重组人脑利钠肽和螺内酯联合治疗对缺血性心肌病心力衰竭患者心功能及心肌损伤指标的影响  

Effect of combined treatment with recombinant human brain natriuretic peptide and spironolactone on cardiac function and myocardial injury indexes in patients with ischemic cardiomyopathy and heart failure

作　　者：赵云飞 闫晓蕾 谢飞 梁善福 朱占占 张薇 张申伟 ZHAO Yunfei;YAN Xiaolei;XIE Fei;LIANG Shanfu;ZHU Zhanzhan;ZHANG Wei;ZHANG Shenwei(Department of Cardiovascular Medicine,the Seventh People’s Hospital of Zhengzhou,Zhengzhou Henan 450016,China)

机构地区：[1]郑州市第七人民医院心血管内科,河南郑州450016

出　　处：《实用心电与临床诊疗》2025年第1期76-79,共4页PRACTICAL ELECTROCARDIOLOGY AND CLINICAL TREATMENT

摘　　要：目的探究重组人脑利钠肽(recombinant human brain natriuretic peptide,rh-BNP)和螺内酯联合治疗缺血性心肌病心力衰竭(简称心衰)患者对心功能及心肌损伤指标的影响。方法选取缺血性心肌病心衰患者106例,按照随机数字表法分为螺内酯组(n=53,选择螺内酯片口服)和联合用药组(n=53,采用rh-BNP+螺内酯片治疗),两组均持续治疗14 d。对比两组临床疗效及治疗前后的心功能、心肌损伤指标、运动耐力、生活质量和不良反应发生率。结果治疗后,联合用药组总有效率明显高于螺内酯组(94.34%vs.81.13%;χ^(2)=4.296,P<0.05)。联合用药组的左心室射血分数(LVEF)和生活质量评分明显高于螺内酯组,而左心室舒张末期内径(left ventricular end-diastolic diameter,LVEDD)、左心室收缩末期内径(left ventricular end-systolic diameter,LVESD)明显低于螺内酯组(P<0.05);心肌肌钙蛋白I(cTn I)、乳酸脱氢酶(lactate dehydrogenase,LDH)、NT-proBNP水平均明显低于螺内酯组(均P<0.05);6 min步行试验距离长于螺内酯组(P<0.05)。两组不良反应发生率间的差异无统计学意义(P>0.05)。结论在缺血性心肌病心衰中,相较于单纯的螺内酯治疗,rh-BNP联合螺内酯疗效更显著,对心功能、运动耐力以及生活质量的改善作用明显提升。Objective To investigate the efficacy of recombinant human brain natriuretic peptide(rh-BNP)and spironolactone on cardiac function and myocardial injury indexes in patients with ischemic cardiomyopathy and heart failure.Methods A total of 106 patients with ischemic cardiomyopathy and heart failure were selected,and divided into spironolactone group(n=53,spironolactone tablets taken orally)and combination medication group(n=53,rh-BNP+spironolactone tablets)in the random number table method.Both groups were treated continuously for 14 days.The clinical efficacy,and the incidence of adverse reactions were compared between the two groups,as well as cardiac function,myocardial injury indexes,exercise tolerance,and quality of life before and after the treatment.Results After treatment,the overall effectiveness rate of the combination medication group was significantly higher than that of the spironolactone group(94.34%vs.81.13%;χ^(2)=4.296,P<0.05).Left ventricular ejection fraction(LVEF)and quality of life score of the combination medication group were significantly higher than those of the spironolactone group,while left ventricular end-diastolic diameter(LVEDD)and left ventricular end-systolic diameter(LVESD)were significantly lower than those of the spironolactone group(P<0.05).The cardiac troponin I(cTn I),lactate dehydrogenase(LDH)and NT-proBNP levels in the combination medication group were all significantly lower than those in the spironolactone group(all P<0.05),while the 6-minute walking test distance was longer than that in the spironolactone group(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Compared with the medication of spironolactone alone,rh-BNP combined with spironolactone has more obvious therapeutic effect on ischemic cardiomyopathy and heart failure,with significant improvement of cardiac function,exercise tolerance and quality of life.

关 键 词：缺血性心肌病 心力衰竭 重组人脑利钠肽 螺内酯 心功能 心肌损伤指标 

分 类 号：R542.2[医药卫生—心血管疾病]