Abstract:

Objective　To observe the effect of Levosimendan on myocardial function and disease progression in patients with chronic heart failure (CHF). Methods　This study was a randomized controlled trial. A total of 125 CHF patients admitted to Zhengzhou Seventh People's Hospital from May 2020 to March 2023 were selected and were divided into a conventional group (62 cases) and a combined group (63 cases) by the computer grouping method. In the conventional group, there were 30 males and 32 females, the age was 52-78 (65.44±5.18) years old, the course of CHF was 3-7 (5.25±1.33) years, the cardiac function classification was grade II in 33 cases and grade III in 29 cases, and the complications included hypertension in 35 cases and diabetes in 27 cases. There were 33 males and 30 females in the combined group, the age was 50-80 (65.75±5.33) years old, the course of CHF was 4-6 (5.31±1.28) years, the cardiac function classification was grade II in 32 cases and grade III in 31 cases, and the complications included hypertension in 38 cases and diabetes in 25 cases. The conventional group was treated with conventional medicine, and the combined group was treated with Levosimendan via intravenous injection combined with conventional medicine for 15 d. The changes in myocardial function [soluble growth stimulator expression gene 2 protein (sST2) and growth differentiation factor 15 (GDF-15)], myocardial fibrosis indicators [connective tissue growth factor (CTGF), laminin (LN), and hyaluronic acid (HA)], and cardiac function indexes [left ventricular ejection fraction (LVEF), stroke output (SV), and cardiac output (CO)] before and after treatment, as well as occurrence of adverse cardiovascular events within 3 months after treatment and medication safety were compared between the two groups. Independent sample t test, paired t test, and χ² test were used. Results　After treatment, the levels of sST2 [(86.24±10.35) μg/L] and GDF-15 [(814.36±50.25) ng/L] in the combined group were lower than those in the conventional group [(92.37±10.41) μg/L and (841.72±50.47) ng/L](both P<0.05), the levels of CTGF [(1.04±0.52) μg/L], LN [(103.52±10.32) μg/L], and HA [(95.15±10.36) μg/L] in the combined group were lower than those in the conventional group [(1.77±0.36) μg/L, (110.75±10.25) μg/L, and (102.77±10.65) μg/L](all P<0.05), and the levels of LVEF [(55.41±10.28)%], SV [(58.72±10.45) ml], and CO [(4.52±1.36) L/min] in the combined group were higher than those in the conventional group [(49.14±10.33)%, (52.33±10.06) ml, and (3.77±0.82) L/min] (all P<0.05). The total incidence of adverse cardiovascular events in the combined group [4.76% (3/63)] was lower than that in the conventional group [16.13% (10/62)] (P<0.05). There was no statistically significant difference in the total incidence of drug-related adverse reactions between the two groups (P>0.05). Conclusions　Levosimendan can effectively improve the myocardial function of CHF patients and delay the course of myocardial fibrosis. It has positive significance in promoting the patients' cardiac function recovery and reducing the risk of cardiovascular adverse events. Moreover, this drug has high safety and does not significantly increase the risk of drug-related adverse reactions.

Key words:

Chronic heart failure, Levosimendan, Myocardial function, Myocardial fibrosis, Drug safety

摘要：

目的　观察左西孟旦治疗慢性心力衰竭（CHF）对患者心肌功能及病情进展的影响。方法　本研究为随机对照试验，选取2020年5月至2023年3月郑州市第七人民医院收治的CHF患者125例，采用电脑分组法将其分为常规组（62例）和联合组（63例）。常规组男30例，女32例；年龄52～78（65.44±5.18）岁；CHF病程3～7（5.25±1.33）年；心功能分级：Ⅱ级33例，Ⅲ级29例；合并症：35例合并高血压，27例合并糖尿病；采用常规药物治疗。联合组男33例，女30例；年龄50～80（65.75±5.33）岁；CHF病程4～6（5.31±1.28）年；心功能分级：Ⅱ级32例，Ⅲ级31例；合并症：38例合并高血压，25例合并糖尿病；采用左西孟旦（静脉注射）配合常规治疗。两组均治疗15 d。比较两组患者治疗前和治疗15 d后的心肌功能［可溶性生长刺激表达基因2蛋白（sST2）、生长分化因子15（GDF-15）］、心肌纤维化指标［结缔组织生长因子（CTGF）、层黏连蛋白（LN）、透明质酸（HA）］、心功能指标［左心室射血分数（LVEF）、每搏输出量（SV）、心排血量（CO）］变化情况，治疗后3个月的心血管不良事件发生情况及用药安全性。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，联合组sST2［（86.24±10.35）μg/L］和GDF-15［（814.36±50.25）ng/L］均低于常规组［（92.37±10.41）μg/L、（841.72±50.47）ng/L］（均P<0.05）；联合组CTGF［（1.04±0.52）μg/L］、LN［（103.52±10.32）μg/L］和HA［（95.15±10.36）μg/L］均低于常规组［（1.77±0.36）μg/L、（110.75±10.25）μg/L、（102.77±10.65）μg/L］（均P<0.05）；联合组LVEF［（55.41±10.28）%］、SV［（58.72±10.45）ml］和CO［（4.52±1.36）L/min］均高于常规组［（49.14±10.33）%、（52.33±10.06）ml、（3.77±0.82）L/min］（均P<0.05）；联合组的心血管不良事件总发生率［4.76%（3/63）］低于常规组［16.13%（10/62）］（P<0.05）；两组药物相关不良反应总发生率比较，差异无统计学意义（P>0.05）。结论　左西孟旦可有效改善CHF患者心肌功能并延缓心肌纤维化病程，在改善患者心功能的同时，可一定程度上降低心血管不良事件发生风险；且此药安全性较高，未明显增加患者用药后的相关不良反应发生风险。

关键词:

慢性心力衰竭, 左西孟旦, 心肌功能, 心肌纤维化, 用药安全性