摘要
目的观察大剂量螺内酯对老年慢性心力衰竭（CHF）患者心功能和血浆脑钠肽（BNP）的影响。方法选取纽约心脏病协会（NYHA）心功能分级Ⅲ～Ⅳ级的老年CHF患者68例，随机分为试验组和对照组各34例，两组在常规治疗基础上分别给予螺内酯20mg／d和60mg／d，治疗6个月后评价患者的心功能和检测BNP。结果试验组血浆BNP浓度由（921．4±284．5）ng／L降低为（316．4±193．3）ng／L（t=14．722，P=0．000）；对照组血浆BNP浓度由（904．3士274．0）ng／L降低为（481．3±202．5）ng／L（t=9．271，P=0．000）；治疗后两组比较差异均有统计学意义（t=4．280，P=0．011）。两组患者治疗前后左室射血分数（LVEF）均改善[试验组（32．2±4．7）％与（45．1±6．2）％，t=6．820，P=0．004；对照组（31．8±5．1）％与（38．3±5．7）％，t=5．283，P=0．0083，治疗后两组比较差异也有统计学意义（t=3．844，P=0．017）。两组患者治疗前后左室舒张末期内径（LVEDD）缩小[试验组（58．6±4．4）mm与（45．7±4．4）mm，t=5．822，P=0．006；对照组（59．1±5．2）mm与（52．4±4．8）mm，t=3．018，P=0．0243，治疗后两组比较差异也有统计学意义（t=3．393，P=0．020）。两组治疗前后NYHA心功能分级有明显好转（χ^2=5．527，P=0．009；χ^2=4．180，P=0．013）。治疗后两组比较差异有统计学意义（χ^2=3．273，P=0．022）。观察组和对照组不良反应发生率分别为11．76％和8．82％（χ^2=1．063，P=0．116）。结论在常规用药基础上采用大剂量螺内酯可以明显改善CHF患者的心功能，降低BNP水平，可能更适合老年重症CHF患者。
Objective To investigate the effect of large dosage of spironolactone on cardiac function and plasma level of brain natriuretic peptide （BNP） in elderly patients with chronic heart failure （CHF）. Methods Totally 68 cases with CHF （NYHA cardiac function class Ⅲ and Ⅳ） were randomly divided into study group （with adding spironolaetone 20 mg/d and 60 mg/d to conventional treatment, n = 34） and control group （conventional treatment, n = 34）. The cardiac function and plasma level of BNP were evaluated after 6 months treatment. Results The posttreatment plasma level of BNP dropped from （921.4±284.5）ng/L to （316.4±193.3）ng/L in study group （t= 14. 722, P= 0. 000） and from （904.3 ± 274.0） ng/L to （481.3 ± 202.5） ng/L in control group （t= 9. 271, P= 0. 000） with significant difference in posttreatment BNP level between two groups （t=4. 280, P=0. 011）. The values of left ventrieular ejection fraction （LVEF） were higher after treatment than before treatment in study group [（32.2 ±4.7）% vs. （45.1±6.2） %, t= 6. 820, P= 0. 004] and in control group [（31.8± 5.1） % vs. （38.3±5.7） %, t= 5. 283, P= 0. 008], and the post-treatment LVEF was much higher in study group than in control group （t= 3. 844, P= 0. 017）. The value of left ventricular end diastolic diameter （LVEDD） dropped significantly after treatment as compared to before treatment in study group [（58.6±4.4） mm vs. （45.7±4.4） mm, t =5.822, P=0.006] and in control group [（59.1±5.2） mm vs. （52.4±4.8） mm, t=3.018, P= 0. 024], and there was remarkable difference in LVEDD value between the two groups after treatment （t=3. 393, P=0. 020）. The cardiac function after treatment was markedly improved as compared to before treatment in study group （χ^2=5.527, P=0.009） and in control group （χ^2=4.180, P-= 0. 013）, and the study group showed a more satisfactory result than control group （χ^2=3. 273, P： 0. 022）. The incidence of side effects were 11.76% in the
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2011年第10期827-829,共3页
Chinese Journal of Geriatrics
关键词
螺内酯
心力衰竭
利钠肽
脑
Spironolactone
Heart failure
Natriuretic peptide, brain
