CAJ | 학술논문

目的：观察美托洛尔联合辛伐他汀治疗慢性充血性心力衰竭（ chronic heart failure, CHF)的临床效果及对心室重构的影响。方法选择2012年11月—2013年11月资阳市第一人民医院收治且符合纳入排除标准的CHF 119例,根据不同治疗方法将其分为对照组（56例)和观察组（63例)两组。两组均接受常规治疗,对照组在常规治疗基础上加用琥珀酸美托洛尔缓释片治疗,观察组在对照组治疗基础上加用辛伐他汀治疗。观察比较两组临床疗效、心功能指标、心肌重塑相关因子血清基质金属蛋白酶（ MMP)-3、MMP-9浓度以及不良反应发生情况,并对心肌重塑相关因子与超声心动图各参数的相关性进行分析,评价血清MMP-3及MMP-9诊断CHF的价值。结果治疗结束后对照组总有效率低于观察组,差异具有统计学意义（ P>0．05)。治疗结束后,两组心功能指标均较治疗前明显改善,对照组心功能指标改善幅度明显低于观察组；两组心肌重塑相关因子血清MMP-3、MMP-9浓度均较治疗前下降,对照组降低幅度明显低于观察组,差异均具有统计学意义（ P<0．05)。两组不良反应发生率比较差异无统计学意义（P>0．05)。相关性分析结果显示血清MMP-3、MMP-9浓度与超声心动图各参数均具相关性,血清MMP-3、MMP-9与左心室射血分数及左心室短轴缩短率均呈负相关,与左心室舒张末期内径及左心室收缩末期内径均呈正相关。血清MMP-3及MMP-9诊断CHF均具有理想的敏感度及特异度。结论美托洛尔联合辛伐他汀可明显改善CHF患者的心功能,其原因可能与降低心肌重塑相关因子血清MMP-3、MMP-9浓度有关。
목적：관찰미탁락이연합신벌타정치료만성충혈성심력쇠갈（ chronic heart failure, CHF)적림상효과급대심실중구적영향。방법선택2012년11월—2013년11월자양시제일인민의원수치차부합납입배제표준적CHF 119례,근거불동치료방법장기분위대조조（56례)화관찰조（63례)량조。량조균접수상규치료,대조조재상규치료기출상가용호박산미탁락이완석편치료,관찰조재대조조치료기출상가용신벌타정치료。관찰비교량조림상료효、심공능지표、심기중소상관인자혈청기질금속단백매（ MMP)-3、MMP-9농도이급불량반응발생정황,병대심기중소상관인자여초성심동도각삼수적상관성진행분석,평개혈청MMP-3급MMP-9진단CHF적개치。결과치료결속후대조조총유효솔저우관찰조,차이구유통계학의의（ P>0．05)。치료결속후,량조심공능지표균교치료전명현개선,대조조심공능지표개선폭도명현저우관찰조；량조심기중소상관인자혈청MMP-3、MMP-9농도균교치료전하강,대조조강저폭도명현저우관찰조,차이균구유통계학의의（ P<0．05)。량조불량반응발생솔비교차이무통계학의의（P>0．05)。상관성분석결과현시혈청MMP-3、MMP-9농도여초성심동도각삼수균구상관성,혈청MMP-3、MMP-9여좌심실사혈분수급좌심실단축축단솔균정부상관,여좌심실서장말기내경급좌심실수축말기내경균정정상관。혈청MMP-3급MMP-9진단CHF균구유이상적민감도급특이도。결론미탁락이연합신벌타정가명현개선CHF환자적심공능,기원인가능여강저심기중소상관인자혈청MMP-3、MMP-9농도유관。
Objective To observe the curative effect of Metoprolol combined Simvastatin on chronic congestive heart failure ( CHF) and the effects on ventricular remodeling. Methods 119 patients who met the inclusion criteria and exclusion criteria during November 2012 and November 2013 in the First People's Hospital of Ziyang were included in the research and were divided into control group (56 cases) and observation group (63 cases) according to the treatment. Both the two groups received conventional treatment, and the control group received additional Metoprolol Succinate sustained-release tablets on the basis of conventional treatment, and observation group was combined with Simvastatin on the basis of treatment of the control group. Clinical curative effect, cardiac function indexes and serum myocardial remodeling associated factors, matrix metallo-proteinases (MMP)-3 and MMP-9, and adverse reactions of the two groups were compared and correlation analysis of serum myocardial remodeling associated factors, and the parameters of echocardiography were performed. The value of serum MMP-3 and MMP-9 in the diagnosis of CHF was evaluated. Results After treatment, the total effective rate of the control group was lower than that of the observation group, and the differences were of statistical significance (P>0. 05). After the treat-ment, cardiac function indexes of the two group were obviously improved, and the improvement of cardiac function index in the control group was significantly less than that of the observation group;concentration of serum myocardial remodeling associated factors, MMP-3, MMP-9 in the two groups were lower than that before the treatment, the reduction of the control group was significantly less than that of the observation group, and the differences were of statistical significance (P<0. 05). The com-parison of the adverse reaction rates between the two groups had no statistical significances (P>0. 05). Correlation analysis showed that serum concentration of MMP-3, MMP-9 and echocardiographic parameters were correlated, serum MMP-3, MMP-9 showed negative correlation with LVEF and LVFS, and positive correlation with LVDD and LVSD. Serum levels of MMP-3 and MMP-9 both had ideal diagnostic sensitivity and specific degree of CHF. Conclusion Metoprolol combined with Simvas-tatin can obviously improve the cardiac function in patients with CHF, and the cause may be related to the reduction of serum myocardial remodeling associated factors, MMP-3 and MMP-9.