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目的观察依普利酮对慢性心衰(CHF)患者炎症细胞因子及心功能的影响,探讨其治疗心衰的机制。方法采用前瞻性随机对照研究方法,选择CHF患者68例为研究对象,并随机分为常规抗CHF组(34例)和依普利酮组(34例),后者在常规抗心衰治疗基础上加用依普利酮,开始剂量25mg/d,治疗1个月,可耐受者改为50mg/d。两组疗程均为1年。所有CHF患者于治疗前、治疗6个月、1年时检测肿瘤坏死因子α(TNF-α)、白介素6(IL-6),检查心功能指标包括:左室舒张末期内径(LVDd)和收缩末期内径(LVDs)、左室射血分数(LVEF),并比较两组因心衰再次入院的比率。结果 1治疗6个月、1年后,两组细胞因子TNF-α,IL-6水平均较治疗前显著降低(P<0.05),且依普利酮组与常规抗CHF组的差异有统计学意义(P<0.05);治疗1年后,两组各指标与治疗6个月的差异均有统计学意义(P<0.05);2治疗6个月后,依普利酮组心功能各指标与治疗前的差异均有统计学意义(P<0.05),常规抗CHF组LVEF与治疗前的差异有统计学意义(P<0.05);治疗1年后与治疗前比较,两组心功能各指标差异均有统计学意义(P<0.05);治疗1年后,依普利酮组各指标以及常规抗心衰组LVEF与治疗6个月的差异均有统计学意义(P<0.05);治疗6个月、1年后,依普利酮组与常规抗CHF组各指标的差异有统计学意义(P<0.05);3依普利酮组再住院率显著低于常规抗CHF组。结论依普利酮可降低肿瘤坏死因子α、白细胞介素6细胞因子水平及改善心功能,并显著降低因心衰再入院率。
Objective To observe the effects of eplerenone on inflammatory cytokines and cardiac function in patients with chronic heart failure (CHF) and to explore its mechanism of treating heart failure. Methods A prospective randomized controlled study was conducted. Sixty-eight patients with CHF were selected and randomly divided into conventional anti-CHF group (34 patients) and eplerenone group (34 patients) Plus eplerenone, the initial dose of 25mg / d, treatment for 1 month, tolerable to 50mg / d. Two courses of treatment are 1 year. All CHF patients were tested for TNF-α and IL-6 at 6 months and 1 year before treatment. Cardiac function indexes included left ventricular end diastolic diameter (LVDd) and systolic LVDs and LVEF. The rates of re-admission due to heart failure were compared between the two groups. Results After treatment for 6 months and 1 year, the levels of cytokines TNF-α and IL-6 in both groups were significantly lower than those before treatment (P <0.05), and there was statistical difference between eplerenone group and conventional anti-CHF group (P <0.05). After one year of treatment, there was significant difference between each index and the 6-month treatment (P <0.05). After 6 months of treatment, the cardiac function in each group of eplerenone (P <0.05). There was a significant difference between LVEF and pre-treatment in the conventional anti-CHF group (P <0.05). After one year of treatment, compared with before treatment, the cardiac function (P <0.05). After one year of treatment, there was significant difference between each index of eplerenone group and LVEF of conventional anti-heart failure group and the 6-month treatment (P <0.05) ; After 6 months and 1 year, there was significant difference between the indexes of eplerenone group and conventional anti-CHF group (P <0.05); The rehospitalization rate of eplerenone group was significantly lower than that of the conventional anti-CHF group . Conclusion Eplerenone can reduce the levels of tumor necrosis factor α, interleukin 6 cytokines and improve cardiac function, and significantly reduce the rate of rehospitalization due to heart failure.