左西孟旦和米力农治疗难治性心力衰竭的疗效比较及对血清NT-proBNP、ET-1水平的影响

目的:观察和比较左西孟旦(LEV)与米力农(MIL)治疗难治性心力衰竭(RHF)的临床效果及对患者血清N末端B型利钠肽原(NT-proBNP)、内皮素(ET)-1水平的影响。方法:选取我院2015年1月~2017年4月收治的102例RHF患者,采取随机数字表法均分为两组。MIL组给予MIL治疗,LEV组予以LEV治疗。比较两组的临床疗效,治疗前后超声心动图指标左室射血分数(LVEF)、二尖瓣舒张早期/舒张晚期峰值流速(E/A)、左室舒张末期内径(LVIDd)]、血清NT-proBNP、ET-1水平的变化及不良反应的发生情况。结果:治疗7 d后,LEV组总有效率较MIL组明显升高(P0.05)。与治疗前对比,两组治疗7 d后LVEF、E/A值均显著上升(P0.01),LVIDd值均显著下降(P0.01),且LEV组LVEF、E/A值均显著高于MIL组,LVIDd值均显著低于MIL组(P0.01)。两组治疗7 d后血清NT-proBNP、ET-1水平较治疗前均显著降低(P0.01),且LEV组血清NT-proBNP、ET-1水平均明显低于MIL组(P0.01)。LEV组不良反应的发生率较MIL组明显降低(P0.05)。结论:与米力农相比,左西孟旦治疗难治性心力衰竭能更有效缓解或消除患者症状体征、抑制心室重构、改善心功能,且安全性更高,可能与其显著降低血清NT-proBNP、ET-1水平有关。

Comparison of Efficacy of Levosimendan and Milrinone in Treatment of Refractory Heart Failure and Effects on Serum NT-proBNP and ET-1 Levels

ABSTRACT Objective: To observe and compare the clinical effects of levosimendan(LEV) and milrinone (MIL) in the treatment of refractory heart failure (RHF) and the effects on the serum N-terminal pro-brain natriuretic peptide (NT-proBNP) and endothelin (ET)-1 levels. Methods: 102 cases of RHF patients admitted in our hospital from January 2015 to April 2017 were selected and divided into the following two groups according to the random number table. MIL group was given MIL treatment, while LEV group was treated with LEV. The clinical efficacy, echocardiographic index left ventricular ejection fraction (LVEF), early diastolic mitral valve/ late diastolic peak velocity(E/A), left ventricular end diastolic diameter (LVIDd) ] and serum NT-proBNP and ET-1 levels before and after the treat- ment and incidence of adverse reaction were compared between the two groups. Results: After 7 days'' treatment, the total effective rate of LEV group was significantly higher than that of the MIL group (P<0.05). Compared with those before the treatment, the LVEF and E/A of two groups after 7 days'' treatment were significantly increased (P<0.01), while the LVIDd levels were significantly decreased(P<0.01). The LVEF and E/A of LEV group were significantly higher than those of the MIL group (P<0.01), while LVIDd level was obviously lower. The levels of serum NT-proBNP and ET-1 levels of two groups after 7days'' treatment were were significantly lower than those before the treatment (P<0.01), which were significantly lower in the LEV group than those of the MIL group (P<0.01). The incidence rate of ad- verse reaction of LEV group was significantly lower than that of the MIL group (P<0.05). Conclusion: Compared with MIL, LEV can al- leviate or eliminate the symptoms and signs, inhibit ventricular remodeling and improve cardiac function with better safety in the treat- ment of heart failure, which might be related to the decrease of serum serum NT-proBNP and ET-1 levels.