应用血CTnT、IGF-1、NT-proBNP水平综合评价左西孟旦治疗慢性心力衰竭的疗效  

Evaluation of the efficacy of levosimendan in treating chronic heart failure by detecting blood cTnT, IGF-1 and NT-proBNP

作　　者：刘聪聪[1,2] 邢艳秋[3] 张会珍[4] 章萌[5] 张琼[1,2] 

机构地区：[1]山东省医学科学院基础医学研究所,济南250062 [2]济南大学山东省医学科学院医学与生命科学学院 [3]山东大学齐鲁医院干部保健科 [4]济南医院内一科 [5]聊城市人民医院心内科

出　　处：《中华临床医师杂志（电子版）》2014年第6期57-61,共5页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的：应用血肌钙蛋白T（cTnT）、类胰岛素生长因子1（IGF-1）、氨末端脑利钠肽前体（NT-proBNP）水平的变化，评价左西孟旦治疗慢性心力衰竭临床疗效及其安全性。方法采用随机、平行、阳性对照临床研究。选择心功能Ⅲ～Ⅳ级、LVEF＜40%的住院患者80例，其中40例给予常规抗心衰治疗；试验组40例在常规治疗基础上加用左西孟旦；两组分别于治疗前及治疗72 h后监测患者的生命体征，呼吸困难程度及全身临床状况，检测IGF-1、cTnT、NT-proBNP值，并观察血流动力学指标的变化。结果2例在试验开始前退出，4例在治疗后失访，共74例纳入结果分析，其中试验组36例，对照组38例。试验组临床有效率为83.3%（30/36），对照组临床有效率为55.3%（21/38），两组比较差异有统计学意义（P＝0.027）。治疗72 h后试验组与对照组IGF-1上升均值分别为44.6 ng/ml和6.8 ng/ml（P＝0.018），cTnT下降均值分别为40.3 pg/ml和11.3 pg/ml（P＝0.015）， NT-ProBNP下降均值分别为2958 pg/ml和1936 pg/ml（P＞0.05）。治疗72 h后试验组与对照组SBP下降均值分别为16.15 mmHg和6.14 mmHg（P＝0.044），DBP下降均值分别为20.62 mmHg和10.75 mmHg（P＝0.015），HR下降均值分别为6.65次/min和2.82次/min（P＞0.05）。试验组与对照组不良反应发生率差异无统计学意义（P＞0.05）。结论血cTnT、IGF-1能够准确评价左西孟旦治疗慢性充血性心力衰竭疗效，其敏感性优于NT-proBNP。Objective To assess the efficacy of levosimendan compared with conventional treatment heart failure drugs in chronic heart failure. Methods 80 patients were arranged into this randomized, parallel-group and positive study to receive either levosimendan or conventional treatment for heart failure. 40 were assigned to levosimendan and the other 40 were to conventional treatment group. These two group patients were both monitored vital sign, degree of dyspnea and overall clinical status, level of IGF-1, cTnT, NT-proBNP and hemodynamic index variables before and 72 hours after treatment. Results 74 patients were included in the results of the analysis. Among of them, 36 were levosimendan group, 38 were control group. The clinical efficacy rate was 83.3%（30/36） in levosimendan group and 55.3%（21/38） in control group（P=0.027）. 72 hours after treatment, insulin-like growth factors（IGF-1） was increased by 44.6 ng/ml in levosimendan group, 6.8 ng/ml in control group（P=0.018）. Cardiac troponin T（cTnT） was decreased by 40.3 pg/ml in levosimendan group, compared with 11.3 pg/ml in control group（P=0.015）. N-terminal pro-brain natriuretic peptide （NT-proBNP） was decreased by 2 958 pg/ml in levosimendan group, compared with 1 936 pg/ml in control group（P〉0.05）. Systolic blood pressure（SBP） was decreased by 16.15 mmHg in levosimendan group and 6.14 mmHg in control group（P=0.044）. DBP was decreased by 20.62 mmHg in levosimendan group and 10.75 mmHg in the other respectively（P=0.015）. Heart rate was reduced by 6.65 beats/min in levosimendan group and 2.82 beats/min in the other（P〉0.05）. There was no significant defference in the incidence of adverse reaction between the two groups （P〉0.05）. Conclusion Blood cTnT, IGF-1 can accurately evaluate levosimendan efficacy of the treatment of chronic congestive heart failure, which is more sensitive than NT-proBNP.

关 键 词：心力衰竭 左西孟旦 肌钙蛋白T 胰岛素样生长因子I 利钠肽 脑 治疗结果 

分 类 号：R541.6[医药卫生—心血管疾病]