| 杨晓红,陈 东,刘万宁,李战国,程 琳.目标剂量螺内酯联合曲美他嗪对老年慢性心力衰竭患者炎症因子、RAAS及心率变异性的影响[J].,2021,(22):4348-4352 |
| 目标剂量螺内酯联合曲美他嗪对老年慢性心力衰竭患者炎症因子、RAAS及心率变异性的影响 |
| Effects of Target Dose Spironolactone Combined with Trimetazidine on Inflammatory Factors, RAAS and Heart Rate Variability in Elderly Patients with Chronic Heart Failure |
| 投稿时间：2021-04-07 修订日期：2021-04-30 |
| DOI：10.13241/j.cnki.pmb.2021.22.031 |
| 中文关键词: 螺内酯 曲美他嗪 老年 慢性心力衰竭 炎症因子 RAAS 心率变异性 |
| 英文关键词: Spironolactone Trimetazidine Elderly Chronic heart failure Inflammatory factors RAAS Heart rate variability |
| 基金项目:新疆维吾尔自治区自然科学基金项目（201318101-12） |
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| 中文摘要: |
| 摘要 目的：探讨目标剂量螺内酯（20 mg/d）联合曲美他嗪对老年慢性心力衰竭（CHF）患者炎症因子、肾素-血管紧张素-醛固酮系统（RAAS）、及心率变异性的影响。方法：选取120例老年CHF患者，随机分为对照组和研究组，各60例，其中对照组给予曲美他嗪治疗，研究组给予曲美他嗪联合目标剂量螺内酯治疗，对比两组疗效、炎症因子[超敏C反应蛋白（hs-CRP）、肿瘤坏死因子-α（TNF-α）、白介素-6（IL-6）]、RAAS指标 [肾素（PRA）、血管紧张素Ⅱ（AngⅡ）及醛固酮（ALD）]、心率变异性[24 h平均正常R-R间期标准差（SDNN），24 h连续5 min节段平均正常R-R间期标准差（SDANN），连续正常R-R间期差的均方根（rMSSD）]、心功能[左心室射血分数（LVEF）、左室收缩末期内径（LVESD）、左室舒张末期内径（LVEDD）]及安全性。结果：与对照组相比，研究组的总有效率更高（P<0.05）。治疗6个月后，两组hs-CRP、TNF-α、IL-6、LVESD、LVEDD、PRA、AngⅡ、ALD均较治疗前降低，且研究组上述指标低于对照组（P<0.05）。治疗6个月后，两组LVEF较治疗前升高，且研究组LVEF高于对照组（P<0.05）。治疗6个月后，研究组SDNN、SDANN、rMSSD均较治疗前升高，且研究组上述指标高于对照组（P<0.05）。两组不良反应发生率比较差异不明显（P>0.05）。结论：曲美他嗪联合目标剂量螺内酯治疗老年CHF患者疗效显著且安全性好，可明显改善患者的心功能、心率变异性，降低炎症因子水平，其可能是通过拮抗RAAS发挥作用。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the effects of target dose spironolactone(20mg/d) combined with trimetazidine on inflammatory factors, renin angiotensin aldosterone system (RAAS) and heart rate variability in elderly patients with chronic heart failure (CHF). Methods: 120 elderly patients with CHF were selected, and randomly divided into control group and study group by simple randomization, 60 cases in each group. The control group was treated with trimetazidine, and the study group was treated with trimetazidine combined with target dose of spironolactone. The curative effect, inflammatory factors [high sensitivity C-reactive protein (hs-CRP), tumor necrosis factor - α (TNF-α), interleukin-6 (IL-6)], RAAS indexes [renin (PRA), angiotensin Ⅱ (Ang Ⅱ) and aldosterone (ALD)], heart rate variability[24 h mean standard deviation of normal R-R interval (SDNN), 24 h continuous 5 min segment mean standard deviation of normal R-R interval (SDANN), root mean square of continuous normal R-R interval difference (rMSSD)], cardiac function [left ventricular ejection fraction (LVEF), left ventricular end systolic diameter (LVESD), left ventricular end diastolic diameter (LVEDD)] and safety of the two groups were compared. Results: Compared with the control group, the total effective rate of the study group was higher (P<0.05). 6 months after treatment, hs-CRP, TNF-α, IL-6, LVESD, LVEDD, PRA, Ang Ⅱand ALD of the two groups were lower than those before treatment, and the above indexes of the study group were lower than the control group(P<0.05). 6 months after treatment, LVEF of the two groups was higher than that before treatment, and the LVEF of the study group was higher than the control group(P<0.05). 6 months after treatment, SDNN, SDANN and rMSSD of the study group were higher than those before treatment, and the above indexes of the study group were higher than the control group(P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion: The trimetazidine combined with target dose of spironolactone in the treatment of elderly patients with CHF has remarkable curative effect and the safety is good, it can significantly improve the cardiac function and heart rate variability of patients, reduce the level of inflammatory factors, which may play a role by antagonizing RAAS. |
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