伊伐布雷定治疗慢性心力衰竭的效果及对生物标记物的影响
摘要
目的:观察伊伐布雷定治疗慢性心力衰竭(chronic heart failure,CHF)的临床效果及对血浆脑钠肽(brain natriuretic peptide,BNP)、可溶性人基质裂解素2(soluble suppression of tumorigenicity 2,s ST2)、白介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平的影响。方法:选取2016年11月至2017年11月广西医科大学第二附属医院心内科、江苏省常州市第一人民医院心内科收治的60例病情稳定的CHF患者作为观察对象,随机分为对照组和试验组,每组各30例。两组患者均给予常规抗心力衰竭药物治疗,试验组在此基础上加用伊伐布雷定,初始剂量每次2. 5 mg,2次·d~(-1),治疗2~4周后根据心率调整用量,最大剂量至每次7. 5 mg,2次·d~(-1),连续治疗3个月。记录两组患者治疗前后的心率、左心室射血分数(left ventricular ejection fractions,LVEF)、6 min步行距离(6 minute walking distance,6MWD),同时检测血浆BNP、sST2、IL-6、TNF-α水平。结果:与治疗前比较,试验组心率明显降低,LVEF和6MWT显著增加,血浆BNP、s ST2、IL-6、TNF-α水平显著下降,差异均有统计学意义(P <0. 05);对照组上述各指标均有所改善,但与治疗前比差异不明显。与对照组比较,治疗后试验组上述各指标均显著改善(P <0. 05)。试验组发生药物不良反应5例(16. 7%),均不需要停药处理。结论:在常规抗心力衰竭治疗的基础上,部分CHF患者加用伊伐布雷定治疗有助于控制CHF患者静息心率,改善患者心功能,提高运动耐量,明显降低血浆BNP、s ST2、IL-6、TNF-α水平。
引文
[1] ZIAEIN B,FONAROW G C. Epidemiology and aetiology of heart failure[J]. Nat Rev Cardiol,2016,13(6):368-378.
[2] POCOEK S J,WANG D,PFEFFER M A,et al. Predictors of mortality and morbidity in patients with chronic heart failure[J]. Eur Heart J,2006,27(1):65-75.
[3]MCALISTER F A,WIEBE N,EZEKOWITZ J A,et al. Meta-analysis:beta-blocker dose,heart rate reduction,and death in patients with heart failure[J]. Ann Interu Med,2009,150(1):784-794.
[4]KOMAJDA M,FOLLATH F,SWEDBERG K,et al. The EuroHeart Failure Survey programme-a survey on the quality of care among patients with heart failure in Europe. Part 2:treatnlent[J]. Eur Heart J,2003,24:464-474.
[5]FLANNERY G,GEHFIG-MILLS R,BILLAH B,et al. Analysis of randomized controlled trials on the effect of magnitude of heart rate reduction on clinical outcomes in patients with systolic chronic heart failure receiving beta-blockers[J]. Am J Cardiol,2008,101(6):865-869.
[6] MAJEWSKI S,SLOMKA S,ZIELINSKA-WYDERKIEWICZ E,et al. Heart rate-lowering efficacy and respiratory safety of ivabradine in patients with obslructive airway disease:a randomized,doubleblind,placebo-conlrolled,crossover study[J].Am J Cardiovasc Drugs,2012,12(3):179-188.
[7]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志,2014,42(2):98-122.
[8]ATS Committee on proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement:guidelines for the six-minute walk test[J]. Am J Respir Crit Care Med,2002,166(1):111-117.
[9]SWEDBERG K,KOMAJDA M,BHM M,et al. Ivabradine and outcomes in chronic heart failure(SHIFT):a randomised placebo-controlled study[J]. Lancet,2010,376(9744):875-885.
[10]张明惠.新型控制心率药物伊伐布雷定临床应用研究进展[J].临床荟萃,2011,26(21):1919-1921.
[11] FOX K,FORD I,STEG P G,et al. Ivabradine for patients with stable coronary artery disease and left-ventricular systolic dysfunction(BEAUTIFUL):a randomized,double-blind,placebo-controlled trial[J]. Lancet,2008,372(9641):807-816.
[12] SAVARESE G,TRIMAREO B,DELLEGROTTAGLIE S,et al. Natriuretic peptide-guided therapy in chronic heart failure:a meta-analysis of 2 686 patients in 12 randomized trials[J]. PLo S One,2013,8(3):e58287.
[13]陈雄,崔俊友,李健.慢性心力衰竭患者血浆脑钠肽浓度与体质量指数的相关性[J].东南大学学报(医学版),2012,31(2):199-201.
[14]GRUSON D,LEPOUTRE T,AHN S A,et al. Increased soluble ST2 is a stronger predictor of long-term cardiovascular death than natriuretic peptides in heart failure patients with reduced ejection fraction[J]. Int J Cardiol,2014,172(1):e250-252.
[15]杨巧梅,梁玉芝,杨威,等.伊伐布雷定延长离体心脏单相动作电位时程及其致心律失常作用[J].中国循环杂志,2015,30(6):585-589.
[16]黄文凤,余剑波,刘敏,等.伊伐布雷定联合比索洛尔对冠心病PCI术后患者心脏康复的影响[J].中国医院药学杂志,2017,37(2):151-154.
[17]赵玉清,袁桂莉,张进顺,等.和肽素联合N末端B型利钠肽原评估慢性心力衰竭患者预后的价值[J].中国循环杂志,2014,29(4):275-278.
[2] POCOEK S J,WANG D,PFEFFER M A,et al. Predictors of mortality and morbidity in patients with chronic heart failure[J]. Eur Heart J,2006,27(1):65-75.
[3]MCALISTER F A,WIEBE N,EZEKOWITZ J A,et al. Meta-analysis:beta-blocker dose,heart rate reduction,and death in patients with heart failure[J]. Ann Interu Med,2009,150(1):784-794.
[4]KOMAJDA M,FOLLATH F,SWEDBERG K,et al. The EuroHeart Failure Survey programme-a survey on the quality of care among patients with heart failure in Europe. Part 2:treatnlent[J]. Eur Heart J,2003,24:464-474.
[5]FLANNERY G,GEHFIG-MILLS R,BILLAH B,et al. Analysis of randomized controlled trials on the effect of magnitude of heart rate reduction on clinical outcomes in patients with systolic chronic heart failure receiving beta-blockers[J]. Am J Cardiol,2008,101(6):865-869.
[6] MAJEWSKI S,SLOMKA S,ZIELINSKA-WYDERKIEWICZ E,et al. Heart rate-lowering efficacy and respiratory safety of ivabradine in patients with obslructive airway disease:a randomized,doubleblind,placebo-conlrolled,crossover study[J].Am J Cardiovasc Drugs,2012,12(3):179-188.
[7]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志,2014,42(2):98-122.
[8]ATS Committee on proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement:guidelines for the six-minute walk test[J]. Am J Respir Crit Care Med,2002,166(1):111-117.
[9]SWEDBERG K,KOMAJDA M,BHM M,et al. Ivabradine and outcomes in chronic heart failure(SHIFT):a randomised placebo-controlled study[J]. Lancet,2010,376(9744):875-885.
[10]张明惠.新型控制心率药物伊伐布雷定临床应用研究进展[J].临床荟萃,2011,26(21):1919-1921.
[11] FOX K,FORD I,STEG P G,et al. Ivabradine for patients with stable coronary artery disease and left-ventricular systolic dysfunction(BEAUTIFUL):a randomized,double-blind,placebo-controlled trial[J]. Lancet,2008,372(9641):807-816.
[12] SAVARESE G,TRIMAREO B,DELLEGROTTAGLIE S,et al. Natriuretic peptide-guided therapy in chronic heart failure:a meta-analysis of 2 686 patients in 12 randomized trials[J]. PLo S One,2013,8(3):e58287.
[13]陈雄,崔俊友,李健.慢性心力衰竭患者血浆脑钠肽浓度与体质量指数的相关性[J].东南大学学报(医学版),2012,31(2):199-201.
[14]GRUSON D,LEPOUTRE T,AHN S A,et al. Increased soluble ST2 is a stronger predictor of long-term cardiovascular death than natriuretic peptides in heart failure patients with reduced ejection fraction[J]. Int J Cardiol,2014,172(1):e250-252.
[15]杨巧梅,梁玉芝,杨威,等.伊伐布雷定延长离体心脏单相动作电位时程及其致心律失常作用[J].中国循环杂志,2015,30(6):585-589.
[16]黄文凤,余剑波,刘敏,等.伊伐布雷定联合比索洛尔对冠心病PCI术后患者心脏康复的影响[J].中国医院药学杂志,2017,37(2):151-154.
[17]赵玉清,袁桂莉,张进顺,等.和肽素联合N末端B型利钠肽原评估慢性心力衰竭患者预后的价值[J].中国循环杂志,2014,29(4):275-278.