单硝酸异山梨酯联合培哚普利叔丁胺治疗老年慢性心力衰竭患者的疗效

doi:10.3760/cma.j.issn.1007-1245.2023.09.021

摘要/Abstract

摘要：

目的　分析老年慢性心力衰竭患者行单硝酸异山梨酯联合培哚普利叔丁胺治疗的近期疗效及对血清生长分化因子-15（GDF-15）、可溶性生长刺激表达基因2蛋白（sST2）水平的影响。方法　本研究为随机对照试验，选取2019年2月至2021年1月聊城市第三人民医院收治的老年慢性心力衰竭患者120例为研究对象，采用随机数字表法分为两组，各60例。对照组男35例、女25例，年龄（70.96±3.85）岁；观察组男38例、女22例，年龄（71.55±4.03）岁。两组入院后均给予常规治疗，对照组患者晨起饭前口服培哚普利叔丁胺治疗，观察组在其基础上加用口服单硝酸异山梨酯治疗，两组均连续治疗1个月。对比两组临床疗效、治疗前后心功能、血清心力衰竭标志物水平［N末端脑钠肽前体（NT-proBNP）、血液胰岛素生长因子-1（IGF-1）、肌钙蛋白T（cTnT）、GDF-15、sST2］及治疗期间不良反应。采用χ²检验、t检验。结果　观察组临床总有效率为85.00%（51/60），高于对照组70.00%（42/60），差异有统计学意义（χ²=3.871，P=0.049）。治疗后，观察组左心室收缩末期内径（LVESD）［（42.55±5.31）mm］、左心室舒张末期内径（LVEDD）［（46.78±8.10）mm］、NT-proBNP ［（274.20±102.11）ng/L］、cTnT ［（76.21±9.28）ng/L］、GDF-15 ［（554.87±23.54）ng/L］、sST2指标［（8.28±2.47）μg/L］均低于对照组［（51.69±4.27）mm、（54.63±8.14）mm、（824.33±412.74）ng/L、（85.77±10.58）ng/L、（845.98±20.14）ng/L、（45.14±6.22）μg/L］，左心室射血分数（LVEF）［（59.78±5.01）%］、每分心输出量（CO）［（5.57±0.68）L/min］、每搏心输出量（SV）［（70.81±6.51）ml］、IGF-1指标［（119.87±20.98）μg/L］均高于对照组［（47.63±6.15）%、（5.09±0.64）L/min、（65.76±6.83）ml、（110.47±23.58）μg/L］，差异均有统计学意义（均P<0.05）。两组治疗期间不良反应发生率比较，差异无统计学意义（χ²=0.120，P=0.729）。结论　单硝酸异山梨酯联合培哚普利叔丁胺治疗老年慢性心力衰竭可改善患者临床症状、体征及心功能，调节患者血清生物标志物水平，安全性有保障。

关键词:

慢性心力衰竭, 单硝酸异山梨酯, 培哚普利叔丁胺, 心功能, 近期疗效

Abstract:

Objective　To analyze the short-term efficacy of isosorbide mononitrate combined with perindopril tert-butylamine in the treatment of elderly patients with chronic heart failure and its effects on serum levels of growth differentiation factor-15 (GDF-15) and soluble growth stimulation-expressed gene 2 protein (sST2). Methods　It was a randomized controlled trial. A total of 120 elderly patients with chronic heart failure admitted to The Third People's Hospital of Liaocheng from February 2019 to January 2021 were divided into two groups by the random number table method, with 60 cases in each group. In the control group, there were 35 males and 25 females, aged (70.96±3.85) years. In the observation group, there were 38 males and 22 females, aged (71.55±4.03) years. After admission, both groups were given routine treatment. The control group received oral perindopril tert-butylamine treatment before meals in the morning, and the observation group was additionally given oral isosorbide mononitrate treatment on this basis. Both groups received continuous treatment for 1 month. The clinical efficacies, cardiac function and serum markers of heart failure [N-terminal precursor brain natriuretic peptide (NT-proBNP), blood insulin growth faction-1 (IGF-1), troponin T (cTnT), GDF-15, and sST2] before and after treatment, and adverse reactions during treatment were compared between the two groups. χ² test and t test were used. Results　The total effective rate of the observation group was 85.00% (51/60), and that of the control group was 70.00% (42/60), with a statistically significant difference between the two groups (χ²=3.871, P=0.049). After treatment, the left ventricular end-systolic diameter (LVESD) [(42.55±5.31) mm], left ventricular end-diastolic diameter (LVEDD) [(46.78±8.10) mm], NT-proBNP [(274.20±102.11) ng/L], cTnT [(76.21±9.28) ng/L], GDF-15 [(554.87±23.54) ng/L], sST2 [(8.28±2.47) μg/L] in the observation group were lower than those in the control group [(51.69±4.27) mm, (54.63±8.14) mm, (824.33±412.74) ng/L, (85.77±10.58) ng/L, ( 845.98±20.14) ng/L, and (45.14±6.22) μg/L], and the left ventricular ejection fraction (LVEF) [(59.78±5.01) %], cardiac output (CO) [(5.57±0.68) L/min], stroke output (SV) [(70.81±6.51) ml], and IGF-1 [(119.87±20.98) μg/L] were all higher than those in the control group [(47.63±6.15) %, (5.09±0.64) L/min, (65.76±6.83) ml, and (110.47±23.58) μg/L], with statistically significant differences (all P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (χ²=0.120, P=0.729). Conclusion　Isosorbide mononitrate combined with perindopril tert-butylamine in the treatment of elderly patients with chronic heart failure can better improve their clinical symptoms and signs, promote the improvement of cardiac function, and regulate their serum biomarker levels, which is responsive and safe.

Key words:

Chronic heart failure, Isosorbide mononitrate, Perindopril tert-butylamine, Cardiac function, Short-term efficacy

窦东锋刘洪光张丽芬.

单硝酸异山梨酯联合培哚普利叔丁胺治疗老年慢性心力衰竭患者的疗效 [J]. 国际医药卫生导报, 2023, 29(9): 1276-1280.

Dou Dongfeng, Liu Hongguang, Zhang Lifen.

Efficacy of isosorbide mononitrate combined with perindopril tert-butylamine in the treatment of elderly patients with chronic heart failure [J]. International Medicine and Health Guidance News, 2023, 29(9): 1276-1280.

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