左西孟旦联合尼可地尔治疗老年缺血性心肌病患者的临床研究  

Clinical trial on levosimendan combined with nicorandil in the treatment of ischemic cardiomyopathy in the elderly

作　　者：吴维玲 陈小彪 张国平 叶飞飞 WU Wei-ling;CHEN Xiao-biao;ZHANG Guo-ping;YE Fei-fei(Pharmaceutica Department,Shaowu Municipal Hospital,Nanping 354000,Fujian Province,China;Laboratory Department,Shaowu Municipal Hospital,Nanping 354000,Fujian Province,China;Cardiovascular Medicine,Shaowu Municipal Hospital,Nanping354000,Fujian Province,China)

机构地区：[1]邵武市立医院药剂科,福建南平354000 [2]邵武市立医院检验科,福建南平354000 [3]邵武市立医院心血管内科,福建南平354000

出　　处：《中国临床药理学杂志》2024年第22期3229-3233,共5页The Chinese Journal of Clinical Pharmacology

摘　　要：目的探究左西孟旦联合尼可地尔治疗老年缺血性心肌病(ICM)患者的应用效果。方法将老年ICM患者按照队列法分为对照组与试验组。对照组给予滴注12μg·kg^(-1)左西孟旦注射液,7 d后重复治疗1次;试验组在此基础上给予口服尼可地尔片,每次5 mg,tid。2组患者均治疗3个月。比较2组患者的临床疗效,比较治疗前后心室重构指标[左心室后壁厚度(LVPWT)、左心室后壁收缩末期厚度(PWS)、心室间隔收缩末期厚度(IVSS)、左心室心肌质量指数(LVMI)]、心功能指标[左心室射血分数(LVEF)、收缩末期内径(LVESD)、舒张末期内径(LVEDD)]、心肌损伤指标[肌钙蛋白(cTnⅠ)、N末端前脑钠肽(NT-proBNP)]、内分泌激素[血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)],并进行安全性评价。结果试验组与对照组分别入组52和46例。治疗3个月后,试验组和对照组的总有效率分别为92.31%(48例/52例)和78.26%(36例/46例),在统计学上差异有统计学意义(P<0.05)。治疗3个月后,试验组和对照组LVPWT分别为(8.17±2.25)和(9.33±2.84)mm,PWS分别为(10.14±2.29)和(11.32±2.90)mm,IVSS分别为(11.19±1.74)和(12.04±1.85)mm,LVMI分别为(1.93±0.21)和(2.06±0.28)mg·g^(-1),LVEF分别为(52.74±8.67)%和(49.30±7.59)%,LVESD分别为(43.87±5.74)和(46.66±6.48)mm,LVEDD分别为(51.40±8.61)和(55.25±9.58)mm,cTnⅠ分别为(0.25±0.03)和(0.36±0.08)μg·L^(-1),NT-proBNP分别为(384.58±36.06)和(401.25±42.83)ng·L^(-1),AngⅡ分别为(56.37±10.03)和(63.25±12.46)ng·L^(-1),ALD分别为(50.87±13.08)和(58.36±16.54)ng·L^(-1)。试验组的上述指标与对照组比较,在统计学上差异均有统计学意义(均P<0.05)。试验组与对照组总药物不良反应发生率分别为7.69%(4例/52例)和4.35%(2例/46例),在统计学上差异无统计学意义(P>0.05)。结论左西孟旦注射液联合尼可地尔片治疗能抑制老年ICM患者心室重构与心肌损伤,同时有助于改善患者心功能与内分泌激素,且安全性�Objective To investigate theapplication neffectof levosimendan combined with nicorandil in the treatment of elderly patients with ischemic cardiomyopathy(ICM).Methods Elderly patients with ICM were divided into the control group and the treatment group by cohort method.The control group was treated with levosimendan at 12μg·kg^(-1).7 d later,and the treatment was carried out once again.On this basis,the treatment group was given oral administration of nicorandil,5 mg per dose,tid.Patients in two groups were treated for 3 months.The two groups were compared in terms of clinical efficacy,ventricular remodeling indicators[left ventricular posterior wall thickness(LVPWT),posterior wall end systolic thickness(PWS),interventricular septum thickness in systole(IVSS)and left ventricular mass index(LVMI)],cardiac function indicators[left ventricular ejection fraction(LVEF),left ventricular end systolic diameter(LVESD)and left ventricular end diastolic diameter(LVEDD)],myocardial injury markers[cardiac troponinⅠ(cTnⅠ)and N-terminal pro-brain natriuretic peptide(NT-proBNP)],and endocrine hormones[angiotensinⅡ(AngⅡ)and aldosterone(ALD)].Safety was evaluated.Results There were 52 cases and 46 cases in the treatment group and the control group,respectively.After 3 months of treatment,the effective rates in the treatment group and the control group were 92.31%(48 cases/52 cases)and 78.26%(36 cases/46 cases),the difference was statistically significant(P<0.05).After 3 months of treatment,LVPWT in the treatment group and the control group were(8.17±2.25)and(9.33±2.84)mm;PWS were(10.14±2.29)and(11.32±2.90)mm;IVSS were(11.19±1.74)and(12.04±1.85)mm;LVMI were(1.93±0.21)and(2.06±0.28)mg:g^(-1);LVEF were(52.74±8.67)%and(49.30±7.59)%;LVESD were(43.87±5.74)and(46.66±6.48)mm;LVEDD were(51.40±8.61)and(55.25±9.58)mm;cTnⅠlevels were(0.25±0.03)and(0.36±0.08)μg·L^(-1);NT-proBNP levels were(384.58±36.06)and(401.25±42.83)ng·L^(-1),AngⅡlevels were(56.37±10.03)and(63.25±12.46)ng·L^(-1);ALD levels were(50.87±1

关 键 词：左西孟旦注射液 尼可地尔片 缺血性心肌病 老年患者 心室重构 肌钙蛋白 N末端前脑钠肽 

分 类 号：R97[医药卫生—药品]