Rho激酶抑制剂短期治疗射血分数保留性心衰疗效评估

摘要

目的 探讨Rho激酶抑制剂-法舒地尔短期治疗对射血分数保留性心衰(HFPEF)患者心脏舒张功能及预后的安全性和有效性.方法 选取年龄在45～65岁,并确诊为HFPEF的患者80例,随机分为2组:对照组37例,单纯传统抗心力衰竭药物治疗;试验组43例,在对照组的基础上给予法舒地尔治疗.分别在用药前、用药2周后,测量患者血清BNP浓度值;并在入院48 h内、用药2周后,分别测量参与患者心脏超声左室压力最大下降速率(-dp/dtmax),计算左室压力下降时间常数(T);随访记录入院2周、出院4周及6周NYHA分级情况.结果 1.NYHA分级比较显示:两组病例经2周治疗后,NYHA分级均有显著改善(χ2=7.318,P=0.026);出院4周时,试验组患者NYHA分级改善更显著(χ2=6.036,P=0.014);而随访6周时,两组之间心功能改善比较,差异无统计学意义(χ2=0.409,P=0.522);2.对照组与试验组入院时,血清BNP浓度比较,差异无统计学意义,P＞0.05,治疗后均有改善.2周后再次测血清BNP浓度并进行组间比较,两组值为[(283.41±34.69)vs(263.65±49.11)pg/mL,P=0.039],试验组较对照组下降更显著;3.左室压力最大下降速率(-dp/dtmax)显示:对照组与试验组入院时-dp/dtmax无统计学差异,P＞0.05,治疗后均有改善,P＜0.05.治疗2周后比较,即[(1 259.50±198.31)vs(1 341.20±178.79)mmHg/s,P=0.056],两组比较,差异无统计学意义;4.左室压力下降时间常数(T)显示:对照组与试验组入院差异无统计学意义,P＞0.05,治疗后均有改善,P＜0.05.治疗2周后,即[(55.16±8.99)vs(47.47±7.27)ms,P＜0.05].结论 两组药物治疗均能改善HFPEF患者的短期症状及心脏舒张功能,但法舒地尔在无明显不良反应的情况下,可进一步改善射血分数保留性心衰患者的短期症状及心脏舒张功能指标.%Objective To investigate the effectiveness of Rho-kinase inhibitor ( fasudil) on diastolic function and prognosis of heart failure with preserved ejection fraction( HFPEF) patients in short term. Methods The study involved 80 subjects diagnosed with HFPEF,age arranged from 45 to 65 years. Randomly divided into two group:37 subjects assigned into group A,as control group received simple traditional anti-heart failure optima] medical therapy;43 subjects assigned into group B, as experimental group not only received traditional optimal medical therapy but also fasudil therapy. All serum BNP values of patients were tested in 24 hours,2 weeks after admission,respectively. Echocar-diography parameters such as left ventricular the maximum rate of pressure drop ( -dp/dtmax) , and calculated the time constant of left ventricular pressure fall( T) of all patients,all data were measured in 48 hours,2 weeks after admission, respectively. Followed-up and recorded the NYHA classification 2 weeks after admission, discharged 4 weeks and 6 weeks,respectively. Results The NYHA classification of patients in both groups were significantly improved(x2= 7. 318,P=0. 026) after 2 weeks treatment;Discharged 4 weeks,on the basis of improvement both groups,the NYHA class of experimental group were improved more significantly (x2 = 6. 036,P =0. 014) ;Followed up for 6 weeks, although both groups cardiac function improved, However, compared between the group A and group B, (x2 = 0. 409 ,P = 0. 522) , no significant difference obtained. Serum BNP concentrations was measured 2 weeks after admission, comparison between two groups[ (283.41 ±34.69)pg/mL vs (263.65 ±49. 11 )pg/mL,P =0.039] .statistical difference significantly. However,-dp/dtMax data comparison between the groups after 2 weeks treatment, that was[ ( 1 259. 50 ± 198. 31 )mmHg/s vs( 1341. 20 ± 178. 79 ) mmHg/s, P = 0. 056 ], there were no statistically significant differences. T values of patients was compared between groups 2 weeks after admission, [ (55. 16 ±8. 99) ms vs(47. 47 ±7. 27)ms, P <0. 05 J , there was statistically significant difference. Conclusion Both managements could improve the short-term symptoms and cardiac diastolic function in HFPEF,but Rho-kinase inhibitor fasudil can further improve the short-term symptoms and cardiac diastolic function indices of patients with HFPEF with few major adverse cardiac events.