Wang Lexin, Song Shukai
School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, NSW 2678, Australia.
Med Hypotheses. 2005;64(1):124-6. doi: 10.1016/j.mehy.2004.02.058.
Digoxin has been used to treat congestive heart failure (CHF) for more than two centuries. It's clinical efficacy, however, has been under question in recent years because recent clinical trials showed that digoxin therapy in CHF patients was associated with no beneficial effects in mortality, but only a modest reduction in clinical symptoms and the frequency of heart failure related hospitalisation. Digoxin's effect on mortality seems closely related to its serum concentrations; high serum concentrations (e.g. >or=1.2 ng/ml) have been found to increase the risk of all-cause mortality in heart failure patients. Digoxin-associated risk in mortality may be due to an increases in myocardial oxygen consumption and arrhythmogenesis at higher serum concentrations. We hypothesized that the serum concentration of digoxin is a major determinant factor of its efficacy on mortality rates in patients with congestive heart failure. The maintenance of digoxin's serum concentration at the lower end of the reference range, i.e., between 0.5 and 0.8 ng/ml, may reduce mortality rates as well as improve clinical symptoms.
两个多世纪以来，地高辛一直用于治疗充血性心力衰竭（CHF）。然而，其临床疗效近年来受到质疑，因为近期临床试验表明，CHF患者接受地高辛治疗对死亡率并无有益影响，只是能适度减轻临床症状并降低与心力衰竭相关的住院频率。地高辛对死亡率的影响似乎与其血清浓度密切相关；已发现高血清浓度（如≥1.2 ng/ml）会增加心力衰竭患者全因死亡率的风险。地高辛相关的死亡风险可能是由于较高血清浓度下心肌氧耗增加和心律失常。我们推测，地高辛的血清浓度是其对充血性心力衰竭患者死亡率疗效的主要决定因素。将地高辛的血清浓度维持在参考范围的下限，即0.5至0.8 ng/ml之间，可能会降低死亡率并改善临床症状。
