CAJ | 학술논문

目的观察不同剂量螺内酯对扩张型心肌病(dilated cardiomyopathy,DCM)心力衰竭患者心功能和血浆脑钠肽(BNP)的影响.方法将扩张型心肌病心力衰竭患者(NYHA心功能分级Ⅲ-Ⅳ级)110例,随机分为小剂量组和大剂量组各55例,两组在常规抗心衰治疗基础上小剂量组给予螺内酯20 mg/d,大剂量组给予螺内酯60 mg/d,经治疗6个月后评价患者的心功能和检测血浆BNP进行比较.结果两组治疗前后NYHA心功能分级比较均有明显好转(P＜0.01)；小剂量组螺内酯治疗前LVEF(31.23±3.61)％与大剂量组螺内酯治疗前LVEF(30.33±3.27)％比较,差异无统计学意义(P＞0.05)；小剂量组螺内酯治疗后LVEF(39.37±8.30)％与大剂量组螺内酯治疗后LVEF(45.17±5.33)％比较,差异有统计学意义(P＜0.05)；小剂量组螺内酯治疗前血浆BNP(973.25±256.23) pg/ml与大剂量组螺内酯治疗前血浆BNP (991.07±211.35) pg/ml比较,差异无统计学意义(P＞0.05)；小剂量组螺内酯治疗后血浆BNP(324.12±122.43) pg/ml与大剂量组螺内酯治疗后血浆BNP(200.58±145.11) pg/ml比较,差异有统计学意义(P＜0.05).但是,大剂量组螺内酯治疗前后比小剂量组下降更明显,两者比较差异有统计学意义(P＜0.05)；小剂量组和大剂量组的不良反应发生率为11.1％和8.82％,差异无统计学意义(P＞0.05).结论在常规用药基础上采用大剂量螺内酯可以降低BNP水平,明显改善扩张性心肌病心力衰竭患者的心功能,疗效较好.
목적 관찰불동제량라내지대확장형심기병(dilated cardiomyopathy,DCM)심력쇠갈환자심공능화혈장뇌납태(BNP)적영향.방법 장확장형심기병심력쇠갈환자(NYHA심공능분급Ⅲ-Ⅳ급)110례,수궤분위소제량조화대제량조각55례,량조재상규항심쇠치료기출상소제량조급여라내지20 mg/d,대제량조급여라내지60 mg/d,경치료6개월후평개환자적심공능화검측혈장BNP진행비교.결과 량조치료전후NYHA심공능분급비교균유명현호전(P＜0.01)；소제량조라내지치료전LVEF(31.23±3.61)％여대제량조라내지치료전LVEF(30.33±3.27)％비교,차이무통계학의의(P＞0.05)；소제량조라내지치료후LVEF(39.37±8.30)％여대제량조라내지치료후LVEF(45.17±5.33)％비교,차이유통계학의의(P＜0.05)；소제량조라내지치료전혈장BNP(973.25±256.23) pg/ml여대제량조라내지치료전혈장BNP (991.07±211.35) pg/ml비교,차이무통계학의의(P＞0.05)；소제량조라내지치료후혈장BNP(324.12±122.43) pg/ml여대제량조라내지치료후혈장BNP(200.58±145.11) pg/ml비교,차이유통계학의의(P＜0.05).단시,대제량조라내지치료전후비소제량조하강경명현,량자비교차이유통계학의의(P＜0.05)；소제량조화대제량조적불량반응발생솔위11.1％화8.82％,차이무통계학의의(P＞0.05).결론 재상규용약기출상채용대제량라내지가이강저BNP수평,명현개선확장성심기병심력쇠갈환자적심공능,료효교호.
Objective To observe the effect of different doses of spironolactone on cardiac function and plasma level of brain natriuretic peptide (BNP) in patients with chronic heart failure (CHF) and dilated cardiomyopathy (DCM).Methods 110 cases of CHF and dilated cardiomyopathy (NYHA cardiac function class Ⅲ-Ⅳ) were randomly divided into large dose group (n=55) and small dose group (n=55),the two groups were treated with sprironolactone 20 mg/d and 60 mg/d respectively based on the routine anti-CHF therapy,the two group' s cardiac function and plasma level of BNP were evaluated 6 months after the treatment.Results The NYHA cardiac function of two groups were improved markedly before and after the treatment (P＜0.01); the small dose group' s LVEF was (31.23 ± 3.61)％ before the treatment and there was no statistical significant difference found compared with large dose group' s LVEF (30.33 ± 3.27)％,(P＞0.05) ; the small dose group' s LVEF was (39.37 ± 8.30)％ after the treatment and there was statistical significant difference compared with large dose group' s LVEF (45.17 ± 5.33)％,(P＜0.05) ;the small dose group' s plasma level of BNP was (973.25 ± 256.23) pg/ml before the treatment and there was no statistical significant difference compared with large dose group' s plasma level of BNP (991.07 ± 211.35) pg/ml,(P＞0.05);,the small dose group' s plasma level of BNP was (324.12 ± 122.43) pg/ml after the treatment and there was statistical significant difference compared with large dose group' s plasma level of BNP (200.58 ± 145.11) pg/ml (P＜0.05).But compared with the small dose group,there was significant decrease in the plasma level of BNP of the large dose group before and after the treatment (P＜0.05) ; the incidence of adverse reaction of small and large dose group were 11.1％ and 8.82％ respectively without any statistical significant difference between the two groups (P＞0.05).Conclusion Large dose of spironolactone on the basis of regular medicine treatment can lower BNP and improve the heart function of patients with CHF and DCM.