법)분위A조(42례,상규치료)、B조(41례,상규치료+배타보리)、C조(43례,상규치료+배타보리+배린선감포알),료정위14 d.분별우급약전、급약14 d후측정좌실사혈분수(LVEF)、좌실서장말기내경(LVEDD)급혈장NT-proBNP농도.결과 CHF환자혈장NT-proBNP농도여뉴약심장병협회(NYHA)심공능분급급LVEDD정정상관(r=0.617,P＜0.01;r=0.412,P＜0.01),여LVEF정부상관(r=-0.372,P＜0.01).여A조비교,B、C량조치료후LVEF、LVEDD균유경명현개선(P＜0.05),혈장NT-proBNP적농도역현저강저(P＜0.05);C조여B조상비혈장NT-proBNP농도강저경명현(P＜0.05),단심공능삼수량조칙차이무통계학의의(P＞0.05).결론 혈장NT-proBNP농도여CHF환자적심쇠엄중정도밀절상관,시심력쇠갈진단、치료화예후평고적량호지표.배타보리가강저CHF환자혈장NT-proBNP농도병현저개선기심공능,MAC연합배타보리수불능진일보개선환자LVEF,단능사혈장NT-proBNP농도진일보강저,차환자내수성량호,치료CHF료효현저.
Objective To explore the relationship of plasma NT-proBNP level and severity of chronic congestive heart failure (CHF) and investigate the curative effect and security of meglumine adenosine cyclophosphate (MAC) combined with perindopril on patients with CHF.Methods From June 2011 to June 2013,126 inpatients with chronic congestive heart failure were randomly divided into A group (42 cases,routine therapy),B group (41 cases,routine therapy and perindopril) and C group (43 cases,routine therapy and perindopril plus MAC),all cases treated for 14 days.The left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) by echocardiography and plasma NT-proBNP levels were evaluated before and after 14 days therapy.Results The plasma NT-proBNP levels in NYHA Ⅱ ～ Ⅳ classes were significantly difference compared each other between any two classes (P ＜0.05) and the levels was positively correlated with NYHA cardiac function class and LVEDD (r =0.617,P ＜ 0.01 ; r =0.412,P ＜ 0.01),negatively correlated with LVEF (r =-0.372,P ＜ 0.01).After 14 days therapy,compared with A group,the LVEF and LVEDD significantly improved (P ＜ 0.05) and NT-proBNP level significantly decreased (P ＜ 0.05) in B,C groups; Compared with B group,C group had lower NT-proBNP level (P ＜ 0.05) although no further improvement in cardiac function.Conclusions The plasma NT-proBNP level is correlated closely with the severity of CHF and it is a good examination of diagnose,therapy and evaluating prognosis of CHF.Perindopril may significantly decline plasma NT-proBNP level and improve cardiac function of CHF patients,combined with MAC may further decline plasma NT-proBNP level although not further improved LVEF.Giving MAC and perindopril to patients with CHF was secure and patients tolerated it well.