小剂量螺内酯在收缩性心力衰竭治疗中的疗效观察

目的:探讨并比较小剂量螺内酯在依那普利联合倍他乐克基础上治疗收缩性心力衰竭的临床疗效.方法:在采用依那普利及倍他乐克治疗的基础上将60例心功能Ⅲ级或Ⅳ级患者采用双盲法随机分组,给予小剂量螺内酯(治疗组,20 mg/d,n=34)、安慰剂(对照组,n=26),16周后对比观察左心室收缩末期容积、左心室射血分数、胰岛素抵抗指数、血钾平均值的变化,并记录高钾血症的发生率.结果:治疗组患者左心室收缩末期容积、左心室射血分数及胰岛素抵抗指数与治疗前比较有显著改善(P＜0.05～0.01),与对照组治疗后比较存在明显差异(P＜0.05～0.01),心功能改善的有效率治疗组亦明显高于对照组,血钾平均值及高钾血症发生率两组之间比较无明显差异.结论:小剂量螺内酯联合依那普利、倍他乐克治疗收缩性心力衰竭能明显改善收缩性心力衰竭患者的左心室功能及胰岛素抵抗程度,能从生物学调整的角度来改善收缩性心力衰竭.     

曲美他嗪对心力衰竭患者运动耐量的影响

目的分析曲美他嗪对心力衰竭患者运动耐量的影响。方法选取心力衰竭住院患者60例,以随机数字表法分为两组,对照组30例行常规治疗,观察组30例在常规治疗基础上加用曲美他嗪治疗,比较两组患者治疗效果、运动耐量。结果两组治疗总有效率比较差异显著(P0.05)。治疗前两组左室射血分数(LVEF)、6 min步行距离对比无显著差异(P0.05),两组治疗后各指标改善显著(P0.05),且观察组患者治疗后相应指标明显优于对照组(P0.05)。结论常规治疗基础上加用曲美他嗪治疗心力衰竭,患者心脏收缩力可显著提高,且运动耐量显著增强。     

螺内酯对扩张型心肌病心力衰竭患者某些体液因子的影响

目的:探讨螺内酯对扩张型心肌病心力衰竭患者血浆儿茶酚胺、肾素活性、血管紧张素Ⅱ及醛固酮的影响.方法:入选30例扩张型心肌病心力衰竭患者,随机分入螺内酯组与对照组,各15例,用螺内酯治疗前与治疗1个月后,用高效液相色谱法测定血浆去甲肾上腺素、肾上腺素,同时采用均相竞争放射免疫方法检测血浆肾素活性、血管紧张素Ⅱ与醛固酮.结果:治疗1个月后螺内酯组血浆去甲肾上腺素、肾上腺素、肾素活性、血管紧张素Ⅱ及醛固酮明显低于治疗前,也低于对照组治疗后,均有显著性差异(P＜0.05～0.01).结论:螺内酯可明显抑制扩张型心肌病心力衰竭患者的儿茶酚胺水平,降低肾素活性及醛固酮.     

慢性充血性心力衰竭与运动耐量异常

慢性充血性心力衰竭(CHF)病人的生活质量与运动耐量关系密切。运动耐量不仅受心功能影响,骨骼肌的功能状态对其也有重要作用。因此,评价 CHF 的运动耐量应包括心功能和骨骼肌状况两方面的改变。治疗目标上不仅要优化心功能、也应注重肢体骨骼肌功能的改善,以全面提高病人的运动耐量和生活质量。     

长期小剂量螺内酯治疗对收缩功能中间型心力衰竭的临床疗效

目的:研究长期小剂量螺内酯治疗对收缩功能中间型心力衰竭(HFmrEF)的疗效。方法:100例HFmrEF患者被随机均分为常规治疗组(接受慢性心力衰竭标准治疗)和螺内酯组(在常规治疗组基础上加用小剂量螺内酯),两组均治疗随访2年。观察比较两组治疗前后血压、心率(HR)、血脂、空腹血糖(FBG)、血肌酐(SCr)、血钾(K+)、血浆脑钠肽(BNP)、NYHA分级、舒张功能分级和LVEF,治疗1年后的主要不良心血管事件(MACE)和次要终点事件发生率,以及不良反应情况。结果:与治疗前比较,治疗1年后两组SBP、DBP、HR、血浆TC、LDL-C、FBG、BNP水平、NYHA分级和舒张功能分级均显著降低,LVEF和螺内酯组K+水平显著升高,P均<0.01;与常规治疗组比较,治疗1年后螺内酯组HR[(67.6±6.9)次/min比(61.1±5.5)次/min]、血浆LDL-C[(3.5±0.8)mmol/L比(2.8±0.6)mmol/L]、BNP水平[(491.4±295.5)ng/L比(360.5±226.6)ng/L]、NYHA分级[(2.0±0.7)级比(1.4±0.5)级]和舒张功能分级[(2.2±0.7)级比(1.4±0.5)级]降低更显著,K+水平[(4.2±0.7)mmol/L比(4.9±1.4)mmol/L]和LVEF[(46.1±3.8)%比(47.9±4.1)%]升高更显著,P<0.05或<0.01。治疗1年后,螺内酯组MACE发生率(26.0%比86.0%)和心衰住院率(14.0%比66.0%)均显著低于常规治疗组,P均=0.001。结论:在慢性心力衰竭标准治疗基础上施加小剂量螺内酯可显著提高HFmrEF患者的心功能、降低MACE的发生率,从而降低心衰患者后期住院率。     

螺内酯对心力衰竭犬心房颤动的影响

目的探讨螺内酯对心力衰竭犬心房颤动（房颤）的影响及其作用机制。方法21只犬随机分为3组：假手术组（n=7）、起搏组（n=7）和螺内酯组（n=7）。采用心室快速起搏建立心力衰竭犬模型。假手术组植入起搏器后不起搏;起搏组和螺内酯组以220次／min快速起搏心室6周;螺内酯组起搏前1周给予螺内酯至起搏后6周。通过缝置于左、右心房的4对电极测定房颤诱发次数及持续时间,超声心动图测定心房、心室结构和功能变化,Masson染色测定心房胶原容积分数,Westernblot半定量分析心房肌基质金属蛋白酶．9（MMP-9）、转化生长因子-β1（TGF-β1）及血小板衍生生长因子（PDGF）蛋白含量。结果（1）心室快速起搏6周后,起搏组犬房颤诱发率和持续时间显著增加（P〈0．01）,螺内酯组房颤诱发率显著降低、持续时间显著缩短（P〈0．05）。（2）与假手术组相比,起搏组犬左心室最大容积（LVVmax）及左心房最大容积（LAVmax）显著增加（P〈0．01）,左心房射血分数（LAEF）及左心室射血分数（LVEF）显著降低（P〈0．01）,螺内酯组犬LVVmax、LAVmax显著缩小（P〈0．01）,LAEF及LVEF显著升高（P〈0．01）。（3）与假手术组相比,起搏组犬心房胶原容积分数显著升高（P〈0．01）,TGF-β1、PDGF、MMP-9蛋白质表达量显著增加（P〈0．05）;与起搏组相比,螺内酯组胶原容积分数显著降低（P〈0．01）,TGF-β1、PDGF、MMP-9蛋白表达量显著减少（P〈0．01）。结论螺内酯可以减少心力衰竭后房颤的发生,其机制可能与抑制心房肌PDGF、TGF-β1表达有关。     

螺内酯在老年高血压并发舒张性心力衰竭的应用研究

目的 探讨螺内酯在老年高血压并发舒张性心力衰竭中的疗效.方法 选择2009年6月-2011年10月我院心内科住院的高血压合并舒张性心力衰竭患者64例,随机分为观察组和对照组,每组各32例.对照组给予β-受体阻滞剂、血管紧张素转化酶抑制剂、钙拮抗剂、硝酸酯类及他汀类等治疗;观察组在常规治疗基础上加用螺内酯,疗程共6个月.比较两组治疗前后6min步行试验、左房室瓣舒张早期血流最大速度E峰、舒张晚期最大速度A峰以及舒张早期和晚期充盈速度比值(E/A)变化.结果 观察组治疗后E峰、A峰、E/A以及6min步行试验均显著改善(P＜0.05),与对照组比较,差异有统计学意义(P＜0.05).结论 螺内酯可改善老年高血压并发舒张性心力衰竭患者心脏舒张功能,并逆转心室重塑.     

小剂量螺内酯对慢性心力衰竭患者心功能及血浆脑钠素的影响

目的观察小剂量螺内酯对慢性心力衰竭患者心功能及血清脑利钠肽水平的影响。方法选择慢性心力衰竭患者(NYHA心功能分级为Ⅱ级~Ⅲ级)60例,在常规接受洋地黄、利尿剂、血管紧张素转换酶抑制剂类药物治疗基础上,随机分为3组。小剂量螺内酯组20例,在常规治疗基础上每日给予螺内酯20 mg;中剂量螺内酯组20例,在常规治疗基础上每日给予螺内酯40mg。常规治疗组20例,不给予螺内酯治疗,余治疗同前。动态观察心衰患者治疗前及治疗后4个月NYHA分级变化和采用放射免疫法测定血浆脑钠肽(BNP)浓度,并应用心脏彩超测定左室射血分数和左心室舒张末期内径。结果中剂量螺内酯组、小剂量螺内酯组和常规治疗组1个月临床综合疗效分别为90.0%、90.0%和75.0%。螺内脂组与常规组患者治疗4个月后NYHA分级均有所改善,但螺内酯组治疗后改善显著(P<0.05),治疗后小剂量、中剂量螺内酯组患者左室射血分数显著升高(P<0.05),治疗后常规治疗组、小剂量、中剂量螺内酯组血清BNP水平显著下降(P<0.05)。结论小剂量螺内酯能明显改善慢性心力衰竭患者的左室重构及心功能,降低血清脑利钠肽水平。血清脑利钠肽水平可作为评价螺内酯治疗慢性心力衰竭患者疗效评估的指标。     

螺内酯对老年收缩性心力衰竭患者心室重构和安全性研究

目的探讨螺内酯对老年纽约心脏病协会(NYHA)心功能Ⅰ～Ⅱ级收缩性心力衰竭患者心室重构的影响及应用的安全性。方法入选我院2008年12月至2011年6月门诊及住院老年NYHAⅠ～Ⅱ级收缩性心力衰竭[左室射血分数(LVEF)40%,左室舒张末期容积指数(LVEDVI)75ml/m2]患者107例,对照组54例接受常规治疗,螺内酯组53例在常规治疗的基础上接受螺内酯24mg/d,所有患者在入选前及药物应用6月后行超声心动图检查评估LVEDVI、左室收缩末期容积指数(LVESVI)、左室质量指数(LVMI)和LVEF的变化,入选前及治疗后1、2、4周,随后每月监测电解质、肾功能。结果治疗6月后,2组LVEDVI、LVESVI、LVMI和LVEF均较治疗前有明显改善(P均0.05);与对照组相比,螺内酯组改善更为显著(P均0.05)。螺内酯组高钾血症的发生率(9.4%)明显升高,但无严重高钾血症(血钾≥6.0mmol/L)及肾功能衰竭(血肌酐≥353μmol/L)发生。结论在应用ACEI治疗的基础上加用螺内酯治疗可进一步改善老年NYHAⅠ～Ⅱ级收缩性心力衰竭患者的心室重构且在严密监测下是安全的。     

左室舒张性心力衰竭左室舒张功能与运动耐量关系的研究

采用二维、Ｍ型、多普勒超声心动图及活动平板运动耐量试验检测４０例左室舒张性心力衰竭（ＬＶＤＨＦ）患者，并与２０例正常人对照。发现ＬＶＤＨＦ患者运动耐量减退，其运动耐量减退与左室收缩功能参数无关，而与左室舒张功能参数Ｅ峰最大流速（ＥＰＦＶ）、ＥＰＦＶ／Ａ峰最大流速（ＡＰＦＶ）、Ｅ峰减速度呈负相关，与ＡＰＦＶ呈正相关。并且与间接反映左室舒张功能障碍的左房内径、心肌重量指数呈负相关。     

Effects of exercise training on diastolic and systolic dysfunction in patients with chronic heart failure

BACKGROUNDChronic heart failure (CHF) is a complex syndrome characterized by a progressive reduction of the left ventricular (LV) contractility, low exercise tolerance, and increased mortality and morbidity. Diastolic dysfunction (DD) of the LV, is a keystone in the pathophysiology of CHF and plays a major role in the progression of most cardiac diseases. Also, it is well estimated that exercise training induces several beneficial effects on patients with CHF. AIMTo evaluate the impact of a cardiac rehabilitation program on the DD and LV ejection fraction (EF) in patients with CHF.METHODSThirty-two stable patients with CHF (age: 56 ± 10 years, EF: 32% ± 8%, 88% men) participated in an exercise rehabilitation program. They were randomly assigned to aerobic exercise (AER) or combined aerobic and strength training (COM), based on age and peak oxygen uptake, as stratified randomization criteria. Before and after the program, they underwent a symptom-limited maximal cardiopulmonary exercise testing (CPET) and serial echocardiography evaluation to evaluate peak oxygen uptake (VO_2peak), peak workload (W_peak), DD grade, right ventricular systolic pressure (RVSP), and EF.RESULTSThe whole cohort improved VO_2peak, and W_peak, as well as DD grade (P < 0.05). Overall, 9 patients (28.1%) improved DD grade, while 23 (71.9%) remained at the same DD grade; this was a significant difference, considering DD grade at baseline (P < 0.05). In addition, the whole cohort improved RVSP and EF (P < 0.05). Not any between-group differences were observed in the variables assessed (P > 0.05).CONCLUSIONExercise rehabilitation improves indices of diastolic and systolic dysfunction. Exercise protocol was not observed to affect outcomes. These results need to be further investigated in larger samples.     

Long-term,dose-dependent effects of spironolactone on left ventricular function and exercise tolerance in patients with chronic heart failure

OBJECTIVES: This study was designed to assess the effects of spironolactone (SP) on left ventricular (LV) function and exercise tolerance in patients with chronic heart failure (CHF). BACKGROUND: In severe heart failure (HF), SP improves survival, but the underlying mechanisms are not clear. METHODS: We randomized 106 outpatients with HF to SP (12.5 to 50 mg/day) (group 1) or control (group 2). Complete echocardiography and cardiopulmonary exercise testing were performed at baseline and 12 months after randomization. RESULTS: Left ventricular end-systolic volume at baseline and at follow-up was 188 +/- 94 ml and 171 +/- 97 ml in group 1 and 173 +/- 71 ml and 168 +/- 79 ml in group 2 (treatment group-by-time interaction, p = 0.03). Left ventricular ejection fraction at baseline and at follow-up was 33 +/- 7% and 36 +/- 9% in group 1 and 34 +/- 7% and 34 +/- 9% in group 2 (treatment group-by-time interaction, p = 0.02). At baseline, 9 patients in group 1 and 3 patients in group 2 had a restrictive mitral filling pattern, a marker of severe diastolic dysfunction; at follow-up, 3 patients in group 1 and no patient in group 2 improved their pattern. No patient in group 1 and 4 patients in group 2 worsened their pattern (chi-square, p = 0.02). Peak oxygen consumption increased significantly in patients treated with 50 mg of SP and decreased in group 2 (17.7 +/- 5.2 vs. 18.5 +/- 5.9 and 19.1 +/- 5.6 vs. 17.9 +/- 5.3, respectively; analysis of variance, p = 0.01). CONCLUSIONS: Spironolactone improves LV volumes and function; furthermore, it improves exercise tolerance at the highest administered dose. Our data might explain the mortality reduction during aldosterone antagonism in patients with HF.     

螺内酯对老年舒张性心力衰竭患者血清Ⅰ型前胶原羧基端肽水平的影响

目的观察老年舒张性心力衰竭患者使用螺内酯治疗前后血清Ⅰ型前胶原羧基端肽(PICP)水平的变化,探讨螺内酯减轻心肌纤维化、改善心脏舒张功能的可能机制。方法选择舒张性心力衰竭患者37例,随机分为常规治疗组及螺内酯(20 mg/d)治疗组,随访6个月,测定治疗前后血清PICP水平,并通过超声心动图观察治疗前后左心房、左心室大小、左心室壁厚度、左心室射血分数及舒张早期和晚期充盈速度(E、A)及其比值(E/A)。结果两组治疗后血清PICP水平与治疗前相比均明显下降(P<0.05),且螺内酯组低于常规治疗组(P<0.05)。两组治疗后E/A比值与治疗前相比均增高(P<0.05),且螺内酯组高于常规治疗组(P<0.05)。结论螺内酯通过降低Ⅰ型胶原的合成可能可以减轻心肌纤维化,改善心脏舒张功能。     

Exaggerated hypertensive response to exercise in patients with diastolic heart failure

Systolic load elevation during exercise prolongs left ventricular (LV) relaxation, compromises filling, and raises end-diastolic pressure, leading to reduced exercise tolerance. The aim of this study was to test the hypothesis that the hypertensive response to exercise is exaggerated in patients with diastolic heart failure (DHF). Echocardiograms and treadmill testing were performed in patients with DHF (n=20) and age-matched hypertension with LV hypertrophy (HTN; n=20). The Minnesota Living with Heart Failure Questionnaire was used to estimate quality of life (QOL). There were no differences in resting blood pressure or echocardiographic parameters between the groups. The maximum exercise time was significantly shorter in the DHF group than in the HTN group (6.0+/-3.0 vs. 12.5+/-2.5 min), and the peak systolic blood pressure during exercise was significantly higher in the DHF group (212+/-18 vs. 189+/-16 mmHg, p<0.05). After 4 weeks of treatment with candesartan, an angiotensin II receptor blocker (8 mg/d), peak systolic blood pressure during exercise decreased to 191+/-13 mmHg, maximum exercise time increased (10.4+/-3.0 min; p<0.05), and QOL improved in patients with DHF, while there was no change in patients with HTN, despite the similar resting blood pressure. In patients with DHF, systolic blood pressure markedly increased during exercise, and this was accompanied by impaired exercise tolerance and a decreased QOL, both of which were partly suppressed by blocking angiotensin II.     

Effects of enoximone on exercise tolerance in patients with mild to moderate heart failure.

To evaluate the efficacy of enoximone on exercise tolerance in patients with mild to moderate heart failure, 33 patients underwent cardiopulmonary exercise tests before and 3 hours after placebo or after receiving 25 or 100 mg of enoximone administered randomly in a double-blind manner. The electrocardiogram was monitored and blood pressure measured every minute throughout cycle ergometer exercise testing with a ramp protocol in which the work rate increased 1 W every 6 seconds after a 4-minute 20-W warm-up. Minute ventilation, oxygen uptake (VO2), and carbon dioxide output were measured every 10 seconds in order to determine anaerobic threshold (AT) and peak VO2. Five patients were excluded from evaluation before breaking the double-blind key because of insufficient data. Heart rate increased and systolic blood pressure decreased throughout the testing only in the group taking 100 mg (n = 10). Significant increases in AT (14.4 to 16.2 ml/min/kg) and peak VO2 (20.8 to 22.9 ml/min/kg) were observed in the group taking 100 mg. The increases in AT showed a dose response, namely +0.7% in the placebo (n = 9), +6.9% in the 25-mg (n = 9) and 12.5% in the 100-mg group. The work rates at the AT point increased in the 25- and 100-mg groups. These results indicate that a single oral administration of enoximone improves exercise tolerance in patients with mild to moderate heart failure.     

Effects of quinapril on exercise tolerance in patients with mild to moderate heart failure.

The objective of this double-blind, placebo-controlled, randomized multicentre study was to determine whether treatment with the new non-sulfhydryl angiotensin converting enzyme (ACE) inhibitor quinapril, as an addition to maintenance therapy with digitalis and/or diuretics, would improve exercise tolerance and patients' symptomatology over a treatment period of 3 months. Two hundred and twenty-five patients with mild to moderate heart failure were studied in four parallel treatment groups receiving either placebo or quinapril in a dose of 10, 20, or 40 mg day-1. Compared to placebo, quinapril therapy resulted in a significant improvement in exercise time. The improvement in exercise tolerance was dose-related and showed a significant increase at the end of the study in the patients who completed the trial and in an intent-to-treat analysis. Twenty-six patients were on monotherapy with quinapril without concomitant medication. In this subgroup of patients, the increase in exercise time was comparable to the subgroup of patients on diuretic treatment alone. After the 12-week study, 189 patients entered an open-label trial for 12 months, in which the dose of the ACE inhibitor could be adjusted according to clinical response. Despite a reduction in the daily dose of quinapril, the patients reached the same level of exercise capacity as in the 3-month study. No serious side effects were recorded, particularly no symptomatic hypotension or deterioration of renal function. The results of the study show that quinapril has a significant favourable effect on exercise tolerance and symptoms in patients with mild to moderate heart failure.     

运动训练对心衰患者的影响

目的探讨运动训练对慢性心力衰竭患者运动耐苗的影响。方法将60例NYHA心功能Ⅱ-Ⅲ级心哀患者随机分为训练组和对照组,两组均予以常规抗心哀治疗,训练组予以有氧操训练1次,d,疗程10周。两组均分别在入院后24h内（治疗前）及治疗10周后分别进行6分钟步行试验及行超声心动图检查,测定左室射血分数（LVEF）,并比较两组前后的结果。结果治疗10周后,两组6分钟步行的行止距离及LVEF均有所增加,且训练组增加更明显。结论适量运动训练与其他常规药物联用可显著增强心哀患者的运动耐量,可作为该病治疗的辅助方法。     

美托洛尔对舒张功能不良性心衰患者心率变异性的影响

目的探讨舒张功能不良性心衰患者应用美托洛尔后心脏自主神经功能的变化。方法对照组常规抗心衰治疗,治疗组在常规抗心衰治疗的基础上加服美托洛尔,从12.5mg/d开始,缓慢增加剂量至25～50mg/d,治疗前和治疗3个月后分别进行心率变异性(HRV)分析。结果与对照组比较,治疗组治疗3个月后HRV指标SDNN、SDANN、rMSSD、PNN50均明显提高(P<0.01),且心功能改善明显优于对照组(P<0.05)。结论在常规治疗的基础上,加用美托洛尔治疗舒张功能不良性心衰,可改善心脏自主神经调节功能,可提高HRV,增强疗效。