恩格列净联合rhBNP治疗对射血分数降低型心力衰竭患者心室重构和血清NT-proBNP、hs-CRP、IL-6水平的影响.pdf
《恩格列净联合rhBNP治疗对射血分数降低型心力衰竭患者心室重构和血清NT-proBNP、hs-CRP、IL-6水平的影响.pdf》由会员分享,可在线阅读,更多相关《恩格列净联合rhBNP治疗对射血分数降低型心力衰竭患者心室重构和血清NT-proBNP、hs-CRP、IL-6水平的影响.pdf(5页珍藏版)》请在文库网上搜索。
1、:1934:2022,20(6):1058 1061.19 朱素楠。冠心病患者血清 Gal-3、C y s -C、h s -C R P 水平与其冠状动脉病变程度的相关性分析J医药论坛杂志,2 0 2 0,41(11):166-169.Journal of Clinical and Experimental Medicine Vol.22,No.18 Sep.202320蒋志丽,王成钢,李艳芳,等一氧化氮及内皮素1与急性ST段抬高型心肌梗死直接经皮冠状动脉介人患者复流相关性研究J中国医药,2 0 2 0,15(2):16 5-16 8.(收稿日期:2 0 2 3-0 4-2 8)D0I:10.3
2、969/j.issn.1671-4695.2023.18.009恩格列净联合rhBNP治疗对射血分数降低型心力衰竭患者心室重构和血清 NT-proBNP、h s-CR P、I L-6 水平的影响潘丽华孙国位黄竹君黄芳敏(海南医学院第二附属医院心内血管内科海南海口57 0 0 0 0)【摘要】目的恩格列净联合重组人脑利钠肽(rhBNP)治疗对射血分数降低型心力衰竭(HFrEF)患者心室重构和血清N末端脑钠肽前体(NTproBNP)、超敏 C 反应蛋白(hs-CRP)、白细胞介素-6(IL-6)水平的影响。方法前瞻性选取2 0 2 1年1月至2 0 2 2 年12 月海南医学院第二附属医院收治的1
3、2 0 例HFrEF患者为研究对象,按照随机数字表法分为对照组和观察组,每组各6 0 例。对照组予以rhBNP治疗,1 mg/d,24 h 静脉持续泵入,连用 3 d;观察组予以恩格列净联合rhBNP治疗,rhBNP用法同对照组,恩格列净片,10 mg/d,口服,连用12 周。比较两组临床疗效及治疗前后心功能左室射血分数(LVEF)6 min步行试验(6 MWD)生活质量堪萨斯城心肌病患者生活质量量表(KCCQ)、心室重构左室收缩末期内径(LVEDS)、左室舒张末期内径(LVEDD)及血清学 NT-proBNP、h s-CR P、IL-6 水平。结果观察组临床总有效率为9 5.0 0%,明显高
4、于对照组(8 0.0 0%),差异有统计学意义(P0.05)。治疗后,两组LVEF、6 M W D 及KCCQ评分均较治疗前明显提高,且观察组LVEF、6 M W D 及KCCQ评分分别为(38.7 45.8 5)%、(46 7.5351.2 4)m、(6 7.57 7.33)分,均明显高于对照组(34.7 6 5.2 4)%、(411.7 549.6 4)m、(6 2.6 8 6.59)分,差异均有统计学意义(P0.05)。治疗后,两组LVEDS、L VED D 均较治疗前明显降低,且观察组LVEDS、L VED D 分别为(36.544.0 8)、(42.47 4.6 1)m m,均明显低
5、于对照组(40.9 8 4.6 2)、(44.8 8 4.7 9)mm】,差异均有统计学意义(P0.05)。治疗后,两组血清 NT-proBNP、h s-C R P、I L-6 水平均较治疗前明显降低,且观察组血清 NT-proBNP、h s-C R P、I L-6 水平分别为(346.8 6 9 5.2 3)pg/mL、(5.59 1.52)mg/L、(4.531.52)n g/L,均明显低于对照组(7 54.8 9 116.58)p/mL、(6.2 8 1.8 0)mg/L、(5.18 1.7 7)n g/L),差异均有统计学意义(P0.05)。结论恩格列净联合rhBNP治疗HFrEF疗效
6、显著,可明显改善患者心功能,提高其生活质量,逆转心室重构,降低血清 NT-proBNP、h s-C R P、I L-6 水平。【关键词】心力衰竭心室重构利钠肽,脑恩格列净炎症因子Effects of empagliflozin combined with rhBNP on ventricular remodeling and serum NT-proBNP,hs-CRP and IL-6 levels in pa-tients with heart failure with reduced ejection fraction.PAN Li-hua,SUN Guo-wei,HUANG Zhu-j
7、un,et al.Department of EndocardialVascular Medicine,the Second Affiliated Hospital of Hainan Medical College,Haikou Hainan 570000,China.Abstract】O b j e c t i v e T o i n v e s t i g a t e t h e e f f e c t s o f e m p a g l i f l o z i n c o m b i n e d w i t h r e c o m b i n a n t h u m a n b r a
8、 i n n a t r i u r e t i c p e p t i d e (r h BNP)o nventricular remodeling and serum levels of N-terminal pro-brain natriuretic peptide(NT-proBNP),high-sensitivity C-reactive protein(hs-CRP)and interleukin-6(IL-6)in patients with heart failure with reduced ejection fraction(HFrEF).Methods A total o
9、f 120 patientswith HFrEF admitted to the Second Affiliated Hospital of Hainan Medical College from January 2021 to December 2022 were divided into controlgroup and observation group according to the random number table method,60 cases in each group.The control group was treated with rhBNP at1 mg/d,c
10、ontinuously pumped intravenously for 24 hours,and continuously used for 3 days.The observation group was treated with empagliflozincombined with rhBNP,the use of rhBNP was the same as that of the control group,empagliflozin tablets,10 mg/d,were taken orally for 12weeks.The clinical efficacy and card
11、iac function left ventricular ejection fraction(LVEF),6-minute walking distance(6 MWD),quality oflife Kansas City Cardiomyopathy Quality of Life Scale(KCCQ)J,ventricular remodeling left ventricular end-systolic diameter(LVEDS),leftventricular end-diastolic diameter(LVEDD)J and serum NT-proBNP,hs-CRP
12、 and IL-6 levels were compared between the two groups be-fore and after treatment.Results The total effective rate of the observation group was 95.00%,which was significantly higher than that of thecontrol group(80.00%),the difference was statistically significant(P 0.05).After treatment,the LVEF,6M
13、WD,and KCCQ scores of thetwo groups were significantly higher than those before treatment,and the LVEF,6MWD,and KCCQ scores of the observation group were(38.745.85)%,(467.53 51.24)m,and(67.57 7.33)points,respectively,which were significantly higher than those of the control group(34.76 5.24)%,(411.7
14、5 49.64)m,and(62.68 6.59)points,the differences were statistically significant(P 0.05).Aftertreatment,LVEDS and LVEDD in the two groups were significantly lower than those before treatment,and the LVEDS and LVEDD in the observa-tion group were(36.54 4.08)and(42.47 4.61)mm,respectively,which were sig
15、nificantly lower than those of the control group(40.984.62)and(44.88 4.79)mm,the differences were statistically significant(P 0.05).After treatment,the serum levels of NT proBNP,hs CRP,and IL-6 in both groups were significantly lower than before treatment,and the serum levels of NT proBNP,hs CRP,and
16、 IL-6 in the基金项目:海南省卫生健康行业科研项目(编号:2 0 A200521)文章编号:16 7 1-46 9 5(2 0 2 3)18-19 34-0 5临床和实验医学杂志2 0 2 3年9 月第2 2 卷第18 期observation group were(346.86 95.23)pg/mL,(5.59 1.52)mg/L,and(4.53 1.52)ng/L,respectively,which were significantly lowerthan those in the control group(754.89 116.58)pg/mL,(6.28 1.80)m
17、g/L,and(5.18 1.77)ng/L,the differences were statisticallysignificant(P 0.05).Conclusion Empagliflozin combined with rhBNP is effective in the treatment of HFrEF,which can significantly improve the cardiac func-tion of patients,improve their quality of life,reverse ventricular remodeling,and reduce s
18、erum NT-proBNP,hs-CRP and IL-6 levels.Key words Heart failure;Ventricular remodeling;Natriuretic peptide,brain;Empagliflozin;Inflammatory factors心力衰竭是各种心血管疾病引起的心功能下降,当左室射血分数(left ventricular ejection fraction,LVEF)40%时为射血分数降低型心力衰竭(eartfailurewithre-ducedejection fraction,H Fr EF),约占慢性心力衰竭的50%,具有患病率高
19、、致残率高、病死率高、医疗费用高的特点,严重影响了患者及其家庭的生活质量。因此,对HFrEF 患者予以长期、规范的治疗管理对控制病情进展具有重要的临床意义。目前,临床治疗HFrEF常选用RAAS抑制剂、受体拮抗剂、正性肌力药等药物,但其效果仍未达理想2 。探究HFrEF治疗新药物、新方案仍是心血管领域的研究重点。重组人脑利钠肽(recombinant human brain natriuretic peptide,rhBNP)具有连排尿、抗心室重构、扩血管、抗神经内分泌系统过度激活等作用,可快速改善HFrEF患者临床症状,给予后续治疗有利的支持和保障3。恩格列净为钠葡萄糖共转运蛋白2(sodi
20、um-dependent glucose transporters2,SGLT2)抑制剂,虽常用作降糖药,近年研究发现,该类药物亦具有一定的心血管、肾脏保护作用,可明显降性别(例)体重指数组别例数男性女性(岁,xs)(kg/m,x s)观察组60对照组60t/x值P值1.2纳入与排除标准纳人标准:(1)符合HFrEF诊断标准6 (存在心力衰竭体征和症状,且LVEF40%);(2)年龄18 8 0 岁;(3)NYHA心功能分级为IV级;(4)患者及其家属知情同意参与研究。排除标准:(1)合并严重肝肾功能不全、反复低血糖、严重低血压、恶性肿瘤、免疫系统疾病、严重感染;(2)有先天性心脏病、恶性心律
21、失常、血管性水肿;(3)急性代偿性心力衰竭;(4)有心脏手术既往史;(5)合并严重精神疾病或智力障碍;(6)因各种原因中途退出研究。1.3治疗方法两组均按中国心力衰竭诊断和治疗指南2 0 18 6 规范予以血管紧张素受体拮抗剂、血管紧张素转化酶抑制剂、醛固酮受体拮抗剂、肾上腺素受体阻滞药、利尿药等药物治疗。在此基础上,对照组予以rhBNP(成都诺迪康生物制药有限公司,国药准字:S20050033)治疗,1mg/d,24h静脉持续泵入,连用3d。观察组予以恩格列净片(正大天晴药业集团股份有限公司,国药准字:H20213065)10 m g/d,口服,连用12 周;1935.低糖尿病患者心力衰竭发
22、生风险,且单纯心力衰竭患者亦可获益(改善临床预后、降低心力衰竭再住院率等)4-5。但该疗法在国内仍存在一定争议。基于此,本研究旨在探究恩格列净联合rhBNP治疗对HFrEF患者心室重构和血清 N末端脑钠肽前体(Nt e r mi n a l p r o-brain natriuretic peptide,NT-proBNP)、超敏 C反应蛋白(hypersensitive C-reactive protein,hs-CRP)、白细胞介素-6(interleukin-6,IL-6)水平的影响。现将结果报道如下。1资料与方法1.1一般资料与分组2022年12 月海南医学院第二附属医院收治的12 0
23、 例HFrEF患者为研究对象。按随机数字表法将患者分为对照组和观察组,每组各6 0 例。两组性别构成比、年龄、体重指数、纽约心脏病协会(NewYorkHeart Associa-tion,NYHA)分级等一般资料比较,差异均无统计学意义(P0.05),具有可比性,见表1。本研究通过海南医学院第二附属医院伦理委员会审批。表1两组一般资料比较年龄NYHA分级(例)IV411939210.1500.699前瞻性选取2 0 2 1年1月至高血压高血脂糖尿病(例)(例)69.73 8.9523.14 2.7868.42 9.7722.96 3.040.7660.3380.4450.736(例)51781
24、80.9430.624rhBNP用法用量同对照组。1.4观察指标于治疗前后检测两组心功能左室射血分数(left ventricular ejection fraction,LVEF),6 m i n 步行试验(6-minute walking distance,6MWD)、生活质量堪萨斯城心肌病患者生活质量量表(Kansas City Car-diomyopathy Patient Quality of Life Scale,KCCQ)7、心室重构左室收缩末期内径(left ventricular end systolicdiameter,L V ED S)左室舒张末期内径(leftventr
25、icularend diastolic diameter,LVEDD)及血清 NT-proBNP,hs-CRP、IL-6 水平。其中,LVEF、L VED S、L VED D 用三维超声心动图(飞利普SONOS7500)检测;KCCQ共2 3条目,总分0 10 0 分,评分越高提示生活质量越高;6MWD用6 min步行监测分析系统检测;NT-proBNP用荧光免疫干式定量法检测,hs-CRP用免疫比浊法检测,IL-6用化学发光法检测,血样均为空腹外周静脉血。1.5疗效评价显效:心力衰竭相关症状明显改善,NYHA分级提高2 级及以上;有效:心力衰竭相关症状383433360.3070.58026
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- 恩格列净 联合 rhBNP 治疗 对射 分数 降低 心力衰竭 患者 心室 血清 NT proBNP hs CRP IL 水平 影响
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