Abstract:

Objective　To explore the impact of levosimendan combined with cyclic adenosine monophosphate (cAMP) on the ventricular remodeling and levels of serum cardiac troponin I (TnI) and transient receptor potential channel 1 (TRPC1) in elderly patients with acute left heart failure. Methods　Ninety-six elderly patients diagnosed with acute left heart failure in Hancheng People's Hospital from June 2022 to November 2023 were selected and were divided into an observation group and a control group by the envelope method with 48 patients in each group, in a prospective study. In the observation group, there were 25 males and 23 females; the age was (76.97±5.23) years old; the body mass index was (25.35±2.79) kg/m²; the cardiac function classification was grade III in 30 cases and grade IV in 18 cases. In the control group, there were 26 males and 22 females; the age was (77.41±5.16) years old; the body mass index was (25.14±2.62) kg/m²; the cardiac function classification was grade III in 31 cases and grade IV in 17 cases. Both groups received conventional interventions such as diuretics, cardiotonics, and vasodilators. The control group was treated with intravenous drip with cAMP, and the observation group received intravenous drip with levosimendan and cAMP for a treatment period of 7 days. The clinical efficacy, ventricular remodeling indexes [interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT), and left ventricular mass index (LVMI)], cardiac reserve function indexes [left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVESD), and left ventricular end-diastolic diameter (LVEDD)], serum TnI and TRPC1 levels, and incidence of adverse reactions were compared between the two groups. Independent sample t test, paired sample t test, and χ² test were used. Results　After treatment, the total effective rate of the observation group [91.67% (44/48)] was higher than that of the control group [75.00% (36/48)] (P<0.05). After treatment, the ventricular remodeling indexes in the observation group were better than those in the control group [IVST: (7.45±0.82) mm vs. (9.04±1.11) mm, LVPWT: (8.09±0.84) mm vs. (8.89±1.07) mm, LVMI: (112.67±15.12) g/m² vs. (120.21±16.83) g/m²] (all P<0.05). After treatment, the LVEF of the observation group was higher than that of the control group [(56.32±6.01)% vs. (51.78±5.90)%], but the LVESD and LVEDD were lower than those of the control group [(50.27±5.98) mm vs. (59.46±6.24) mm, (53.92±7.47) mm vs. (62.85±7.22) mm] (all P<0.05). After treatment, the serum TnI and TRPC1 levels in the observation group were lower than those in the control group [(0.34±0.06) μg/L vs. (0.46±5.90) μg/L, (8.25±1.62) ng/L vs. (13.27±2.07) ng/L] (both P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the observation group [16.67% (8/48)] and the control group [14.58% (7/48)] (P>0.05). Conclusion　Levosimendan combined with cAMP effectively improves the ventricular remodeling, enhances the cardiac function, and reduces the serum levels of TnI and TRPC1 in elderly patients with acute left heart failure, benefiting the recovery treatment of left heart failure patients.

Key words:

Levosimendan, Cyclic adenosine monophosphate, Elderly, Acute left heart failure, Ventricular remodeling, TnI, TRPC1

摘要：

目的　探讨左西孟旦联合环磷腺苷对老年急性左心衰竭患者心室重构及血清肌钙蛋白I（TnI）和瞬时受体电位通道1（TRPC1）水平的影响。方法　选取2022年6月到2023年11月在韩城市人民医院诊治的老年急性左心衰竭患者96例，采用信封法分为观察组和对照组，每组48例，进行前瞻性研究。观察组男25例，女23例；年龄（76.97±5.23）岁；体质量指数（25.35±2.79）kg/m²；心功能分级：Ⅲ级30例，Ⅳ级18例。对照组男26例，女22例；年龄（77.41±5.16）岁；体质量指数（25.14±2.62）kg/m²；心功能分级：Ⅲ级31例，Ⅳ级17例。两组均给予利尿、强心、扩张血管等常规干预；对照组给予环磷腺苷治疗，观察组给予左西孟旦联合环磷腺苷治疗，两组均为静脉滴注给药，治疗周期均为7 d。比较两组临床疗效、心室重构指标［室间隔厚度（IVST）、左室后壁厚度（LVPWT）、左心室质量指数（LVMI）］、心脏储备功能指标［左心室射血分数（LVEF）、左心室收缩末期内径（LVESD）、左心室舒张末期内径（LVEDD）］、血清TnI和TRPC1水平及不良反应发生情况。采用独立样本t检验、配对样本t检验和χ²检验。结果　治疗后，观察组的总有效率［91.67%（44/48）］高于对照组［75.00%（36/48）］（P<0.05）。治疗后，观察组心室重构指标均优于对照组［IVST：（7.45±0.82）mm比（9.04±1.11）mm、LVPWT：（8.09±0.84）mm比（8.89±1.07）mm、LVMI：（112.67±15.12）g/m²比（120.21±16.83）g/m²］（均P<0.05）。治疗后，观察组患者的LVEF高于对照组［（56.32±6.01）%比（51.78±5.90）%］，LVESD、LVEDD均低于对照组［（50.27±5.98）mm比（59.46±6.24）mm、（53.92±7.47）mm比（62.85±7.22）mm］（均P<0.05）。治疗后，观察组血清TnI和TRPC1水平均低于对照组［（0.34±0.06）μg/L比（0.46±5.90）μg/L、（8.25±1.62）ng/L比（13.27±2.07）ng/L］（均P<0.05）。观察组在治疗期间总不良反应发生率［16.67%（8/48）］与对照组［14.58%（7/48）］比较，差异无统计学意义（P>0.05）。结论　左西孟旦联合环磷腺苷能有效改善老年急性左心衰竭患者的心室重构，提高心脏功能，降低血清TnI和TRPC1水平，有利于左心衰竭患者的康复治疗。

关键词:

左西孟旦, 环磷腺苷, 老年, 急性左心衰竭, 心室重构, 肌钙蛋白I, 瞬时受体电位通道1