心脉隆注射液对高龄2型心肾综合征患者的疗效评价
|
摘要
目的观察心脉隆注射液对高龄2型心肾综合征(CRS)患者的中性粒细胞明胶相关载脂蛋白(NGAL)、超敏肌钙蛋白T(hs-cTnT)及肾素-血管紧张素醛固酮系统(RAAS)的影响,评价其临床疗效及安全性。方法收集2015年11月至2017年2月我院老年病科就诊的诊断为2型CRS的高龄患者86例,根据随机数字表法随机分为对照组43例,给予常规内科治疗;心脉隆组43例,在常规内科治疗的基础上加用心脉隆注射液5 mg/kg,2次/日,共治疗15 d。两组分别于治疗前后测定NGAL、hs-cTnT、脑钠肽(BNP)、血浆肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)、左室射血分数(LVEF)、六分钟步行试验等指标。结果两组患者经治疗后,NGAL、hs-cTnT、BNP、PRA、AngⅡ、ALD较治疗前均下降,LVEF、六分钟步行距离较治疗前升高(均P <0.05);心脉隆组较同期对照组上述指标变化更明显(均P <0.05);实验过程中两组无不良反应发生。结论心脉隆注射液可降低高龄2型心肾综合征患者的NGAL、hs-cTnT、BNP水平,改善心肾功能,疗效确切,安全性良好,其机制可能与心脉隆注射液抑制RAAS活性有关。
Objective Observation of the effects of Xinmailong injection on NGAL, hs-cTnT and RAAS in elderly patients with type 2 cardio-renal syndrome( CRS), and EvaluatIon of the clinical efficacy and safety.Methods A total of 86 elderly patients who were collected from November 2015 to February 2017 were diagnosed as type 2 CRS in our department of geriatrics. According to the random number table method, they were randomly divided into two groups. Control group(43 cases) were treated with conventional medical therapy and xinmailong group(43 cases) were treated with xinmailong injection with a dose of 5 mg/kg twice a day for 15 days. The value of sneutrophil gelatin-associated apolipoprotein(NGAL), hypersensitive troponin T(hs-cTnT), brain natriuretic peptide(BNP), plasma renin activity(PRA), and angiotensin Ⅱ(Ang Ⅱ),aldosterone(ALD), left ventricular ejection fraction(LVEF), six-minute walking test and other indicators were measured before and after treatment. Results After treatment, the value of NGAL, hs-cTnT, BNP, PRA, AngⅡ and ALD decreased in both groups, the value of LVEF and six-minute walking distance increased compared with those before treatment(P <0.05); The above indicators in the xinmailong group experienced a more significant alteration than in control group in the same period(P < 0.05); no side effect occurred in both two groups during the experiment. Conclusion Xinmailong injection can reduce the levels of NGAL, hs-cTnT and BNP in elderly patients with type 2 cardio-renal syndrome, improve heart and kidney function, and have curative positive effect and good safety. This study underlined the mechanism of Xinmailong injection may be related to the inhibition of RAAS activity.
Objective Observation of the effects of Xinmailong injection on NGAL, hs-cTnT and RAAS in elderly patients with type 2 cardio-renal syndrome( CRS), and EvaluatIon of the clinical efficacy and safety.Methods A total of 86 elderly patients who were collected from November 2015 to February 2017 were diagnosed as type 2 CRS in our department of geriatrics. According to the random number table method, they were randomly divided into two groups. Control group(43 cases) were treated with conventional medical therapy and xinmailong group(43 cases) were treated with xinmailong injection with a dose of 5 mg/kg twice a day for 15 days. The value of sneutrophil gelatin-associated apolipoprotein(NGAL), hypersensitive troponin T(hs-cTnT), brain natriuretic peptide(BNP), plasma renin activity(PRA), and angiotensin Ⅱ(Ang Ⅱ),aldosterone(ALD), left ventricular ejection fraction(LVEF), six-minute walking test and other indicators were measured before and after treatment. Results After treatment, the value of NGAL, hs-cTnT, BNP, PRA, AngⅡ and ALD decreased in both groups, the value of LVEF and six-minute walking distance increased compared with those before treatment(P <0.05); The above indicators in the xinmailong group experienced a more significant alteration than in control group in the same period(P < 0.05); no side effect occurred in both two groups during the experiment. Conclusion Xinmailong injection can reduce the levels of NGAL, hs-cTnT and BNP in elderly patients with type 2 cardio-renal syndrome, improve heart and kidney function, and have curative positive effect and good safety. This study underlined the mechanism of Xinmailong injection may be related to the inhibition of RAAS activity.
引文
[1]秦明照,王宁.关注高龄高血压患者的血压管理问题[J].中华老年心脑血管病杂志,2018,20(1):2-3.
[2]ZHANG Y,CHEN Y,MA L.Depression and cardiovascular disease in elderly:Current understanding[J].J Clin Neurosci Official J Neurosurgical Soc,2018,47:1.
[3]O′SULLIVAN E D,HUGHES J,FERENBACH D A.Renal aging:causes and consequences.[J].J Am Soc Nephrol,2017,28(2):407.
[4]MATSUSHITA K.Pathogenetic pathways of cardiorenal syndrome and their possible therapeutic implications[J].Curr Pharm Design,2016,22(30):4629-4637.
[5]韩越,李志樑,杨龙江,等.真武汤对心肾综合征大鼠的心肾保护作用[J].实用医学杂志,2015,31(13):2112-2115.
[6]余云华,沈明,李然,等.心肾综合征发病机制和治疗新进展[J].实用医学杂志,2016,32(2):169-171.
[7]PREETI J,ALEXANDRE M,PUPALAN I,et al.Chronic heart failure and comorbid renal dysfunction-a focus on type 2 cardiorenal syndrome[J].Curr Cardiol Rev,2016,12(3):186-194.
[8]ZHENGTAO L I,SUJUAN L I,LIN H U,et al.Mechanisms underlying action of xinmailong injection,a traditional chinese medicine in cardiac function improvement[J].Afr J Tradit Comple,2017,14(2):241-252.
[9]LI H,MAO Y,ZHANG Q,et al.Xinmailong mitigated epirubicininduced cardiotoxicity via inhibiting autophagy[J].J Ethnopharmacol,2016,192:459-470.
[10]黄峻.慢性心衰治疗的基本理念:过去、现在和未来[J].天津医药,2016,44(8):929-931.
[11]陈锐,万静,任坤,等.N末端B型利钠肽原在老年心肾综合征患者中的水平变化[J].中国老年学杂志,2015,(14):4041-4042.
[12]SIVALINGAM Z,LARSEN S B,GROVE E L,et al.Neutrophil gelatinase-associated lipocalin as a risk marker in cardiovascular disease.[J].Clin Chem Lab Med,2017,56(1):5-18.
[13]卓慧.急性肾损伤生物标志物研究进展[J].国际泌尿系统杂志,2017,37(1):6-9.
[14]SIDDIQI Z,KAROLI R,KAUL A,et al.Evaluation of neutrophil gelatinase-associated lipocalin and cystatin C as early markers of diabetic nephropathy[J].Ann Afr Med,2017,16(3):101.
[15]中华医学会心血管病学分会,中华医学会检验医学分会.高敏感方法检测心肌肌钙蛋白临床应用中国专家共识(2014)[J].中华内科杂志,2015,54(10):899-904.
[16]肖文凯,叶平.慢性肾脏病患者血清高敏肌钙蛋白T水平变化及意义[J].中华老年心脑血管病杂志,2015,17(5):546-548.
[2]ZHANG Y,CHEN Y,MA L.Depression and cardiovascular disease in elderly:Current understanding[J].J Clin Neurosci Official J Neurosurgical Soc,2018,47:1.
[3]O′SULLIVAN E D,HUGHES J,FERENBACH D A.Renal aging:causes and consequences.[J].J Am Soc Nephrol,2017,28(2):407.
[4]MATSUSHITA K.Pathogenetic pathways of cardiorenal syndrome and their possible therapeutic implications[J].Curr Pharm Design,2016,22(30):4629-4637.
[5]韩越,李志樑,杨龙江,等.真武汤对心肾综合征大鼠的心肾保护作用[J].实用医学杂志,2015,31(13):2112-2115.
[6]余云华,沈明,李然,等.心肾综合征发病机制和治疗新进展[J].实用医学杂志,2016,32(2):169-171.
[7]PREETI J,ALEXANDRE M,PUPALAN I,et al.Chronic heart failure and comorbid renal dysfunction-a focus on type 2 cardiorenal syndrome[J].Curr Cardiol Rev,2016,12(3):186-194.
[8]ZHENGTAO L I,SUJUAN L I,LIN H U,et al.Mechanisms underlying action of xinmailong injection,a traditional chinese medicine in cardiac function improvement[J].Afr J Tradit Comple,2017,14(2):241-252.
[9]LI H,MAO Y,ZHANG Q,et al.Xinmailong mitigated epirubicininduced cardiotoxicity via inhibiting autophagy[J].J Ethnopharmacol,2016,192:459-470.
[10]黄峻.慢性心衰治疗的基本理念:过去、现在和未来[J].天津医药,2016,44(8):929-931.
[11]陈锐,万静,任坤,等.N末端B型利钠肽原在老年心肾综合征患者中的水平变化[J].中国老年学杂志,2015,(14):4041-4042.
[12]SIVALINGAM Z,LARSEN S B,GROVE E L,et al.Neutrophil gelatinase-associated lipocalin as a risk marker in cardiovascular disease.[J].Clin Chem Lab Med,2017,56(1):5-18.
[13]卓慧.急性肾损伤生物标志物研究进展[J].国际泌尿系统杂志,2017,37(1):6-9.
[14]SIDDIQI Z,KAROLI R,KAUL A,et al.Evaluation of neutrophil gelatinase-associated lipocalin and cystatin C as early markers of diabetic nephropathy[J].Ann Afr Med,2017,16(3):101.
[15]中华医学会心血管病学分会,中华医学会检验医学分会.高敏感方法检测心肌肌钙蛋白临床应用中国专家共识(2014)[J].中华内科杂志,2015,54(10):899-904.
[16]肖文凯,叶平.慢性肾脏病患者血清高敏肌钙蛋白T水平变化及意义[J].中华老年心脑血管病杂志,2015,17(5):546-548.