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目的:评价依普利酮在轻度症状收缩性心力衰竭患者的疗效。方法:选取我院2013年2月至2015年10月收治的NYHA分级Ⅱ级的收缩性心力衰竭患者,随机分为对照组(41例,常规心衰治疗)与观察组(42例,加依普利酮治疗)。治疗6个月后,观察、分析2组间患者治疗前后症状、体征、超声指标、脑钠肽(brain natriuretic peptide,BNP)、转化生长因子-β1(transforming growth factor-β1,TGF-β1)、6 min步行试验(6 min walking test,6MWT)、生活质量评分变化。结果:2组患者血浆BNP与TGF-β1水平均较治疗前降低,左室射血分数(left ventricular shoot ejection fraction,LVEF)、左心室收缩末期内径(left ventricular contraction end systolic diameter,LVESD)、室间隔厚度(interventricular septal thickness,IVS)、6MWT、生活质量评分均较治疗前有所改善,差异有统计学意义(P<0.05)。治疗后2组间对比,观察组患者血浆BNP与TGF-β1水平分别为(274.08±175.90)pg/m L和(114.28±39.50)ng/L,均低于对照组的(452.85±128.52)pg/m L和(255.08±41.05)ng/L,观察组患者LVEF(49.02%±7.41%)和6MWT[(710.57±158.25)m]高于对照组,LVESD[(38.54±8.05)mm]和生活质量评分(41.54±10.59)低于对照组,差异均有统计学意义(P<0.05)。2组间不良反应发生率差异无统计学意义。观察组治疗总有效率高于对照组(69.08%vs.39.02%,P<0.05)。结论:在常规治疗基础上,依普利酮作为新型高选择性醛固酮受体阻滞剂,能够降低轻度症状收缩性心力衰竭患者血浆TGF-β1水平,在逆转心肌重构、改善心功能中发挥重要作用。
Objective: To evaluate the efficacy of eplerenone in patients with mild symptoms of systolic heart failure. Methods: Patients with NYHA Ⅱ grade systolic heart failure who were admitted to our hospital from February 2013 to October 2015 were randomly divided into control group (41 cases, conventional heart failure treatment) and observation group (42 cases, plus Pulianidin treatment). Six months after treatment, the symptoms, signs, ultrasound indexes, brain natriuretic peptide (BNP), transforming growth factor-β1 (TGF-β1) 6 min walking test (6MWT), quality of life score changes. Results: The plasma levels of BNP and TGF-β1 in the two groups were significantly lower than those before treatment. The left ventricular ejection fraction (LVEF), left ventricular contraction end systolic diameter (LVESD) Interventricular septal thickness (IVS), 6MWT, quality of life scores were improved than before treatment, the difference was statistically significant (P <0.05). After treatment, the levels of plasma BNP and TGF-β1 in the observation group were (274.08 ± 175.90) pg / m L and (114.28 ± 39.50) ng / L, respectively, which were lower than that of the control group (452.85 ± 128.52) pg LVEF (49.02% ± 7.41%) and 6MWT [(710.57 ± 158.25) m] in the observation group were significantly higher than those in the control group, LVESD [(38.54 ± 8.05) mm] and Quality score (41.54 ± 10.59) was lower than the control group, the difference was statistically significant (P <0.05). There was no significant difference in the incidence of adverse reactions between the two groups. The total effective rate of observation group was higher than that of control group (69.08% vs.39.02%, P <0.05). Conclusion: Based on routine treatment, eplerenone, a new and highly selective aldosterone blocker, can reduce the plasma levels of TGF-β1 in patients with mild symptoms of systolic heart failure. In reversing myocardial remodeling and improving cardiac function Play an important role.