螺内酯对老年收缩性心力衰竭患者心室重构和安全性研究

摘要

Objective To investigate the effects of spironolactone on ventricular remodeling and safety in the elderly patients with NYHA Ⅰ-Ⅱ systolic heart failure.Methods A total of 107 elderly patients with NYHA Ⅰ-Ⅱ systolic heart failure [left ventricular ejection fraction(LVEF) ＜ 40％,left ventricular end diastolic volume index(LVEDVI) ＞ 75ml/ m2] were enrolled in this study from December 2008 to June 2011.The patients in the control group received routine treatment and the patients in spironolactone intervention group received 24 mg/d spironolactone.All the patients received the examination of echocardiography to assess LVEDVI,left ventricular end systolic volume index (LVESVI),left ventricular mass index(LVMI) and LVEF before and 6 months after treatment.Results Six months after treatment,LVEDVI,LVESVI,LVMI and LVEF were improved significantly in both groups (P ＜ 0.05),and the improvement was more significant in spironolactone intervention group(P ＜0.05).The incidence rate of hyperkalemia was higher in spironolactone intervention group than that in control group,but there were no serious cases of hyperkalemia (serum level of K + ≥ 6.0mmol/L) and kidney dysfunction(serum level of creatinine≥353 pmol/L) in two groups.Conclusions Spironolactone combined with ACEI treatment for NYHA Ⅰ-Ⅱ systolic heart failure in the elderly patients could improve the ventricular remodeling safely.%目的 探讨螺内酯对老年纽约心脏病协会(NYHA)心功能Ⅰ～Ⅱ级收缩性心力衰竭患者心室重构的影响及应用的安全性. 方法 入选我院2008年12月至2011年6月门诊及住院老年NYHAⅠ～Ⅱ级收缩性心力衰竭[左室射血分数(LVEF)＜ 40％,左室舒张末期容积指数(LVEDVI) ＞75 ml/m2]患者107例,对照组54例接受常规治疗,螺内酯组53例在常规治疗的基础上接受螺内酯24 mg/d,所有患者在入选前及药物应用6月后行超声心动图检查评估LVEDVI、左室收缩末期容积指数(LVESVI)、左室质量指数(LVMI)和LVEF的变化,入选前及治疗后1、2、4周,随后每月监测电解质、肾功能. 结果 治疗6月后,2组LVEDVI、LVESVI、LVMI和LVEF均较治疗前有明显改善(P均＜0.05)；与对照组相比,螺内酯组改善更为显著(P均＜0.05).螺内酯组高钾血症的发生率(9.4％)明显升高,但无严重高钾血症(血钾≥6.0 mmol/L)及肾功能衰竭(血肌酐≥353 μmol/L)发生.结论 在应用ACEI治疗的基础上加用螺内酯治疗可进一步改善老年NYHAⅠ～Ⅱ级收缩性心力衰竭患者的心室重构且在严密监测下是安全的.