摘要
目的观察心脉隆注射液对老年2型心肾综合征(cardio renal syndrome,CRS)患者心肾功能及血清对氧磷酶1(paraoxonase l,PON1)、超氧化物歧化酶(supero xide dismutase,SOD)、丙二醛(malondial dehyde,MDA)的影响,评价心脉隆注射液对老年2型CRS的疗效及安全性,探讨心脉隆注射液治疗老年2型CRS的机制。方法收集老年2型CRS患者98例,随机分为对照组(49例)和心脉隆组(49例)。对照组按照现行指南给予抗心衰、保肾治疗,心脉隆组在对照组相同治疗方案基础上加用心脉隆注射液,5 mg/kg,日二次静点,疗程15 d。2组分别于治疗前及治疗15 d测定血尿素氮(BUN)、血清胱抑素C(CysC)、肾小球滤过率(eGFR)、N末端脑钠肽前体(NT proBNP)、PON1、SOD、MDA,超声心动图测定左心室射血分数(EF);采用pearson相关分析,分析PON1、SOD、MDA分别与NT proBNP、EF、CysC、eGFR的关系;记录治疗前后2组患者临床症状、体征、心功能分级(NYHA)及治疗期间的不良反应。结果治疗15 d后2组EF较治疗前均升高(P<0.05),CysC、NT proBNP较治疗前均降低(P<0.05),其中心脉隆组上述指标的变化较对照组更明显(P<0.05);心脉隆组治疗后eGFR高于治疗前及同期对照组(P<0.05);治疗15 d后两组PON1、SOD较治疗前升高(P<0.05),MDA较治疗前下降(P<0.05),心脉隆组上述指标的变化较同期对照组更明显(P<0.05);心脉隆组临床总有效率明显高于对照组(95.92%vs 89.80%,P<0.05);pearson相关性分析表明,PON1、SOD分别与eGFR、EF正相关(P<0.05),与CysC、NT proBNP呈负相关(P<0.05);MDA与eGFR、EF呈负相关(P<0.05),与CysC、NT proBNP呈正相关(P<0.05);治疗期间2组均无不良反应发生。结论血清PON1、SOD、MDA水平与老年2型CRS患者心肾功能相关,可用于老年2型CRS病情监测;在常规西药治疗基础上加用心脉隆注射液,对老年2型CRS患者的心肾功能有较明显的改善作用,疗效确切,安全性好,其机制可能与心脉隆注射液能减轻老年2型CRS机体氧化应激反应有关。
Objective To observe the effects of Xinmailong injection on heart and kidney function and serum paraoxonase 1(PON1),superoxide dismutase(SOD)and malondialdehyde(MDA)in elderly patients with type 2 cardio renal syndrome(CRS),to evaluate the efficacy and safty of Xinmailong injection,and to explore its mechanism in the treatment of elderly type 2 CRS.Methods Ninety eight elderly patients with type 2 CRS were randomly divided into control group(49 cases)and Xinmailong group(49 cases).The control group was given anti heart failure and kidney reinforcing treatment according to the guidelines.The Xinmailong group was given addi tional Xinmailong injection(5 mg/kg,twice daily for 15 days).Serum cystatin C(CysC),urea nitrogen(BUN),estimated glomerular filtration rate(eGFR),N terminal pro brain natriuretic peptide(NT proBNP),PON1,SOD and MDA were detected and left ventricular ejection fraction(EF)was measured by ultrasound.The relationship between PON1,SOD,and MDA and NT proBNP,EF,CysC and eGFR were analyzed by pearson correlation anal ysis.Clinical symptoms,signs,cardiac function grading and adverse reactions during the treatment of the two groups were recorded before and after the treatment.Results After the treatment,EF in the two groups were higher(P<0.05)but CysC and NT proBNP lower(P<0.05)and the changes in Xinmailong group were more significant than those in the control group(P<0.05).The eGFR in Xinmailong group was higher than that before the treatment and in the control group(P<0.05);PON1 and SOD in the two groups were higher than those before the treatment(P<0.05)but MDA was lower(P<0.05),and the changes in Xinmaillong group were more obvious than those in the control group(P<0.05).The total clinical effective rate of Xinmailong group was significantly higher than that of the control group(P<0.05).Correlation analysis showed that PON1 and SOD were positively correlated with eGFR and EF but negatively with CysC,and NT proBNP(P<0.05);and MDA was negatively correlated with eGFR and EF but positively with CysC,and NT proBNP(P<0.05).No adverse reactions occurred in the two groups.Conclusion The levels of serum PON1,SOD and MDA are related to the heart and kidney function of elderly patients with type 2 CRS and can be used for the monitoring of type 2 CRS in elderly patients.Xinmailong injection combined with conventional western medicines has obvious improvement effect on heart and kidney func tion in elderly type 2 CRS patients and the curative effect is clear and it is safe.The mechanism may be related to the effect of Xinmailong injection on reducing oxidative stress in elderly type 2 CRS.
作者
邵伟华
姚丽霞
王素星
吕彩霞
王娜
李绍冰
SHAO Weihua;YAO Lixia;WANG Suxing;LV Caixia;WANG Na;LI Shaobing(The Second Depart ment of Geriatrics,Hebei General Hospital,Shijiazhuang 050051,China)
出处
《实用医学杂志》
CAS
北大核心
2019年第20期3218-3222,共5页
The Journal of Practical Medicine
基金
河北省中医药管理局科研计划项目(编号：2018074)
关键词
老年
2型CRS
心脉隆注射液
PON1
氧化应激
elderly
type 2 cardio renal syndrome
Xinmailong injection
PON1
oxidative stress
作者简介
通信作者:李绍冰,E mail:taiyang8182@163.com。
