左卡尼汀治疗慢性充血性心力衰竭的疗效观察

目的观察左卡尼汀治疗慢性充血性心力衰竭的疗效。方法入选65例NYHA心功能分级Ⅲ～Ⅳ级的慢性充血性心力衰竭患者,随机分为左卡尼汀治疗组35例和对照组30例。左卡尼汀组在常规治疗基础上给予左卡尼汀3g/d口服,连用14d。对照组给予常规治疗。分别于治疗前及治疗14d后进行6min步行试验、NYHA心功能分级、LVEF及血清生化等指标的检查,评价两组的疗效,记录不良反应。结果治疗前后比较,两组6min步行距离、左室射血分数和NYHA心功能分级均较治疗前有明显改善（P=0.031,0.042,0.20）。两组血清BNP水平均有降低（P=0.026）。治疗后两组间比较,左卡尼汀组6min步行距离平均增加32m,对照组平均增加15m（P=0.036）;LVEF平均增加12%,对照组平均增加7%（P=0.044）;B型利钠肽水平下降61.22ng/L,而对照组下降46.18ng/L（P=0.038）;左卡尼汀组心功能改善1级以上共32例,对照组共19例（P=0.019）。所有实验对象均无肝肾功能损害及严重不良反应。结论左卡尼汀可以改善慢性左心衰竭患者的6分钟步行距离、LVEF和心功能,降低B型利钠肽水平,提高运动耐量,是一种安全、有效的药物。

Evaluation of the therapeutic effects of L-Carnitine on chronic congestive heart failure

Objective To evaluate the therapeutic effects of L-Carnitine on chronic congestive heart failure.Methods A total of 65 patients with confirmed diagnosis of chronic congestive heart failure were included in this study,patients were divided into L-Carnitine group（n=35） and control group（n=30）.All patients received conventional treatment according to guideline for chronic congestive heart failure.The patients in L-Carnitine group received 3g/d L-Carnitine po for 14 days.Six-minute walking distance,LVEF,serum BNP level and NYHA heart functional class were evaluated at baseline and 14 days after enrollment.Results Compared to the baseline,six-minute walking distance,LVEF,and NYHA heart functional class were significantly improved（P=0.031,0.042,0.020 respectively）,serum BNP level was significantly decreased（P=0.026）.But the increase of six-minute walking distance was greater in the L-Carnitine group than control group（32m in mean vs 15m,P=0.036）,the increase of LVEF in the L-Carnitine group was also higher than control group（12% vs 7%,P=0.044）,the decrease of serum level of BNP in L-Carnitine group was significant higher than control group（61.22ng/L vs 46.18ng/L,P0.038）.The improvement of NYHA heart functional class was still different in 2 groups（32 cases in L-Carnitine group vs 19 cases in control group,P= 0.019）.No subject quit the study for therapeutically induced severe dysfunction of liver and kidney.Conclusion L-Carnitine can improve short-term six-minute walking distance,LVEF and NYHA heart functional class in chronic congestive heart failure patients.