摘要
目的 探讨尼可地尔联合左卡尼汀对缺血性心力衰竭(IHF)患者心室重构、心肌纤维化及血管新生的影响。方法选取自2019年5月至2021年5月于衡水市第二人民医院接受治疗的90例IHF患者为研究对象,采用随机数字表法分为A组(n=45)与B组(n=45)。A组给予尼可地尔治疗,B组在A组治疗基础上给予左卡尼汀静脉滴注。两组患者均连续治疗3个月,评估两组患者治疗后临床疗效。记录并比较两组患者治疗前、治疗后的左心室重构指标[左心室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室收缩内径(LVESD)、左室质量指数(LVMI)、N末端B型脑钠肽(NTproBNP)]、明尼苏达心力衰竭生活质量调查表(MLHFQ)评分、6 min步行试验(6MWT)、心肌纤维化指标[转化生长因子-β1(TGF-β1)、Ⅲ型前胶原(PCⅢ)、透明质酸(HA)]、血管再生相关指标[血管内皮生长因子(VEGF)、缺氧诱导因子-1α(HIF-1α)]。结果 B组总有效率为93.3%(42/45),显著高于A组的77.8%(35/45),差异有统计学意义(P<0.05)。治疗后,两组LVEF明显高于治疗前,且B组高于A组;两组LVEDD、LVESD、LVMI、NT-proBNP低于治疗前,且B组低于A组,差异均有统计学意义(P<0.05)。治疗后,两组MLHFQ评分较治疗前降低,且B组低于A组;两组6MWT较治疗前增加,且B组长于A组,差异均有统计学意义(P<0.05)。治疗后,两组血清TGF-β1、PCⅢ、HA水平均低于治疗前,且B组低于A组,差异有统计学意义(P<0.05)。治疗后,两组血清VEGF、HIF-1α水平均高于治疗前,且B组高于A组,差异有统计学意义(P<0.05)。结论 尼可地尔联合左卡尼汀治疗可能通过改善心肌纤维化、促进心肌血管新生来改善患者心室重构,缓解临床症状,提高生活质量。
Objective To investigate the effect of nicorandil combined with levocarnitine on ventricular remodeling,myocardial fibrosis and angiogenesis in patients with ischemic heart failure(IHF).Methods A total of 90 patients with IHF admitted to the Second People’s Hospital of Hengshui from May 2019 to May 2021 were randomly divided into group A(n=45)and group B(n=45).The patients in the group A were treated with nicorandil,and the patients in the group B were treated with levocarnitine intravenous drip on the basis of the group A.The patients in both groups were continuously treated for 3 months,and then the clinical efficacy of the two groups was evaluated.The left ventricular remodeling indexes[left ventricular ejection fraction(LVEF),left ventricular enddiastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),left ventricular mass index(LVMI),N-terminal B-type natriuretic peptide(NT-proBNP)],Minnesota Living with Heart Failure Questionnaire(MLHFQ)score,6-minute walk test(6MWT),myocardial fibrosis indexes[transforming growth factorβ1(TGF-β1),typeⅢprocollagen(PCⅢ),hyaluronic acid(HA)],vascular regeneration related indexes[vascular endothelial growth factor(VEGF),hypoxia-inducible factor-1α(HIF-1α)]were evaluated before and after the treatment,and the differences between the two groups were compared.Results The total effective rate of the group B[93.3%(42/45)]was statistically higher than that of the group A[77.8%(35/45),P<0.05].After the treatment,the level of LVEF in both groups was significantly higher than before the treatment,and the level of LVEF in group B were significantly higher than that in group A(P<0.05).After the treatment,the levels of LVEDD,LVESD,LVMI and NT-proBNP in both groups were significantly lower than before the treatment,and the level of LVEF in group B were significantly lower than those in group A(P<0.05).After the treatment,mLHFQ score in both groups was significantly lower than before the treatment,and mLHFQ score in group B was significantly lower than that in group A(P<0.05).After the treatment,6MWT in both groups was significantly increased than before the treatment,and 6MWT in group B was significantly longer than that in group A(P<0.05).After the treatment,the serum levels of TGF-β1,PCⅢand HA in both groups were significantly lower than before the treatment,and the serum levels of TGF-β1,PCⅢand HA in group B were significantly lower than those in group A(P<0.05).After the treatment,the serum levels of VEGF,HIF-1αin both groups were significantly higher than before the treatment,and the serum levels of VEGF,HIF-1αin group B were significantly higher than those in group A(P<0.05).Conclusion Nicorandil combined with levocarnitine can improve ventricular remodeling,relieve clinical symptoms and improve quality of life by improving myocardial fibrosis and promoting myocardial angiogenesis.
作者
王文娟
闫彩影
王晶
韩立
刘琳琳
隋世华
WANG Wen-juan;YAN Cai-ying;WANG Jing;HAN Li;LIU Lin-lin;SUI Shi-hua(Department of Pharmacy,the Second People's Hospital of Hengshui,Hengshui 053000,China)
出处
《创伤与急危重病医学》
2022年第4期272-277,共6页
Trauma and Critical Care Medicine
基金
河北省卫生健康委医学科学研究计划项目(J2020RD2110)。
关键词
缺血性心力衰竭
尼可地尔
左卡尼汀
心室重构
心肌纤维化
血管新生
Ischemic heart failure
Nicorandil
Levocarnitine
Ventricular remodeling
Myocardial fibrosis
Angiogenesis
作者简介
第一作者:王文娟(1971-),女,河北衡水人,副主任药师。
