Emergency Department, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China.
Cardiovasc Ther. 2013 Apr;31(2):108-14. doi: 10.1111/1755-5922.12001.
Only limited data of the long-term effect of levosimendan on renal dysfunction in patients with decompensated heart failure (DHF) have been published previously. To date, there has been no similar study carried out in a Chinese population.
A prospective, randomized, placebo-controlled, and double-blind study was performed to investigate the effect of levosimendan on estimated glomerular filtration rate (eGFR) in DHF patients with renal dysfunction during a 30-day period. Sixty-six patients with left ventricular ejection fraction (LVEF) ≤40% and eGFR 15-89 mL/min/1.73 m(2) were randomized in a 1:1 ratio to receive a 24-h infusion with levosimendan or placebo. The B-type natriuretic peptide (BNP) and eGFR were determined at baseline and day 1, 3, 7, 14, 30 after the start of treatment.
The eGFR levels were obviously enhanced following levosimendan, peaked at 3 days, sustained for at least 14 days, and returned to baseline by day 30 after starting infusion. In contrast, placebo did not induce any significant changes in eGFR levels during the follow-up. In addition, levosimendan resulted in a distinct decrease in BNP levels in comparison with placebo, and the beneficial effect returned to baseline by day 14 and remained so at day 30 postinfusion.
A 24-h infusion with levosimendan transiently improved the renal dysfunction compared with placebo in patients with DHF, and its beneficial effects persisted for at least 14 days after the initiation of treatment.
先前仅有有限的数据报道了左西孟旦对失代偿性心力衰竭（DHF）患者肾功能障碍的长期影响。迄今为止，尚未在中国人中开展过类似的研究。
进行了一项前瞻性、随机、安慰剂对照、双盲研究，以调查左西孟旦对肾功能障碍的 DHF 患者在 30 天内估算肾小球滤过率（eGFR）的影响。将 66 例左心室射血分数（LVEF）≤40%和 eGFR 为 15-89 mL/min/1.73 m²的患者按 1:1 的比例随机分为两组，分别接受 24 小时左西孟旦或安慰剂输注。在治疗开始时、第 1、3、7、14 和 30 天测定 B 型利钠肽（BNP）和 eGFR。
左西孟旦可明显增强 eGFR 水平，于第 3 天达峰值，至少持续 14 天，并在开始输注后第 30 天恢复至基线。相比之下，安慰剂在随访期间未引起 eGFR 水平的显著变化。此外，与安慰剂相比，左西孟旦可显著降低 BNP 水平，并且其有益作用在第 14 天恢复至基线，并在输注后第 30 天保持不变。
与安慰剂相比，DHF 患者接受 24 小时左西孟旦输注可短暂改善肾功能障碍，且其有益作用至少在治疗开始后持续 14 天。
