依普利酮与伊伐布雷定治疗慢性心力衰竭疗效及其对血TNF-α、IL-6、BNP水平的影响

摘要

目的 比较依普利酮和伊伐布雷定治疗慢性心力衰竭(CHF)的临床效果及对血白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、脑钠肽(BNP)水平的影响.方法 选择2014年3月-2016年1月青海红十字医院心内科收治病情稳定CHF患者76例作为观察对象,采用随机数字表法分为2组,各38例.2组患者均给予常规抗心力衰竭治疗,在此基础上对照组加用依普利酮,观察组加用盐酸伊伐布雷定,均治疗12个月.比较2组患者的临床疗效,于治疗前后检测血清IL-6、TNF-α及血浆BNP水平,并进行心脏超声检查.结果 观察组临床总有效率为71.5％,显著高于对照组的39.5％(χ2=7.664,P=0.005).治疗12个月后,2组血清TNF-α、IL-6和血浆BNP水平均显著下降(对照组:t=9.760、3.799、3.481,P<0.01,观察组:t=18.734、10.404、5.029,P<0.01),且观察组改善均优于对照组(t=2.153、2.704、2.515,P<0.05或P<0.01);2组6分钟步行距离和左室射血分数均增加,观察组收缩压、舒张压、左室后壁厚度、室间隔厚度及左室舒张末期内径均显著减少,且观察组改善均优于对照组(t=2.020、2.251、6.237、4.712、4.875、3.188、3.742,均P<0.01).随访12个月,观察组再住院率显著低于对照组(18.42％ vs.42.11％,χ2=5.050,P=0.025).结论 在常规抗心力衰竭治疗的基础上加用盐酸伊伐布雷定治疗,可明显降低患者血清TNF-α、IL-6及血浆BNP水平,并改善患者心功能.%Objective To investigate the clinical effect of eplerenone and ivabradine hydrochloride in the treatment of chronic heart failure (CHF).Methods A total of 76 patients with chronic heart failure were selected from March 2014 to January 2016.The patients were divided into two groups according to the random number table method.The two groups of patients were given conventional anti heart failure treatment,patients of control group treated with eplerenone on the basis of routine therapy in 38 patients,patients of observation group treated with iviradepine hydrochloride treatment of 38 patients,two groups of patients were treated for 12 months.The levels of interleukin 6 (IL-6) and tumor necrosis factor (TNF-α) were measured before and after treatment,and the clinical efficacy of the two groups was compared.Results The total effective rate of the observation group was 71.5％,which was higher than the control group of 39.5％ (χ2=7.664,P=0.005).After 12 months of treatment,the 6 min walking distance and LVEF were significantly increased in the observation group than those in control group (t=6.237,P=0.000;t=4.712,P=0.000),serum TNF-α level,IL-6 level,BNP,systolic blood pressure,diastolic blood pressure,LVPWT,IVST and LVEDD were significantly improved than those in control group(t=2.153,P=0.035;t=2.704,P=0.009;t=2.215,P=0.029;t=2.020,P=0.047;t=2.251,P=0.027;t=4.875,P=0.000;t=3.188,P=0.002;t=3.742,P=0.000).Conclusion In the treatment of conventional anti-heart failure treatment,the combination of ivabradine hydrochloride can significantly reduce the serum TNF-α level and IL-6 level,and improve the cardiac function of patients.