左旋卡尼汀在治疗慢性心力衰竭中的临床观察
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摘要
目的：观察左旋卡尼汀治疗慢性心力衰竭患者的临床疗效。
方法：选择慢性心力衰竭患者60例,随机分为常规治疗组(对照组,30例)和左旋卡尼汀组(治疗组,30例),对照组给予利尿剂、血管紧张素转换酶抑制剂(ACEI)或者血管紧张素受体拮抗剂(ARB)、β受体阻滞剂、洋地黄制剂以及硝酸酯类药物治疗,治疗组在此基础上加用左旋卡尼汀2.0g静脉滴注,1天/次,连续用药连用7-10天。观察治疗前后患者的心功能。
结果：两组患者临床疗效间差异有显著性意义(P<0.05)；心功能检查方面,与治疗前比较左室射血分数(LVEF)、左室短轴缩短率(LVFS)、左室舒张末内径(LVEDD)明显改善。治疗组患者治疗后的生活质量有明显改善,与治疗前比较差异有显著意义(P<0.05)。
结论：左旋卡尼汀可以辅助性治疗慢性心力衰竭,提高心功能,尤其提高左室收缩功能以及改善生活质量。
Objective:To evaluate the efficacy of L-carnitine on the heart function in chronic heart failure patients.
Methods:Sixty patients with chronic heart failure were divided into conventional therapy group (control group,30 patients) and L-carnitine therapy group (therapy group,30 patients). The control group patients were given basic treatment with digoxin, diuretics, angiotensin converting enzyme inhibitor(ACEI) or angiotensinⅡreceptor blocker (ARB), andβ2blocker; the therapy group were given L-carnitine 2g/d for 7 to 10days in addition to the basic treatment.Heart function was observed before and after L-carnitine treatment.
Results:Clinical efficacy between the two groups were statistically differences(P<0.05). Inspection of cardiac function, left ventricular ejection fraction(LVEF),left ventricular fractional shortening(LVFS),left ventricular end diastolic diameter(LVEDD) of patients increased signi-ficantly in L-carnitine group. In the quality of Life, the therapy group after treatment, which compared with before treatment, wassignificantly improvement (P<0.05).
Conclusion:L-carnitine can be used as adjuvant treatment with chronic heart failure, and it can increase cardiac function,especially in left ventricular function. At the same time improving the quality of life.
方法：选择慢性心力衰竭患者60例,随机分为常规治疗组(对照组,30例)和左旋卡尼汀组(治疗组,30例),对照组给予利尿剂、血管紧张素转换酶抑制剂(ACEI)或者血管紧张素受体拮抗剂(ARB)、β受体阻滞剂、洋地黄制剂以及硝酸酯类药物治疗,治疗组在此基础上加用左旋卡尼汀2.0g静脉滴注,1天/次,连续用药连用7-10天。观察治疗前后患者的心功能。
结果：两组患者临床疗效间差异有显著性意义(P<0.05)；心功能检查方面,与治疗前比较左室射血分数(LVEF)、左室短轴缩短率(LVFS)、左室舒张末内径(LVEDD)明显改善。治疗组患者治疗后的生活质量有明显改善,与治疗前比较差异有显著意义(P<0.05)。
结论：左旋卡尼汀可以辅助性治疗慢性心力衰竭,提高心功能,尤其提高左室收缩功能以及改善生活质量。
Objective:To evaluate the efficacy of L-carnitine on the heart function in chronic heart failure patients.
Methods:Sixty patients with chronic heart failure were divided into conventional therapy group (control group,30 patients) and L-carnitine therapy group (therapy group,30 patients). The control group patients were given basic treatment with digoxin, diuretics, angiotensin converting enzyme inhibitor(ACEI) or angiotensinⅡreceptor blocker (ARB), andβ2blocker; the therapy group were given L-carnitine 2g/d for 7 to 10days in addition to the basic treatment.Heart function was observed before and after L-carnitine treatment.
Results:Clinical efficacy between the two groups were statistically differences(P<0.05). Inspection of cardiac function, left ventricular ejection fraction(LVEF),left ventricular fractional shortening(LVFS),left ventricular end diastolic diameter(LVEDD) of patients increased signi-ficantly in L-carnitine group. In the quality of Life, the therapy group after treatment, which compared with before treatment, wassignificantly improvement (P<0.05).
Conclusion:L-carnitine can be used as adjuvant treatment with chronic heart failure, and it can increase cardiac function,especially in left ventricular function. At the same time improving the quality of life.
引文
1. Bremer J.(1983) Carnitine metabolism and function. Physiol Rev 63:1420-1479.
2. Lysiak-Szydlowska W., Llilly K.,Di Lisa F., Toth P.P., Bieber L.L.(1988) Quantitation of the effect of L-carnitine on the levels of acid-soluble short-chain Acyl-CoA and CoA-SH in rat heart and liver mitochondria. J Biol Chem 263:1151-1156.
3. Winter S.C.(1992) Carnitine deficiency in paediatrics, L-Carnitine, eds Ferrari R., Di Mauro S., Sherwood G. (Academic Press, London), pp 209-221.
4. Cohn JN, Johnson G. Heart failure with normal ejection fraction:the V-HeFTStudy. Circulation 1990; 81(SupplⅢ):Ⅲ-48-Ⅲ-53.
5.上海市心力衰竭调查协作组.上海市1980、1990、2000年心力衰竭住院患者流行病及治疗状况调查[J].中华心血管病杂志,2002,30：24-27.
6. Ingwall JS, Poole-wilson PA, Coluccl WS, et al. ATP synthesis in the normal and failing heart [A].Heart failure [M].USA:Churchill Livigstone,1997.75-85.
7. Lenflant.C.Report for the task force on research in heart failure [J]. Circulation,1994,90:1118.
8. Katz A.The myocardium in congestive heart failure [J].AmJ Cardiol,1989, 63:12A-16A.
9. Unverferth DV, Fetters J K,Barbara BS, et al. Human myocardial histologic characteristics in congestive heart failure[J]. Circulation,1983,68:1194.
10.Braunwald E,Bristow MR. Congestive heart failure:fifty years of progress [J].Circulation,2000,102:Ⅳ 214.
11.Sabbah HN. Apoptotic cell death in heart failure [J] Cardiovasc Res,2000,45 7042712.
12. Yokota T, Kinugawa S, Tsutsui H.Nippon Rinsho.2010 Apr;68(4):621-4.
13.张镜如,乔健天,等.生理学[M].北京：人民卫生出版社,1995.412-414.
14. Feraille E, Doucet A. Sodium-potassium-adenosinetriphosphatase-dependent sodium transport in the kidney:hormonal control. Physiol Rev 81:345-418, 2001.
15.Regitz V,Shug AL,Flock E. Defective myocardial carnitine metabolism in congestive heart failure secondary to dilated cardiomyopathy and to coronary, hypertensive and valvular heart diseases. Am J Cardiol,1990,65(11):755-760
16.Calvani M,Reda E,Arrigoni-Martelli E.Regulation by carnitine of myocardial fatty acid and carbohydrate metabolism under normal and pathological conditions. Basic Res Cardiol,2000,95(2):75-83.
17. Rizxos I. Three-year survival of patients with heart failure Caused by dilated cardiomyopathy and L-carnitine administration. Am Heart J,2000,139(2 pt 3):120-123
18.刘文,赵星祥,夏德义,等心肌损伤过程中心肌细胞内肉毒碱含量的变化[J].中国地方病学杂志,1992；11(5)：2722-2741.
19.Leipala JA,Bhatnagar R1 protection of the reperfused heart by Lpropiony carnitine (J) 1 J App 1 Physio 1,1991; 71 (4):1518-2221.
20. Clusin W T,BuchbinderM,Calcium overload,"injure" current, andearly zschaemic cardiac arrhythmias:A direct conrection (J).Lancet,1983:2722-2731.
21.陈灏珠.心脏病学第7版.北京：人民卫生出版社,2007.519-520.
22. Jeny C, YangMH, Chen PL, et al. The influence of exercise tolerance on quality of life among patients with heart failure [J]. Qual Life Res,2004,13 (5):925-932.
23. Comelia HM, Robbert S, Ida M, et al. Changes in health-related quality of life in older patients with acute myocardial infarction or congestive heart failure:a prospective study[J]. J Am Geriatr Soc,2001,49(8):1052-1058.
24.曹癸兰,王朝晖.充血性心力衰竭患者抑郁状态及相关因素的研究[J].心血管康复医学杂志,2004,13(2)：149-151.
25. Carels RA. The association between disease severity, functional status, depression and daily quality of life in congestive heart failure patients [J]. Qual Life Res,2004,13 (1):63-72.
26. Degl'Innocenti A,Elmfeldt D, Hansson L,et al.Cognitive function and health-related quality of life in elderly patients with hypertension-baseline data from the study on cognition and prognosis in the elderly(SCOPE) [J]. Blood Press,2002, 11 (3):157-165.
27. Nonald A, David J. Neurocognitive functioning and improvement in quality of life following participation in cardiac rehabilitation [J]. Am J Cardiol,1999,83 (9):1374-1378.
28. Riegel B, Bennett JA, Davis A, et al. Cognitive impairment in heart failure: issues of measurement and etiology [J]. Am J Crit Care,2002,11 (6):520-528.
29. Almeida O, FlickerL. The mind of a failing heart:a systematic review of the association between congestive heart failure and cognitive functioning[J]. Intern Med J,2001,31 (5):290-295.
30. Bosworth HB, Steinhauser KE,OrrM, et al. Congestive heart failure patients'perceptions of quality of life:the integration of physical and psychosocial factors[J]. Aging Ment Health,2004,8 (1):83-91.
31.Kempen M, Sanderman R,Miedema I, et al. Functional decline after congestive heart failure and acute myocardial infarction and the impact of psychological attributes[J]. Qual life Res,2000,9 (4):439-450.
32. Tsay SL, Chao YF, Yann FC. Effects of perceived self-efficacy and functional status on depression in patients with chronic heart failure [J]. J Nurs Res,2002, 10 (4):271-278.
1.上海市心力衰竭调查协作组.上海市1980、1990、2000年心力衰竭住院患者流行病及治疗状况调查[J].中华心血管病杂志,2002,30：24-27.
2. Gregorio Brevetti, Fabio di Lisa, Sergio Perna, Roberta Menabo, Roberta Barbato, Vincenzo Domenico Martone, and Noris Siliprandi,Carnitine-Related Alterations in Patients With Intermittent Claudication:Indication for a Focused Carnitine Therapy Circulation, May 1996; 93:1685-1689.
3. Winter S.C.(1992) Carnitine deficiency in paediatrics, L-Carnitine, eds Ferrari R. Di Mauro S., Sherwood G. (Academic Press, London), pp 209-221.
4. Regitz V,Shug AL,Flock E.Defective myocardial carnitine metabolism in congestive heart failure secondary to dilated cardiomyopathy and to coronary, hypertensive and valvular heart diseases. Am J Cardiol,1990,65(11):755-760.
5.孙彩霞,高春霖,薛玉良,等。左旋卡尼汀对大鼠心肌缺血、再灌注损伤能量代谢的影响[J].天津医药,2005,33(12)：783-785.
6. Gorelik O, Almozino SD, Alon I, et al. Heart failure in diabetes mellitus:clinical features and prognostic implications[J].Cardiology,2005,103(3):161-166.
7.刘文,赵星祥,夏德义,等心肌损伤过程中心肌细胞内肉毒碱含量的变化[J].中国地方病学杂志,1992：11(5)：27222741
8. Leipala JA,Bhatnagar RIP rotection of the reperfused heart by L 2 propiony carnitine (J) 1 Appl Physiol,1991; 71 (4):15182221
9. McGarry JD, Mills SE, Long CS, Foster DW. Observations on the affinity for carnitine, and malonyl-CoA sensitivity, of carnitine palmitoyltransferase I in animal and human tissues.Biochem J 1983;214:21-8.
10. Abbas AS, Wu G, Schulz H. Carnitine acetyltransferase is not a cytosolic enzyme in rat heart and therefore cannot function in the energy-linked regulation of cardiac fatty acid oxidation. J Mol Cell Cardiol 1998;30:1305-9.
11. Braunwald E,Bristow MR. Congestive heart failure:fifty years of progress [J].Circulation,2000,102:Ⅳ 214.
12.Sabbah HN.Apoptotic cell death in heart failure [J]Cardiovasc Res,2000,45: 7042712.
13. Yokota T, Kinugawa S, Tsutsui H.Nippon Rinsho.2010 Apr;68(4):621-4.
14.张镜如,乔健天,等.生理学[M].北京：人民卫生出版社,1995.412-414.
15. Feraille E, Doucet A. Sodium-potassium-adenosinetriphosphatase-dependent sodium transport in the kidney:hormonal control. Physiol Rev 81:345-418, 2001.
16. Clusin W T,BuchbinderM,Calcium overload,"injure" current, and early zschaemic cardiac arrhythmias:A direct conrection (J).Lancet,1983:2722-2731.
17. Grady K J,Meyer P M, Dressler D, et al. Longitudinal change in quality of life and impact on survival after left ventricular assist device implantation[J].Ann Thorac Surg,2004,77:1321-1327.
18. Faller H, Stork S, Schowalter M, et al. Is health-related quality of life an independent predictor of survival in patients with chronic heart failure[J].Journal of Psychosomatic Research,2007,63(5):533-538.
19. Gehlbach BK, Geppert E.The pulmonary manifestations of left heart failure.Chest. 2004 Feb;125(2):669-82.
20. Jeny C, Yang MH, Chen PL, et al. The influence of exercise tolerance on quality of life among patients with heart failure [J].Qual Life Res,2004,13 (5):925-932.
21.21 Cornelia HM, Robbert S, IdaM, et al. Changes in health related quality of life in older patients with acute myocardial infarction or congestive heart failure:a p respective study[J]. J Am Geriatr Soc,2001,49(8):1052-1058.
22.曹癸兰,王朝晖.充血性心力衰竭患者抑郁状态及相关因素的研究[J].心血管康复医学杂志,2004,13(2)：149-151.
23.Carels RA. The association between disease severity, functional status, depression and daily quality of life in congestive heart failure patients [J]. Qual Life Res,2004,13 (1):63-72.
24. Degl'Innocenti A, Elmfeldt D, Hansson L, et al. Cognitive function and health related quality of life in elderly patients with hypertension baseline data from the study on cognition and prognosis in the elderly(SCOPE) [J]. Blood Press,2002, 11 (3):157-165.
25.Nonald A, David J. Neurocognitive functioning and improvement in quality of life following participation in cardiac rehabilitation [J]. AmJ Cardiol,1999,83 (9):1374-1378.
26. Riegel B,Bennett JA,Davis A, et al. Cognitive impairment in heart failure:issues of measurement and etiology[J]. Am J Crit Care,2002,11 (6):520-528.
27. Almeida O, FlickerL. Themind of a failing heart:a systematic review of the association between congestive heart failure and cognitive functioning [J]. InternMed J,2001,31 (5):290-295.
28. Bosworth HB, Steinhauser KE,OrrM, et al.Congestive heart failure patients'perceptions of quality of life:the integration of physical and psychosocial factors[J]. AgingMent Health,2004,8 (1):83-91.
29. KempenM, Sanderman R,Miedema I, et al. Functional decline after congestive heart failure and acute myocardial infarction and the impact of psychological attributes[J]. Qual life Res,2000,9 (4):439-450.
30. Tsay SL, Chao YF, Yann FC. Effects of perceived self-efficacy and functional status on depression in patients with chronic heart failure [J]. J Nurs Res,2002, 10 (4):271-278.
2. Lysiak-Szydlowska W., Llilly K.,Di Lisa F., Toth P.P., Bieber L.L.(1988) Quantitation of the effect of L-carnitine on the levels of acid-soluble short-chain Acyl-CoA and CoA-SH in rat heart and liver mitochondria. J Biol Chem 263:1151-1156.
3. Winter S.C.(1992) Carnitine deficiency in paediatrics, L-Carnitine, eds Ferrari R., Di Mauro S., Sherwood G. (Academic Press, London), pp 209-221.
4. Cohn JN, Johnson G. Heart failure with normal ejection fraction:the V-HeFTStudy. Circulation 1990; 81(SupplⅢ):Ⅲ-48-Ⅲ-53.
5.上海市心力衰竭调查协作组.上海市1980、1990、2000年心力衰竭住院患者流行病及治疗状况调查[J].中华心血管病杂志,2002,30：24-27.
6. Ingwall JS, Poole-wilson PA, Coluccl WS, et al. ATP synthesis in the normal and failing heart [A].Heart failure [M].USA:Churchill Livigstone,1997.75-85.
7. Lenflant.C.Report for the task force on research in heart failure [J]. Circulation,1994,90:1118.
8. Katz A.The myocardium in congestive heart failure [J].AmJ Cardiol,1989, 63:12A-16A.
9. Unverferth DV, Fetters J K,Barbara BS, et al. Human myocardial histologic characteristics in congestive heart failure[J]. Circulation,1983,68:1194.
10.Braunwald E,Bristow MR. Congestive heart failure:fifty years of progress [J].Circulation,2000,102:Ⅳ 214.
11.Sabbah HN. Apoptotic cell death in heart failure [J] Cardiovasc Res,2000,45 7042712.
12. Yokota T, Kinugawa S, Tsutsui H.Nippon Rinsho.2010 Apr;68(4):621-4.
13.张镜如,乔健天,等.生理学[M].北京：人民卫生出版社,1995.412-414.
14. Feraille E, Doucet A. Sodium-potassium-adenosinetriphosphatase-dependent sodium transport in the kidney:hormonal control. Physiol Rev 81:345-418, 2001.
15.Regitz V,Shug AL,Flock E. Defective myocardial carnitine metabolism in congestive heart failure secondary to dilated cardiomyopathy and to coronary, hypertensive and valvular heart diseases. Am J Cardiol,1990,65(11):755-760
16.Calvani M,Reda E,Arrigoni-Martelli E.Regulation by carnitine of myocardial fatty acid and carbohydrate metabolism under normal and pathological conditions. Basic Res Cardiol,2000,95(2):75-83.
17. Rizxos I. Three-year survival of patients with heart failure Caused by dilated cardiomyopathy and L-carnitine administration. Am Heart J,2000,139(2 pt 3):120-123
18.刘文,赵星祥,夏德义,等心肌损伤过程中心肌细胞内肉毒碱含量的变化[J].中国地方病学杂志,1992；11(5)：2722-2741.
19.Leipala JA,Bhatnagar R1 protection of the reperfused heart by Lpropiony carnitine (J) 1 J App 1 Physio 1,1991; 71 (4):1518-2221.
20. Clusin W T,BuchbinderM,Calcium overload,"injure" current, andearly zschaemic cardiac arrhythmias:A direct conrection (J).Lancet,1983:2722-2731.
21.陈灏珠.心脏病学第7版.北京：人民卫生出版社,2007.519-520.
22. Jeny C, YangMH, Chen PL, et al. The influence of exercise tolerance on quality of life among patients with heart failure [J]. Qual Life Res,2004,13 (5):925-932.
23. Comelia HM, Robbert S, Ida M, et al. Changes in health-related quality of life in older patients with acute myocardial infarction or congestive heart failure:a prospective study[J]. J Am Geriatr Soc,2001,49(8):1052-1058.
24.曹癸兰,王朝晖.充血性心力衰竭患者抑郁状态及相关因素的研究[J].心血管康复医学杂志,2004,13(2)：149-151.
25. Carels RA. The association between disease severity, functional status, depression and daily quality of life in congestive heart failure patients [J]. Qual Life Res,2004,13 (1):63-72.
26. Degl'Innocenti A,Elmfeldt D, Hansson L,et al.Cognitive function and health-related quality of life in elderly patients with hypertension-baseline data from the study on cognition and prognosis in the elderly(SCOPE) [J]. Blood Press,2002, 11 (3):157-165.
27. Nonald A, David J. Neurocognitive functioning and improvement in quality of life following participation in cardiac rehabilitation [J]. Am J Cardiol,1999,83 (9):1374-1378.
28. Riegel B, Bennett JA, Davis A, et al. Cognitive impairment in heart failure: issues of measurement and etiology [J]. Am J Crit Care,2002,11 (6):520-528.
29. Almeida O, FlickerL. The mind of a failing heart:a systematic review of the association between congestive heart failure and cognitive functioning[J]. Intern Med J,2001,31 (5):290-295.
30. Bosworth HB, Steinhauser KE,OrrM, et al. Congestive heart failure patients'perceptions of quality of life:the integration of physical and psychosocial factors[J]. Aging Ment Health,2004,8 (1):83-91.
31.Kempen M, Sanderman R,Miedema I, et al. Functional decline after congestive heart failure and acute myocardial infarction and the impact of psychological attributes[J]. Qual life Res,2000,9 (4):439-450.
32. Tsay SL, Chao YF, Yann FC. Effects of perceived self-efficacy and functional status on depression in patients with chronic heart failure [J]. J Nurs Res,2002, 10 (4):271-278.
1.上海市心力衰竭调查协作组.上海市1980、1990、2000年心力衰竭住院患者流行病及治疗状况调查[J].中华心血管病杂志,2002,30：24-27.
2. Gregorio Brevetti, Fabio di Lisa, Sergio Perna, Roberta Menabo, Roberta Barbato, Vincenzo Domenico Martone, and Noris Siliprandi,Carnitine-Related Alterations in Patients With Intermittent Claudication:Indication for a Focused Carnitine Therapy Circulation, May 1996; 93:1685-1689.
3. Winter S.C.(1992) Carnitine deficiency in paediatrics, L-Carnitine, eds Ferrari R. Di Mauro S., Sherwood G. (Academic Press, London), pp 209-221.
4. Regitz V,Shug AL,Flock E.Defective myocardial carnitine metabolism in congestive heart failure secondary to dilated cardiomyopathy and to coronary, hypertensive and valvular heart diseases. Am J Cardiol,1990,65(11):755-760.
5.孙彩霞,高春霖,薛玉良,等。左旋卡尼汀对大鼠心肌缺血、再灌注损伤能量代谢的影响[J].天津医药,2005,33(12)：783-785.
6. Gorelik O, Almozino SD, Alon I, et al. Heart failure in diabetes mellitus:clinical features and prognostic implications[J].Cardiology,2005,103(3):161-166.
7.刘文,赵星祥,夏德义,等心肌损伤过程中心肌细胞内肉毒碱含量的变化[J].中国地方病学杂志,1992：11(5)：27222741
8. Leipala JA,Bhatnagar RIP rotection of the reperfused heart by L 2 propiony carnitine (J) 1 Appl Physiol,1991; 71 (4):15182221
9. McGarry JD, Mills SE, Long CS, Foster DW. Observations on the affinity for carnitine, and malonyl-CoA sensitivity, of carnitine palmitoyltransferase I in animal and human tissues.Biochem J 1983;214:21-8.
10. Abbas AS, Wu G, Schulz H. Carnitine acetyltransferase is not a cytosolic enzyme in rat heart and therefore cannot function in the energy-linked regulation of cardiac fatty acid oxidation. J Mol Cell Cardiol 1998;30:1305-9.
11. Braunwald E,Bristow MR. Congestive heart failure:fifty years of progress [J].Circulation,2000,102:Ⅳ 214.
12.Sabbah HN.Apoptotic cell death in heart failure [J]Cardiovasc Res,2000,45: 7042712.
13. Yokota T, Kinugawa S, Tsutsui H.Nippon Rinsho.2010 Apr;68(4):621-4.
14.张镜如,乔健天,等.生理学[M].北京：人民卫生出版社,1995.412-414.
15. Feraille E, Doucet A. Sodium-potassium-adenosinetriphosphatase-dependent sodium transport in the kidney:hormonal control. Physiol Rev 81:345-418, 2001.
16. Clusin W T,BuchbinderM,Calcium overload,"injure" current, and early zschaemic cardiac arrhythmias:A direct conrection (J).Lancet,1983:2722-2731.
17. Grady K J,Meyer P M, Dressler D, et al. Longitudinal change in quality of life and impact on survival after left ventricular assist device implantation[J].Ann Thorac Surg,2004,77:1321-1327.
18. Faller H, Stork S, Schowalter M, et al. Is health-related quality of life an independent predictor of survival in patients with chronic heart failure[J].Journal of Psychosomatic Research,2007,63(5):533-538.
19. Gehlbach BK, Geppert E.The pulmonary manifestations of left heart failure.Chest. 2004 Feb;125(2):669-82.
20. Jeny C, Yang MH, Chen PL, et al. The influence of exercise tolerance on quality of life among patients with heart failure [J].Qual Life Res,2004,13 (5):925-932.
21.21 Cornelia HM, Robbert S, IdaM, et al. Changes in health related quality of life in older patients with acute myocardial infarction or congestive heart failure:a p respective study[J]. J Am Geriatr Soc,2001,49(8):1052-1058.
22.曹癸兰,王朝晖.充血性心力衰竭患者抑郁状态及相关因素的研究[J].心血管康复医学杂志,2004,13(2)：149-151.
23.Carels RA. The association between disease severity, functional status, depression and daily quality of life in congestive heart failure patients [J]. Qual Life Res,2004,13 (1):63-72.
24. Degl'Innocenti A, Elmfeldt D, Hansson L, et al. Cognitive function and health related quality of life in elderly patients with hypertension baseline data from the study on cognition and prognosis in the elderly(SCOPE) [J]. Blood Press,2002, 11 (3):157-165.
25.Nonald A, David J. Neurocognitive functioning and improvement in quality of life following participation in cardiac rehabilitation [J]. AmJ Cardiol,1999,83 (9):1374-1378.
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