托伐普坦对老年心力衰竭患者心功能和神经内分泌因子的影响

Effects of tolvaptan on cardiac function and neuroendocrine factors in elderly patients with heart failure

摘要:

目的 研究托伐普坦对心功能和神经内分泌因子的影响。方法 回顾性分析2017年1月至2019年1月陕西省人民医院心血管内科老年心力衰竭患者84例,根据利尿剂药物不同分为呋塞米组和托伐普坦组,每组42例,用药2周后比较2组患者心功能指标和脑钠肽(BNP)、内皮素(ET)及β-内啡肽水平。应用SPSS 18.0统计软件对数据进行分析。依据数据类型采用t检验或χ²检验进行组间比较。结果 与治疗前相比,2组患者治疗后左心室射血分数(LVEF)和6min步行距离水平升高,左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、心率、BNP、ET和β-内啡肽水平降低,且托伐普坦组治疗后较呋塞米组患者LVEF[(45.77±3.41)%和(40.82±4.09)%]、6min步行距离[(474.51±8.45)和(395.90±6.48)m]、LVESD[(41.09±3.47)和(45.63±4.55)mm]、LVEDD[(52.07±5.47)和(58.61±6.11)mm]和心率[(80.47±8.22)和(90.55±6.45)次/分]改善明显,BNP[(456.36±5.24)和(684.80±6.35)ng/L]、ET[(45.77±5.22)和(66.03±5.76)ng/L]和β-内啡肽[(123.79±10.35)和(140.82±11.64)ng/L]水平降低,差异均有统计学意义(P＜0.05)。与呋塞米组比较,托伐普坦组总有效率[90.48%(38/42)和78.57%(33/42)]升高,差异有统计学意义(χ² ＝5.422,P＝0.020)。2组患者不良反应发生率[4.76%(2/42)和9.52%(4/42)]比较,差异无统计学意义(P>0.05)。结论 托伐普坦用于老年心力衰竭患者可增强心功能,降低神经内分泌因子水平。

Abstract:

Objective To determine the effect of tolvaptan on cardiac function and neuroendocrine factors. Methods A total of 84 elderly patients with heart failure (HF) admitted in Shaanxi People′s Hospital from January 2017 to January 2019 were retrospectively collected in this study. According to the diuretic drugs, they were divided into furosemide group and tolvaptan group (n=42). After 2 weeks of treatment, the cardiac function indicators and the levels of brain natriuretic peptide (BNP), endothelin (ET) and beta-endorphin were compared between the 2 groups. SPSS statistics 18.0 was used to analyze the data. Student′s t test or Chi-square test was employed for intergroup comparison. Results After treatment, left ventricular ejection fraction (LVEF) and 6-minute walking distance were increased, while left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), heart rate, and serum levels of BNP, ET and beta-endorphin were decreased in both groups. After treatment, the levels of LVEF [(45.77±3.41)% vs (40.82±4.09)%], 6-minute walking distance [(474.51±8.45) vs (395.90±6.48)m], LVESD [(41.09±3.47) vs (45.63±4.55)mm], LVEDD [(52.07±5.47) vs (58.61±6.11)mm] and heart rate [(80.47±8.22) vs (90.55±6.45)beats/min] were greatly improved, and the levels of BNP [(456.36±5.24) vs (684.80±6.35)ng/L], ET [(45.77±5.22) vs (66.03±5.76)ng/L] and beta-endorphin [(123.79±10.35) vs (140.82±11.64)ng/L] were notably decreased in the tolvaptan group than in the furosemide group (P<0.05). Compared with the furosemide group, the total effective rate of tolvaptan group was higher in tolvaptan group [90.48%(38/42) vs 78.57%(33/42), χ²=5.422, P=0.020], but no such difference was seen in the incidence of adverse reactions between the 2 group [(4.76%(2/42) vs 9.52%(4/42), P>0.05]. Conclusion Tolvaptan can improve cardiac function and reduce neuroendocrine factors in elderly patients with heart failure.