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目的通过观察心率变异性(HRV)指标、心功能指标及生化指标变化,探讨螺内酯对扩张型心肌病心衰患者心率变异性、心室重构的影响以及用药的安全性。方法选择扩张型心肌病心衰患者67例,分为常规治疗组(32例)和螺内酯组(35例),视液体潴留及血钾浓度情况加用呋噻米及补钾治疗。治疗前1天及治疗3个月后分别检测心率变异性及各项心功能指标。结果两组基线参数无统计学差异。治疗后两组HRV的时域指标SDNN、SDANN、rMSSD及频域指标较治疗前均明显改善,螺内酯组改善更为显著(p<0.05),SDANN、rMSSD的改善以6～10时最显著。治疗后两组的LVEF及左室重构的指标LVMI、LVEDVI、LVESVI均较治疗前有明显改善(p<0.01),螺内酯组改善更为显著(p<0.05)。血钾两组比较无差异性,而血肌酐在螺内酯组升高,但均在正常范围。螺内酯组4例男性患者发生乳房发育,但均可耐受。结论螺内酯能够有效改善扩张型心肌病心衰患者的自主神经系统功能及左室功能,逆转心室重构。只要配合合适剂量的排钾利尿剂并注意监测血钾浓度及肾功能,应用螺内酯治疗是安全的。
Objective To observe the effects of spironolactone on heart rate variability and ventricular remodeling in patients with heart failure due to dilated cardiomyopathy by observing heart rate variability (HRV), cardiac function and biochemical indexes. Methods Sixty-seven patients with heart failure with dilated cardiomyopathy were divided into routine treatment group (n = 32) and spironolactone treatment group (n = 35). Fluvastatin and potassium treatment were given according to the fluid retention and serum potassium concentration. One day before treatment and three months after treatment, heart rate variability and cardiac function were measured. Results There was no significant difference in baseline parameters between the two groups. After treatment, the time domain indices SDNN, SDANN, rMSSD and frequency domain of HRV in both groups were significantly improved compared with that before treatment, and the improvement was more significant in spironolactone group (p <0.05). The improvement of SDANN and rMSSD was the most significant at 6-10. LVEF and LVMI, LVEDVI and LVESVI in both groups after treatment were significantly improved compared with before treatment (p <0.01), and the spironolactone group improved more significantly (p <0.05). There was no difference between the two groups of serum potassium, but serum creatinine increased in the spironolactone group, but both were in the normal range. Spironolactone group 4 cases of male patients with breast development, but can be tolerated. Conclusion Spironolactone can effectively improve autonomic nervous system function, left ventricular function and reverse ventricular remodeling in patients with heart failure of dilated cardiomyopathy. As long as with the appropriate dose of row of potassium diuretics and pay attention to monitoring serum potassium concentration and renal function, the application of spironolactone treatment is safe.