2020 年第 2 期 第 15 卷

伊伐布雷定治疗慢性心力衰竭的效果及对患者B型脑钠肽和N末端B型脑钠肽前体水平的影响

Effect of ivabradine on chronic heart failure, B-type brain natriuretic peptide and N-terminal pro-B-type brain natriuretic peptide

作者：孙军奎薛兴翠贺连栋刘宝明

英文作者：

单位：青海红十字医院全科医学科，西宁810000

英文单位：

关键词：慢性心力衰竭；伊伐布雷定；心功能；炎性反应

英文关键词：

• 摘要：

• 【摘要】目的    探究伊伐布雷定治疗慢性心力衰竭的效果及对患者B型脑钠肽（BNP）和N末端B型脑钠肽前体（NT-proBNP）水平的影响。方法    选取2016年5月至2018年5月于青海红十字医院接受治疗的慢性心力衰竭患者100例，按照完全随机方法分为常规治疗组和伊伐布雷定组，各50例。常规观察组患者进行常规抗心力衰竭、降心率治疗；伊伐布雷定组患者在常规治疗组的基础上使用伊伐布雷定治疗。治疗1个月后，对2组患者治疗前后心功能指标、血压、心率进行检测，酶联免疫吸附试验法检测BNP、NT-proBNP、肿瘤坏死因子α（TNF-α）、白细胞介素6（IL-6）、丙二醛、超氧化物歧化酶（SOD）水平，蛋白质印迹法检测B淋巴细胞瘤2(Bcl-2)、磷脂酰肌醇-3-激酶(PI3K)和蛋白激酶B(Akt)表达，对比2组患者的治疗效果及不良反应发生情况。结果    治疗后，伊伐布雷定组左心室收缩末期内径、左心室舒张末期内径、BNP水平低于常规治疗组［（82±16）ng/L比（122±31）ng/L］、NT-proBNP水平［（456±52）ng/L比（1 024±233）ng/L］，收缩压、舒张压、心率和IL-6、TNF-α、丙二醛水平也低于常规治疗组，SOD水平和Bcl-2、PI3K、Akt相对表达量均高于常规治疗组，差异均有统计学意义（均P＜0.05）。伊伐布雷定组的总有效率明显高于常规治疗组［96.0%(48/50)比82.0%(41/50)］，不良反应发生率明显低于常规观察组［6.0%(3/50)比20.0%(10/50)］，差异均有统计学意义（均P＜0.05）。结论    使用伊伐布雷定对慢性心力衰竭患者进行治疗，能够改善患者心功能，使患者BNP、NT-proBNP水平下降，抑制炎性反应，改善抗氧化能力，抑制心肌细胞凋亡，治疗效果明显，且安全性较高。

• 【Abstract】Objective    To explore the clinical efficacy of ivabradine treating chronic heart failure and the effect on B-type brain natriuretic peptide(BNP) and N-terminal pro-B-type natriuretic peptide(NT-proBNP) levels. Methods    A total of 100 patients with chronic heart failure admitted to Qinghai Red Cross Hospital from May 2016 to May 2018 were randomly divided into routine group and ivabradine group, with 50 cases in each group. The routine group was treated with conventional anti-heart failure and heart rate-lowering therapy and the ivabradine group was treated with ivabradine on the basis of routine therapy for 1 month. Cardiac function indexes, blood pressure and heart rate were measured before and after treatment. Serum levels of BNP, NT-proBNP, tumor necrosis factor-α（TNF-α）, interleukin-6（IL-6）, malonyldiadehyde and superoxide dismutase(SOD) were tested by enzyme linked immunosorbent assay. Expressions of B-lymphocytoma 2(Bcl-2), phosphatidylinositol-3 kinase(PI3K) and protein kinase B(Akt) were tested by western blotting. Therapeutic effect and adverse reactions were observed. Results    After treatment, left ventricular end-systolic dimension, left ventricular end-diastolic dimension, BNP level［（82±16）ng/L vs （122±31）ng/L］, NT-proBNP level［（456±52）ng/L vs （1 024±233）ng/L］, systolic blood pressure, diastolic blood pressure and heart rate in ivabredine group were lower than those in routine group; levels of IL-6, TNF-α and malonydiadehyde in ivabredine group were lower and SOD level was higher than those in routine group; expression levels of Bcl-2, PI3K and Akt in ivabredine group were higher than those in routine group; the differences were significant between groups（all P＜0.05）. Total effective rate in ivabradine group was significantly higher than that in routine group［96.0%(48/50) vs 82.0%(41/50)］(P＜0.05). Incidence of adverse reactions in ivabradine group was significantly lower than that in routine group［6.0%(3/50) vs 20.0%(10/50)］(P＜0.05). Conclusions    Ivabradine treating chronic heart failure can effectively improve heart function, reduce BNP and NT-proBNP levels, inhibit inflammation, improve antioxidant capacity and inhibit cardiomyocyte apoptosis. The therapeutic effect is remarkable and the safety is satisfectory.