李璐娜,张杨春,兰凯,何睿颖,陈旖旎
LI Luna,ZHANG Yangchun,LAN Kai,HE Ruiying,CHEN Yini

• 1:成都市第三人民医院心内科

摘要(Abstract)：

目的:观察螺内酯联合贝那普利对心力衰竭患者治疗效果及机制。方法:选取接受治疗的心力衰竭患者80例,采取随机数字表法均分为观察组与对照组;两组患者入院后均给予常规抗心衰治疗,对照组在此基础上给予贝那普利治疗,观察组在对照组基础上联合螺内酯进行治疗;比较两组患者短期(3个月时)临床疗效,并记录其治疗前、治疗6个月时血清超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)和氧化应激和核因子-κB(NF-κB)、心脏彩色多普勒超声检测左室射血分数(LVEF)、左室舒张末期内径(LVDd)、左室收缩末期内径(LVDs)和左心室短轴缩短率(LVFS)同时检测超敏肌钙蛋白T(hs-TnT)、氨基末端脑钠肽(NT-proBNP)和Ⅲ型前胶原氨基端肽(PⅢNP),同时观察两组患者治疗过程中的不良反应、评估用药安全性。结果:两组治疗3个月时的临床疗效分级比较差异有统计学意义,观察组有效率为90. 00%,显著高于对照组的72. 50%(P <0. 05);治疗6个月时,两组患者血清hs-CRP、TNF-α及NF-κB水平较治疗前均有显著下降,且观察组明显低于对照组,差异有统计学意义(P <0. 05);治疗6个月时,两组患者LVEF、LVFS较治疗前均有显著上升,且观察组明显高于对照组(P <0. 05);而LVDd、LVDs较治疗前均有显著下降,且观察组明显低于对照组(P <0. 05);治疗6个月时,两组患者血清hs-TnT、NT-proBNP、PⅢNP水平较治疗前均显著下降,且观察组明显低于对照组(P <0. 05);两组相关不良反应总发生率比较,差异无统计学意义(χ2=2. 635,P=0. 105)。结论:螺内酯联合贝那普利可有效改善心力衰竭患者心功能,其机制可能与降低机体炎症因子水平、改善内皮细胞功能有关。
Objective: To observe the therapeutic effect and mechanism of spironolactone combined with benazepril on patients with heart failure. Methods: Eighty patients with heart failure were selected and randomly divided into an observation group and a control group. The patients in both groups were given conventional anti-heart failure treatment after admission. In addition,the control group was given benazepril, while the observation group was given benazepril combined with spironolactone. At three months after the treatment,the therapeutic effect of spironolactone on patients weas compared. Before the treatment and 6 months after the treatment,we measured the serum highsensitivity C-reactive protein( hs-CRP),tumor necrosis factor-α( TNF-α),oxidative stress,nuclear factor-κB( NF-κB),left ventricular ejection fraction( LVEF),left ventricular end-diastolic diameter( LVDd),left ventricular end-systolic diameter( LVDs),left ventricular short axis shortening rate( LVFS). In addition,hypersensitivity troponin T( hs-TnT),amino-terminal brain natriuretic peptide( NT-proBNP) and amino terminal of type III procollagen Peptide( PⅢNP) were detected. Moreover,the adverse reactions and the safety of medication were observed. Results: At three months after the treatment,the effective rates in the observation group( 90. 00%) was significantly higher that( 72. 50%) in control group( P < 0. 05). At 6 months after the treatment,the levels of serum hsCRP,TNF-α and NF-κB were significantly decreased,and lower in observation group than in the control group( P < 0. 05). At 6 months of the treatment,the LVEF and LVFS were significantly increased,and higher in observation group than in control group( P < 0. 05). In contrast,LVDd and LVDs were significantly decreased after the treatment,and lower in observation group than in control group( P < 0. 05). Moreover,the serum levels of hs-TnT,NT-proBNP and PⅢNP were significantly decreased after the treatment,and lower in observation group than in control group( P < 0. 05). The adverse reactions were not significantly different between observation and control groups( χ2= 2. 635,P= 0. 105). Conclusion: Spironolactone combined with benazepril can effectively improve the heart function of patients with heart failure, and its mechanism may be related to the reduction of inflammatory factor levels and the improvement of endothelial cell function.

关键词(KeyWords)： 心力衰竭;螺内酯;疗效比较研究;贝那普利;超敏肌钙蛋白T;超敏C反应蛋白;氨基末端脑
heart failure(HF);spironolactone;comparative effectiveness research;benazepril;high-sensitivity troponin T(hs-TnT);hypersensitive C-reactive protein(hs-CRP);N-terminal probrain natriuretic peptide(NT-proBNP)

Abstract:

Keywords:

基金项目(Foundation): 四川省干部保健科研课题(2016-085)

作者(Author): 李璐娜,张杨春,兰凯,何睿颖,陈旖旎
LI Luna,ZHANG Yangchun,LAN Kai,HE Ruiying,CHEN Yini

DOI: 10.19367/j.cnki.2096-8388.2020.05.019

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