Department of Critical Medicine.
Department of Cardiology.
Medicine (Baltimore). 2021 Feb 5;100(5):e23188. doi: 10.1097/MD.0000000000023188.
To explore the short-term effect of high-dose spironolactone (80 mg/d) on chronic congestive heart failure (CHF).The general clinical data of 211 patients with CHF from February 2016 to August 2019 were collected and analyzed. Patients were divided into Low-dose group (taking 40 mg/d spironolactone) and High-dose group (taking 80 mg/d spironolactone) according to the patient's previous dose of spironolactone. The changes of B-type brain natriuretic peptide (BNP), NT-pro BNP (N terminal pro B type natriuretic peptide), echocardiography, 6-minute walking test (6MWT), and comprehensive cardiac function assessment data were collected for analysis.Compared with before treatment, the blood potassium of the two groups increased significantly (P < .05), but the blood potassium did not exceed the normal range. Compared with before treatment, BNP, NT-pro BNP, LVEDD, LVEDV and NYHA grading were significantly decreased (P < .05), LVEF and 6-MWT were significantly increased (P < .05). Compared with the Low-dose group, the high-dose group BNP (117.49 ± 50.32 vs 195.76 ± 64.62, P < .05), NT-pro BNP (312.47 ± 86.28 vs 578.47 ± 76.73, P < .05), LVEDD (45.57 ± 5.69 vs 51.96 ± 5.41, P <.05), LVEDV (141.63 ± 51.14 vs 189.85 ± 62.49, P < .05) and NYHA grading (1.29 ± 0.41 vs 1.57 ± 0.49, P < .05) were significantly reduced, but, 6-MWT (386.57 ± 69.72 vs 341.73 ± 78.62, P < .05), LVEF (41.62 ± 2.76 vs 36.02 ± 2.18, P < .05) and total effective rate (92.68% vs 81.39%, P < .05) increased significantly.Compared with 40 mg spironolactone, 80 mg spironolactone can rapidly reduce BNP and NT-pro BNP concentration, enhance exercise tolerance, improve clinical signs and cardiac function classification, and has better efficacy.
探讨大剂量螺内酯(80mg/d)治疗慢性充血性心力衰竭(CHF)的短期疗效。收集 2016 年 2 月至 2019 年 8 月 211 例 CHF 患者的一般临床资料,根据患者螺内酯的既往剂量分为低剂量组(服用 40mg/d 螺内酯)和高剂量组(服用 80mg/d 螺内酯)。收集分析两组患者治疗前后脑钠肽(BNP)、N 末端脑钠肽前体(NT-pro B 型钠尿肽)、超声心动图、6 分钟步行试验(6MWT)、综合心功能评估数据的变化。与治疗前相比,两组血钾均明显升高(P<0.05),但未超过正常范围。与治疗前相比,两组 BNP、NT-pro BNP、左室舒张末期内径(LVEDD)、左室舒张末期容积(LVEDV)和纽约心功能分级(NYHA)均明显降低(P<0.05),左室射血分数(LVEF)和 6MWT 明显升高(P<0.05)。与低剂量组相比,高剂量组 BNP(117.49±50.32 比 195.76±64.62,P<0.05)、NT-pro BNP(312.47±86.28 比 578.47±76.73,P<0.05)、LVEDD(45.57±5.69 比 51.96±5.41,P<0.05)、LVEDV(141.63±51.14 比 189.85±62.49,P<0.05)和 NYHA 分级(1.29±0.41 比 1.57±0.49,P<0.05)均明显降低,但 6MWT(386.57±69.72 比 341.73±78.62,P<0.05)、LVEF(41.62±2.76 比 36.02±2.18,P<0.05)和总有效率(92.68%比 81.39%,P<0.05)明显升高。与 40mg 螺内酯相比,80mg 螺内酯能更快降低 BNP 和 NT-pro BNP 浓度,提高运动耐量,改善临床体征和心功能分级,疗效更好。