醛固酮受体拮抗剂螺内酯对围生期心肌病的治疗价值  

Efficacy of aldosterone receptor antagonists therapy in patients with peripartum cardiomyopathy

作　　者：黄广勇[1,2] 张连英 杜静[1,4] 张雪松[1,2] 庄芳[1,2] 

机构地区：[1]泰山医学院聊城临床学院 [2]聊城市人民医院心内科,252000 [3]聊城市第四人民医院妇产科 [4]聊城市人民医院妇产科,252000

出　　处：《疑难病杂志》2014年第12期1226-1228,1232,共4页Chinese Journal of Difficult and Complicated Cases

基　　金：聊城市科技发展计划项目(No.2009E092)

摘　　要：目的评价醛固酮受体抗抗剂螺内酯对围生期心肌病(PPCM)的治疗价值。方法收集72例病情相对稳定的PPCM患者,随机分为2组,对照组和干预组各36例,均给予ACEI/ARB、β-受体阻滞剂、曲美他嗪、阿司匹林等抗心力衰竭治疗,对照组维持以上治疗,干预组在以上治疗基础上加用螺内酯20 mg,每天1次,治疗6个月后,测定心率、血压、左室舒张末内径(LVEDD)、左室射血分数(1LVEF)、N末端脑钠肽前体(NT-proBNP)、电解质及心功能NYHA分级。结果治疗6个月后,2组患者心功能分级和LVEF都有改善,心率及NT-proBNP水平下降,无死亡患者。与对照组相比,干预组LVEF明显提高(P<0.05),心功能分级、血压、心率、NT-proBNP均有改善但差异无统计学意义(P>0.05),血钾水平未见异常升高,干预组无症状生存率高于对照组,但不具有统计学意义(85.2%vs.69.1%,Log-rar x^2=1.79,P=0.18)。结论对于病情较稳定的以心功能NYHAⅡ级为主的PPCM患者,在标准抗心力衰竭治疗基础上加用螺内酯可进一步获益,提高了心脏收缩功能,减少了心力衰竭事件,未引起血钾异常升高。Objective To evaluate the effect of aldosterone receptor antagonist spironolactone in the treatment of peripartum cardiomyopathy（PPCM）.Method Collected 72 cases of relatively stable PPCM patients,they were randomly divided into 2 groups,control group and treatment group with 36 cases in each group,they were treated with ACEl/ARB,beta blockers,and trimetazidine,aspirin and other anti-heart failure treatment,the control group maintained the above treatment,treatment group based on the above treatment,also used of spironolactone 20 mg,1 times a day,after 6 months of treatment,the heart rate,blood pressure,left ventricular end diastolic diameter（LVEDD）,left ventricular ejection fraction（LVEF）,N terminal brain precursor,electrolyte and heart function of natriuretic peptide NYHA classification were measured.Results After6 months of treatment,2 groups of patients＇ cardiac functional and LVEF have improved,heart rate and NT-proBNP level were decreased,and no death patients were recorded.Compared with the control group,the treatment group＇s LVEF was increased（P〈0.05）,heart function,blood pressure,heart rate,NT-proBNP were improved,but the difference was not statistically significant（P〈0.05）,and no abnormal increase of blood potassium levels were found,the treatment group＇ s asymptomatic survival rate was higher than the control group,but the difference did not reach with statistical significance（85.2%vs.69.1%,Log rank x^2 = 1-79,P =0.18）.Conclusion Apart from standard anti heart failure drugs,aldosterone receptor antagonist give benefit to NYHA class II PPCM whose heart failure are relative steady.Aldosterone receptor antagonist enhanced cardiac systolic function,decreased onset of heart failure and do not bring serum potassium abnormal.

关 键 词：心肌病 围生期 醛固酮受体拮抗剂 心力衰竭 

分 类 号：R714.7[医药卫生—妇产科学]