醛固酮拮抗剂对老年慢性心力衰竭患者的疗效

目的：探讨长期应用醛固酮拮抗剂（螺内酯）的老年慢性心力衰竭（CHF）患者的左室重构、左室功能与脑钠肽（BNP）水平的关系和临床评价治疗效果。方法：在常规治疗心力衰竭药物治疗的基础上，120例CHF患者采用双盲法随机分为：螺内酯组（66例，螺内酯20mg／d），CHF常规治疗对照组（54例）；检测治疗前、治疗3个月后左室重量指数（LVMI）、左心室射血分数（LVEF）、脑钠肽（BNP）水平的变化并进行比较分析。结果：螺内酯组心功能改善的总有效率80％，明显高于CHF常规治疗对照组的9．25％，P〈0.05；与CHF常规治疗对照组比较，螺内酯组治疗3月后LVMI[（340．7±68．3）g／m2比（179．6±33．3）g／m2]、BNP[（366．15±23．36）pg／ml比（330．38±11．56）pg／ml]水平显著降低，LVEF[（34．11±2．71）％比（46．2±3．9）％]显著升高（P均〈0．05）。结论：醛固酮拮抗剂在常规治疗心力衰竭的药物治疗的基础上，可降低BNP水平，改善心功能，抑制心室重构。

Therapeutic effect of long-term application of aldosterone antagonist in aged patients with chronic heart failure

Objective： To explore curative effect of long- term application of aldosterone antagonist （spironolactone） in aged patients with chronic heart failure （CHF）. Methods.. A total of 120 CHF cases were randomly divided into spironolactone group （n = 66, received spironolactone 20 mg/d, based on routine anti - heart failure drug therapy） and CHF routine treatment control group （n = 54） ; changes of left ventricular mass index （LVMI）, left ventricular ejection fraction （LVEF） and BNP level before and three months after treatment were measured, compared and analyzed in two groups. Results： Total effective rate of cardiac function improvement （80%） of spironolactone group was significantly higher than that of CHF routine treatment control group （9.25%）, P〈0. 05; compared with CHF routine treatment control group, there were significant decrease in LVMI [ （340. 7 ± 68. 3） g/m2 vs. （179. 6 ± 33. 3） g/m2] and BNP level [ （366. 15 ± 23.36） pg/ml vs. （330. 38 ± 11.56） pg/ml], and significant increase in LVEF [ （34. 11 ± 2. 71） % vs. （46. 2 ± 3.9） %] in spironolactone group after three months treatment, P〈0. 05 all. Conclusion： Based on routine anti- heart failure drug therapy, aldosterone antagonist can decrease BNP level, inhibit ventricular remodeling, effectively improve heart function.