不同剂量螺内酯对扩张型心肌病心力衰竭患者心功能和血浆脑钠肽的影响

目的观察不同剂量螺内酯对扩张型心肌病（dilated cardiomyopathy，DCM）心力衰竭患者心功能和血浆脑钠肽（BNP）的影响。方法将扩张型心肌病心力衰竭患者（NYHA心功能分级Ⅲ-Ⅳ级）110例，随机分为小剂量组和大剂量组各55例，两组在常规抗心衰治疗基础上小剂量组给予螺内酯20mg／d，大剂量组给予螺内酯60mg／d，经治疗6个月后评价患者的心功能和检测血浆BNP进行比较。结果两组治疗前后NYHA心功能分级比较均有明显好转（P〈0．01）；小剂量组螺内酯治疗前LVEF（31．23±3．61）％与大剂量组螺内酯治疗前LVEF（30．33±3．27）％比较，差异无统计学意义（P〉0．05）；小剂量组螺内酯治疗后LVEF（39．37±8．30）％与大剂量组螺内酯治疗后LVEF（45．17±5．33）％比较，差异有统计学意义（P〈0．05）；小剂量组螺内酯治疗前血浆BNP（973．25±256．23）pg／ml与大剂量组螺内酯治疗前血浆BNP（991．07±211．35）pg／ml比较，差异无统计学意义（P〉0．05）；小剂量组螺内酯治疗后血浆BNP（324．12±122．43）pg／ml与大剂量组螺内酯治疗后血浆BNP（200．58±145．11）pg／ml比较，差异有统计学意义（P〈0．05）。但是，大剂量组螺内酯治疗前后比小剂量组下降更明显，两者比较差异有统计学意义（P〈0．05）；小剂量组和大剂量组的不良反应发生率为11．1％和8．82％，差异无统计学意义（P〉0．05）。结论在常规用药基础上采用大剂量螺内酯可以降低BNP水平，明显改善扩张性心肌病心力衰竭患者的心功能，疗效较好。

Effect of different doses of spironolactone on cardiac function and plasma level of brain natriuretic peptide in patients with chronic heart failure and dilated cardiomyopathy

Objective To observe the effect of different doses of spironolactone on cardiac function and plasma level of brain natriuretic peptide （ BNP ） in patients with chronic heart failure （CHF） and dilated cardiomyopathy （DCM）. Methods 110 cases of CHF and dilated cardiomyopathy （NYHA cardiac function class Ⅲ- Ⅳ） were randomly divided into large dose group （n=55） and small dose group （n=55）, the two groups were treated with sprironolactone 20 mg/d and 60 mg/d respectively based on the routine anti-CHF therapy, the two group＇ s cardiac function and plasma level of BNP were evaluated 6 months after the treatment. Results The NYHA cardiac function of two groups were improved markedly before and after the treatment （P〈0.01）; the small dose group＇ s LVEF was （31.23 ± 3.61）% before the treatment and there was no statistical significant difference found compared with large dose group＇ s LVEF （30.33 ± 3.27）%, （ P〉0.05 ） ; the small dose group＇ s LVEF was （39.37 ± 8.30）% after the treatment and there was statistical significant difference compared with large dose group＇ s LVEF （45.17 ± 5.33）%, （P〈0.05） ; the small dose group＇ s plasma level of BNP was （973.25 ± 256.23） pg/ml before the treatment and there was no statistical significant difference compared with large dose group＇ s plasma level of BNP （991.07 ± 211.35） pg/ml,（/9〉0.05 ）; the small dose group＇ s plasma level of BNP was （324.12 ± 122.43） pg/ml after the treatment and there was statistical significant difference compared with large dose group＇ s plasma level of BNP （200.58 ± 145.11） pg/ml （P〈0.05） . But compared with the small dose group, there was significant decrease in the plasma level of BNP of the large dose group before and after the treatment （ P〈0.05 ） ; the incidence of adverse reaction of small and large dose group were 11.1% and 8.82% respectively without any statistical significant difference between the two groups （/9〉0.05） . Conclusion Large dose of spironolaetone on the basis of regnlar medicine treatment can lower BNP and improve the heart function of patients with CHF and DCM.