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Objective:To investigate the daily dietary fiber intake, the main adverse cardiovascular events during follow-up and the cardiac event-free survival in patients with chronic heart failure, and to analyze the relationship between dietary fiber intake and cardiac event-free survival in this population.Methods:This study was a prospective investigation. The investigation was performed in chronic heart failure patients from three third-class hospitals in Suzhou using general information questionnaire and 3-day diet diary. Major adverse cardiovascular events within 6 months after discharge and event-free survival were obtained by telephone call and medical records.Results:The incidence of major cardiovascular adverse events in 122 patients with heart failure was 27.9% within 6 months after discharge. Their dietary fiber intake was 8.1(5.8-10.9)g/d, lower than the recommended intake. Kaplan-Meier plots and log-rank tests demonstrated that cardiac event-free survival was significantly shorter in patients with dietary fiber deficiency ( P=0.043). Patients with dietary fiber intake ≥6 g/d after discharge showed decreased risk of major adverse cardiovascular events compared to patients with dietary fiber intake<6 g/d ( HR=0.422; 95% CI=0.189-0.942; P=0.035). Conclusions:This study revealed insufficient dietary fiber intake in patients with heart failure. Insufficient dietary fiber intake was associated with higher risk of major adverse cardiovascular events and shorter cardiac event-free survival in heart failure patients within 6 months after discharge. In conclusion, patients with heart failure can increase dietary fiber intake in order to improve prognosis.
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Objective To understand the related influencing factors of pleural effusion caused by severe congestive heart failure to provide an idea for clinical diagnosis and treatment.Methods Three hundreds patients with severe congestive heart failure admitted to the cardiology department of this hospital from January to June 2015 were selected.The sex,age,heart failure degree,pleural effusion,type of heart disease,diabetes mellitus,atrial fibrillation,B-type pro-brain natriuretic peptide,white blood cell,neutrophil percentage,hemoglobin,blood urea nitrogen,serum albumin and hospital stay were recorded and performed the statistical analysis.Results The sex,heart failure degree,ejection fraction,B-type pro-brain natriuretic peptide,neutrophil percentage and serum albumin had statistical differences between the patients with pleural effusion caused by severe congestive heart failure and patients without pleural effusion(P＜0.05).The left atrial diastolic diameter/left ventricular end-diastolic diameter,white blood cell,hemoglobin,blood urea nitrogen,type of heart disease,diabetes,atrial fibrillation and hospitalization stay had no statistically significant differences(P＞0.05).Conclusion Pleural effusion caused by severe congestive heart failure has the correlation with the sex,heart failure degree,hypoproteinemia and neutrophil percentage.
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Objective To investigate the characteristics and clinical value of dynamic electrocardiogram in the treatment of patients with congestive heart failure and atrial arrhythmia.Methods A total of 226 congestive heart failure patients were taken into this research.124 congestive heart failure and atrial arrhythmia patients were divided into OSG group,102 congestive heart failure patients were divided into CTG group.24 -hour Holter monitoring was examined in both groups with ATA including AFR,AFL,ATC and PAC by dynamic electrocardiogram made in Mei Gaoyi medical equipment company.Results The ATA was (824.6 ±108.2)times(compared with the control group, t =9.054,P =0.019)in 124cases of the OSG group,including ATC (80.4 ±25.8)cases (compared with the control group,P =0.021,t =8.934).duration time (25.4 ±9.7)s,AFL (26.8 ±7.1 )cases(compared with the control group,P =0.014,t =9.162).duration time (13.5 ±5.8)s,AFR (97.5 ±51.3)times (compared with the control group,t =9.314,P =0.009).duration time (70.1 ±18.5)s,PAC (41.9 ±14.3)cases (compared with the control group,t =8.796,P =0.026).duration time (34.8 ±11.2)s.The ATA was (102.6 ±59.3)times in 102cases of the CTG group,including ATC (69.5 ±19.4)cases,duration time(5.7 ±1.3)s,AFL(8.5 ±2.6)cases,duration time (2.6 ±0.9)s,AFR (27.6 ±12.5)times,duration time,PAC(24.8 ±10.4)cases,duration time(19.6 ±7.9)s, which was significantly different with the CTG group(t =8.796,P <0.05).Conclusion CHF patients are probable to be complicated with ATA.The DCG examination in CHF patients is conducive to improve the effect of treatment and limit chances of sudden death,which is worthy of promotion.
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Tolvaptan is a novel oral selective arginine vasopressin V2 receptor antagonist.Tolvaptan improves heart failure signs and symptoms without serious adverse events.Tolvaptan has no effect on all-cause mortality and cardiovascular death or admission rate for heart failure.But in heart failure patients with hyponatremia,tolvaptan can decrease cardiovascular death and admission rate for heart failure.
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Objective To investigate the clinical curative effect and safety of Shenmai combined with meglu-mine adenosine cyclophosphate in the treatment of chronic heart failure.Methods 118 patients with chronic heart failure were selected as the research subjects.They were randomly divided into control group and observation group, 59 cases in each group.The patients in the control group received routine comprehensive treatment,the observation group was given intravenous Shenmai injection 50mL,1 /d,meglumine adenosine cyclophosphate injection 120mg, 250mL 5% glucose injection intravenous drip note,the 1 time /d,7d for a course of treatment.Two groups of patients received a total of 2 courses of treatment.Before and after treatment,left ventricular ejection fraction (LVEF)was detected by cardiac ultrasound,and the brain natriuretic peptide (BNP)level in patients was measured.The total effective rate of the two groups was analyzed.Results Before treatment,LVEF of the control group and the observa-tion group were (32.19 ±5.72)%,(32.50 ±6.01 )%.After treatment,LVEF of control group was (36.62 ± 4.13)%,LVEF indexes in the observation group was (42.09 ±5.52)%,LVEF increased significantly in the two groups,but that in the observation group was higher than that of the control group (t =-3.882,P =0.017),the difference was statistically significant.Before treatment,BNP index of the observation group and the control group were (485.16 ±206.15 )pg/mL,(489.11 ±178.96)pg/mL,after treatment,BNP level of the observation group was (159.29 ±93.62)pg/mL,BNP level in the control group was (322.36 ±156.58)pg/mL,BNP in the observation group was significantly lower than that of the control group(t =-7.443,P =0.000).24 cases in the observation group after treatment,effective in 30 cases,the total effective rate was 91.53%,which was significantly higher than 76.27% of the control group (χ2 =9.524,P =0.003).No obvious adverse reactions or allergic reaction etc.were observed in the observation group.Conclusion The therapeutic effect of combination of Shenmai injection and meglumine in the treatment of chronic heart failure is accurate,it can significantly improve cardiac function,and has high safety,and without adverse reaction reports,it is worthy of the clinical application and popularization.
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Objective To investigate the clinical effect of continuous blood purification therapy in patients with severe heart failure and renal failure.Methods The clinical data of 38 patients with severe heart failure and renal failure treated by continuous blood purification were analyzed retrospectively.Heart rate,mean blood pressure, APACHE II score,Boston score,blood biochemistry,blood gas analysis and cardiac function changes were compared before and after the treatment of continuous blood purification.Results After treatment 12h and 72h,patients breath-ing[(19.24 ±2.88)times/min],heart rate[(88.57 ±15.68)times/min],APACHE Ⅱ [(14.28 ±3.26)points] and the score of Boston[(6.27 ±1.25 )points]were significantly decreased compared with those before treatment [(35.68 ±5.97)time /min,(131.24 ±24.26)time /min,(26.34 ±5.96)points,(17.88 ±2.87)points],and the differences were statistically significant (t =3.13 3.45,2.12,4.11,3.67,5.68,3.44,609,all P <0.05).38 cases of severe heart failure with renal failure after continuous blood purification treatment,markedly effective in 16 cases, effective in 12 cases,ineffective in 10 cases,the total effective rate was 73.68%.Patients after continuous blood purification treatment,the SCr[(168.15 ±31.16)μmol/L],BUN [(13.13 ±3.44)mmol/L]were significantly decreased.pH[(7.41 ±0.13)],HCO3 [(25.57 ±5.11)mmol/L],PaO2 [(88.26 ±7.72)mmHg],SaO2 [(96.43 ± 3.14)%]and blood biochemistry and blood gas index decreased markedly,and the differences were statistically significant (t =4.55,3.21,2.11,3.45,673,4.21,all P <0.05).After the examination of echocardiography,stroke volume (SV)[(59.31 ±6.58)mL],cardiac output (CO)[(4.57 ±0.62)L/min]and left ventricular ejection fraction (LVEF)[(68.12 ±4.88)%]increased significantly compared with before treatment,and the differences were statistically significant (t =4.33,5.12,367,all P <0.05).Conclusion Continuous blood purification could effectively maintain the hemodynamic stability of patients,and is safe and effective in the treatment of severe heart failure with renal failure.
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Objective To analyze the treatment and pathogenetic condition of chronic heart failure of coro -nary heart disease(CHD) and ventricular arrhythmia (VA).Methods 100 patients with chronic heart failure were collected to observe the treatment of chronic heart failure and pathogenetic condition of VA .Results 44 cases occured VA and 56 cases without VA in 100 patients.NT-proBNP(3 110.00 ±522.00)pg/mL of VA group was sig-nificantly higher than that (2 200.00 ±486.00)pg/mL of non-VA group(t=8.996,P (15.38%) with statistically significant(χ2 =5.853,12.532,27.375,all P<0.05).The amount(44.20 ±12.90)mg of use βreceptor blockers of amiodarone group was significantly lower than that of non -amiodarone group(44.20 ± 12.90)mg (t=5.284,P<0.05).Conclusion NT-proBNP of CHEF of CHD and VA patients will improve and amiodarone can reduce the amount of use anti -heart failure drug .
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Objective To investigate the clinical efficacy of trimetazidine in treatment of ischemic cardiomy-opathy heart failure and its influence on cardiac function and heart rate variability .Methods 160 cases of patients with ischemic cardiomyopathy heart failure were randomly divided into the two groups with 80 cases in each group .The two groups were given conventional treatment of anti heart failure ,the observation group used trimetazidine on basis of that,clinical effect and the influence on the index of heart rate variability and cardiac function of two groups were ob -served.Results The total effective rate of the observation group was 91.25%,significantly higher than 73.75% of the control group (χ2 =9.57,P<0.05);LVEDD and LVESD of the observation group after treatment were (49.88 ± 4.60)mm and (37.10 ±3.15)mm,significantly reduced than before treatment (t=7.44,7.83,all P<0.05) and the control group (t=6.60,6.85,all P<0.05); while the LVEF was (48.04 ±4.20)%,increased significantly than before treatment (t=6.51,P<0.05) and the control group (t=7.11,P<0.05);SDNN,SDANN,rMSSD and PNN50 of the observation group after treatment were (124.72 ±7.02)ms,(111.20 ±5.89)ms,(46.74 ±4.22)ms and (17.72 ±2.08)%,increased significantly than before treatment (t=7.43,7.83,7.06,8.17,all P<0.05) and the control group (t=6.66,6.90,6.15,7.21,all P<0.05).Conclusion Trimetazidine has an exact effect in treat-ment of ischemic cardiomyopathy heart failure ,which can improve heart function and heart rate variability which has an important value in clinical application .
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Objective To observe the effects of creatine phosphate sodium on heart function and B -type natriuretic peptide in patients combination with ischemic cardiomyopathy and intractable heart failure .Methods 70 cases of coronary heart disease combined with ischemic cardiomyopathy and intractable heart failure were randomly ( with the random number table ) divided into the control group ( n=33) and the creatine phosphate sodium treatment group (n=37).The control group treated with conventional therapy (digitalis,diuretics,vasodilator,ACEI,et al) ten days;the treatment group with creatine phosphate sodium treatment on the basis of conventional therapy .The symp-tom,sign of the heart failure patients of the two groups before and after treatment were observed .NYHA cardiac func-tional grading were estimated.Echocardiography was used to detect left ventricular end -systolic diameter(LVESD), left ventricular end diastolic diameter ( LVEDD ) and left ventricular ejection fraction ( LVEF ); amino terminal pro brain natriuretic peptide (NT-proBNP) tested by laboratory of the two groups.Drug treatment for 10 days,the chan-ges of the indicators before and after treatment were observed .Results After treatment , compared with the control group[(50.63 ±4.67) mm,(61.30 ±4.58) mm].LVESD,LVEDD of the creatine phosphate sodium treatment [(47.16 ±4.30)mm,(57.92 ±4.30)mm]significantly decreased(t=5.73,4.96,all P<0.01),LVEF[(40.57 ± 4.51)%,(37.63 ±4.53)%]increased significantly(t =5.53,P<0.01).After ten days of treatment levels of NT-proBNP decreased in both two groups [(1 659.±248.18) pg/mL,1 899.3 ±205.45] than before treatment [2 043.46 ±217.04,(2 105.46 ±239.09)pg/mL](t=3.23,3.64,all P<0.05),and the decrease degree of the creatine phosphate sodium treatment group was more obvious than those of the control group (t=4.11,P<0.05). Conclusion Creatine phosphate sodium can improve the cardiac function and left ventricular ejection fraction of ischemic cardiomyopathy and intractable heart failurepatients ,enhance the clinical symptoms of patients .
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Objective To analyze the effect of erythropoietin therapy with oral iron supplementation on red blood cell distribution width (RDW)in chronic heart failure patients with anemia.Methods 148 patients of chronic heart failure with anemia from September 2014 to March 2015 in our hospital were included and randomly divided into two groups with the random number table,with 74 cases in each group.The control group were treated with convention-al anti heart failure therapy,the treatment group were treated with erythropoietin and oral iron supplementation on the basis of routine treatment for four weeks.RDW was tested by automatic five classification blood analyzer.The correla-tion between RDW and other detection indexes was analyzed.Results The levels of RDW in the treatment group were significantly lower than those of the control group[(13.08 ±0.792)vs (14.32 ±0.864),t =-8.974,P <0.01].Before treatment,bivariate analysis in the treatment group showed that RDW had positive correlation with NT-proBNP and high -sensitivity C -relative protein (hs -CRP)(r =0.783,P <0.01;r =0.870,P <0.01),but negative correlation with serum creatinine (Cr)and hemoglobin (r =-0.338,P <0.01;r =-0.743,P <0.01).Af-ter treatment,bivariate correlations analysis in the treatment group showed that the difference of RDW was positive correlation with the difference of NT -proBNP,high -sensitivity C -relative protein (hs -CRP)(r =0.783,P <0.01;r =0.680,P <0.01),but negative correlation with the difference of hemoglobin(r =-0.459,P <0.01),and no correlation with the others (Cr,UA,LDL,TC,TG and LVEF).Conclusion On the basis of conventional anti heart failure treatment,erythropoietin therapy with oral iron supplementation against anemia could improve heart func-tion of CHF and decrease the levels of RDW.RDW may be served as one of observing indexes of the worsening and effect judgment in chronic heart failure patients with anemia.
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Objective To evaluate the effects and the prognosis of beta receptor blocker (metoprolol)dose adjustment of senile patients with chronic congestive heart failure (CHF)of acute exacerbation,and to provide reference for clinical treatment.Methods 76 cases with chronic CHF in acute exacerbation who treated with beta blockers and other reasonable treatment were randomly divided into half dose group (40 cases)and full stop group (36 cases).After adjusted for 3 months,the clinical symptoms were observed,noninvasive hemodynamic machine was used to detect cardiac index (CI),left cardiac work (LCW),cardiac output (CO)and changes of other indicators. Immunoradiometric analysis was used to detect plasma type B natriuretic peptide (BNP).Results 72h after treatment,in the half dose group,the progression of the disease in 13 cases,improved in 27 cases,in the full stop group,progression in 20 cases,improvement in 16 cases,the difference was statistically significant (χ2 =4.09,P <0.05).Before the adjustment of metoprolol,the index of the two groups had statistically significant difference(χ2 =4.52,P <0.05 ).Compared with pretreatment,the changes of NYHA classification,Co,CI,LCW of the half dose group were not obvious,and he change of NYHA of the full stop group was obvious,,III /IV the progression of the disease the number of cases increased in 5 cases and 3 cases,Co,Ci,LCW were reduced by about 25%,35% and 30%.After the adjustment of metoprolol,BNP of the half dose group was (321.8 ±97.6 )mg/L,which was significantly lower than (422.3 ±139.4)mg/L of the full stop group,the difference was statistically significant (t =3.94,P <0.05 ).Conclusion In the patients with beta blockers combined with other reasonable treatment, CHF patients with acute exacerbation of the beta blockers than the discontinuation of the prognosis,and the safety is high.
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Objective To investigate the prognostic factors for chronic heart failure and the prognostic ability of copeptin,big endothelin-1(Big ET-1)and N-terminal pro-brain natriuretic peptide (NT-proBNP)in patients with chronic heart failure. Methods To study 1 5 9 consecutive patients hospitalized for chronic heart failure.Serum concentration of copeptin,NT-proBNP,cTnI,CKMB and plasma Big ET-1 as well as left ventricular ejection fraction (LVEF)and NYHA classⅠtoⅣ on admission were measured.Cardiac events were found by patients to discharge after 360~490 days,prospectively.Results During a median follow-up period of 385 days,the endpoint of recurrence for cardiac events was reached in 65 patients with 159 heart failure.Multivarlate canonical correlation analysis shows the older and the higher NYHA classification as well as the lower LVEF in patients with heart failure.There were higher concentration of copeptin,Big ET-1 and NT-proBNP.On a Cox proportional hazards regression models analyses,age,copeptin,Big ET-1 and NT-proBNP were found to be the inde-pendent predictors of cardiac events.Risk ratio (RR)were 1.215,1.236,4.031 and 13.052,respectively.Logistic regression models analyses,copeptin,Big ET-1 and NT-proBNP were found independent predictors of death.Odd ratio (OR)were 4.003,2.477 and 1.235,respectively.Conclusion Measurement of copeptin,Big ET-1 and NT-proBNP in patients with chronic heart failure can help to identify patients at higher risk for cardiac events and patients for prognosis.
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Objective:To explore whether the effect relieving chronic heart failure (CHF) induced by Adriamycin of Ginsenoside-Rbl (Gs-Rbl ) is related to inhibiting Toll-like receptor (TLR ) . Methods :Adriamycin-induced CHF model rats were randomly divided into Adriamycin group (n=15) and Gs-Rb1 group (70 mg/kg d ,n=17);another 10 normal rats were regard as control group .Neonate rat cardiomyocytes were also randomly divided into control group ,Adriamycin group (1 μmol/L) and Gs-Rb1 group (1 μmol/L Adriamycin + 200 μmol/L Gs-Rbl) .After the intervention being performed ,echocardiography and expressions of TLR2/TLR4 gene and protein were assessed in all groups .Results:(1) Both studies in vivo and in vitro indicated that expressions of TLR 2 protein and mRNA in Adriamycin group were significantly higher than those of control group ,compared with Adriamycin group ,there were significant reductions in expressions of TLR2 protein [ (0.975 ± 0.022/0.564 ± 0.031) vs .(0.593 ± 0.018/0.344 ± 0.024)] and mRNA [ (0.576 ± 0.029/0.853 ± 0.043) vs .(0.349 ± 0.015/0.401 ± 0.021)] in Gs-Rbl group ,P<0.01 both ;(2) No matter study in vivo or in vitro ,expressions of TLR4 protein and mRNA in Adriamy-cin group were significantly higher than those of control group ,compared with Adriamycin group ,there were signif-icant reductions in expressions of TRL4 protein [ (0.654 ± 0.032/0.519 ± 0.013 ) vs . (0.371 ± 0.013/0.254 ± 0.027)] and mRNA [ (1.602 ± 0.013/0.838 ± 0.021) vs .(1.140 ± 0.021/0.503 ± 0.022)] in Gs-Rbl group , P<0.01 both .Conclusion:Adriamycin may trigger the process of CHF through increasing TLR 2 and TLR4. The effect of Gs-Rbl improving adriamycin-induced CHF may be related to inhibition of TLR 2 and TLR4 .
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Objective:To observe changes of serum uric acid (UA)level and red cell distribution Width (RDW)in se-nile men With chronic heart failure (CHF),and explore their correlation With cardiac function.Methods:A total of 60 senile male CHF patients Were enrolled,including 28 cases of NYHA cardiac function class Ⅱ and 32 cases of NYHA class Ⅲ-Ⅳ.Another 30 cases With normal cardiac functionWere regarded as normal control group.Levels of UA,RDW and high sensitive C reactive protein (hsCRP)Were measured,and patients received color-coded Doppler echocardiography,change of every index Was compared among patients With different cardiac function class.Results:Compared With normal control group,there Were significant rise in serum levels of UA [(318.2± 54.3)μmol/L vs.(434.7±72.7)μmol/L],RDW [(13.84±0.60)% vs.(15.79±0.74)%]and hsCRP [(2.23 ±0.56)mg/L vs.(6.35±2.34)mg/L]in CHF group,and they significantly rose alongWith cardiac function class aggravated,P <0.01 all;there Were significant decrease in transmitral early diastolic peak floW velocity/transmitral late diastolic peak floWvelocity [E/A,(1.02±0.36)vs.(0.75±0.13)]and left ventricular ejection fraction [LVEF,(59±9)% vs.(49±9)%]in CHF group,and they significantly reduced along With cardiac function aggravated, P <0.01 both;in CHF group;UA,RDW and hsCRPWere negatively correlatedWith E/A and LVEF (r =-0.391~-0.731,P <0.05 all);RDW Was positively correlated With hsCRP (r =0.491,P <0.05).Conclusion: Serum uric acid and red cell distributionWidth are correlated to cardiac function in senile male patients,Which can help to judge the severity of heart failure and guide clinical treatment.
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Objective:To observe influence of trimetazidine on cardiac function in patients With chronic heart failure (CHF).Methods:According to number table method,a total of 70 CHF patients accorded With inclusion standards Were randomly and equally divided into trimetazidine group and routine treatment group.According to patient's condition,routine treatment group received digitalis,diuretics,angiotensin converting enzyme inhibitors etc CHF routine freatment.Trimetazidine group additionally received trimetazidine based on routine treatment.The treat-ment period Was four Weeks.Plasma brain natriuretic peptide (BNP)level Was measured and patients received 6min Walking test (6MWT)before and after treatment.Results:Compared With before treatment,there Was significant decrease in plasma BNP level in tWo groups after treatment (P<0.01),compared With routine treatment group, there Was significant increase in decreasing amplitude of BNP level [(655.89±135.61)pg/ml vs.(715.60±181.22) pg/ml,P<0.05]in trimetazidine group;compared With before treatment,there Was significant increase in 6min Walking distance (6MWD)in tWo groups after treatment (P<0.01),compared With routine treatment group,there Was significant increase in increasing amplitude of 6MWD [(181.46±51.16)m vs.(226.06±65.18)m,P<0.01] in trimetazidine group.Conclusion:Treatment trimetazidine can significantly reduce plasma brain natriuretic peptide level and improve heart function based on routine treatment in patients With heart failure.
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Objective To investigate the clinical efficacy and safety of lyophilized recombinant human brain natriuretic peptide(rhBNP) in the treatment of patients with congestive heart failure (CHF).Methods 120 CHF patients were randomly divided into two groups.58 cases in the observation group were given lyophilized rhBNP,and 62 patients in the control group were given sodium nitroprusside.The clinical effect,changes of echocardiographic indicators and hemodynamic parameters,adverse reactions were observed.Results After treatment,the total effective rate of the observation group was 91.37％,which was significantly higher than that of the control group(x2 =4.23,P ＜ 0.05).The LVEF and NT-proBNP levels in observation group were (59.0 ± 8.2)％ and (535.4 ± 123.8)ng/L,which had higher improvement than control group (P ＜ 0.05).The incidence rate of adverse reactions between the two groups had no significant difference (P＞ 0.05).Conclusion Lyophilized rhBNP in the treatment of CHF has significant effect,and it is worthy of clinical application and promotion.
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Objective To explore the effect of conventional western medicine combined with Qiangxin Tongmai decotion in the treatment of patients with chronic heart failure (CHF).Methods According to the digital table,60 patients with CHF were randomly divided into two groups,30 cases in each group.The control group was treated with conventional western medicine,while the treatment group received combination therapy of conventional western medicine and Qiangxin Tongmai decotion.The heart function and plasma brain natriuretic peptide (BNP) level were observed.Results The total effective rate of the treatment group was 93.3％,which was significantly higher than 70.0％ of the control group (x2 =5.455,P ＜ 0.05).After treatment,the level of BNP in the treatment group was (211.3 ± 87.7) ng/L,which was significantly lower than that of the control group [(410.8 ± 94.3) ng/L] (t =8.485,P ＜ 0.01).Conclusion Qiangxin Tongmai decotion can obviously improve the heart function and reduce the level of BNP in patients with CHF.
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Objective To explore the clinical effect and influence on cardiac function of losartan joint tar-trate metoprolol on heart function in patients with coronary heart disease ( CHD ) and chronic heart failure ( CHF ) . Methods 76 patients were randomly divided into two groups with double blind method ,control group adopted tartrate metoprolol treatment ,observation group on the basis of the losartan treatment ,compared two groups of cardiac function changes and clinical curative effect .Results After treatment,changes of DP/dtmax,DP/dtmax,LVEDP were greater than those of the control group ,the difference was statistically significant ( t=9.141,75.458,9.141,75.458,all P<0.05);compared with control group , the differences in LDH, SOD, NO were statistically significant ( t =6.951, 15.694,6.951,P<0.05);Observation group effectiveness was 89.47%,control group effectiveness was 78.95%, the difference in efficient between the two groups have statistical significance (Ridit=16.951,P=16.951);the rate for incidence of major adverse cardiovascular events in observation group was 7.89%;control group was 10.53%, there was no statistically significant difference in two groups (χ2 =0.695,P=0.695).Conclusion Curative effect of losartan with tartrate metoprolol treatment of coronary heart disease (CHD) is distinct,combination may be considered in clinical application and can improve cardiac function in patients adjusting the nerve -endocrine disorder from differ-ent mechanism .
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Objective:To explore the relationship among serum neutrophil gelatinase associated lipocalin (NGAL), cystatin C (Cys-C) levels and cardiac, renal function;and diagnostic value of NGAL and Cys-C for early renal damage in aged patients With coronary heart disease (CHD).Methods:According to NYHA cardiac function classi-fication,a total of 84 aged CHD patients Were divided into class I group (n=30),class Ⅱ group (n=28)and classⅢ-Ⅳ group (n=26).Another 31 aged healthy objects Were selected as healthy control group.Serum N terminal pro B-type natriuretic peptide (NT-proBNP),NGAL and Cys-C etc. levels Were measured,and the correlation a-mong serum NGAL,Cys-C levels and cardiac function,estimated glomerular filtration rate (eGFR)Were analyzed. The accuracy of serum NGAL and Cys-C diagnosing renal insufficiency Was evaluated by receiver operator character-istic curve (ROC).Results:Along With NYHA class increased,there Were significant increase in serum levels of NGAL [(36.96±21.23)μg/L vs.(87.80±61.40)μg/L vs.(141.21±92.96)μg/L vs.(198.15±98.46)μg/L] and Cys-C [(0.75±0.64)mg/L vs.(1.40±1.88)mg/L vs.(2.33±2.03)mg/L vs.(3.45±1.81)mg/L]in healthy control group,NYHA I,Ⅱ,Ⅲ-Ⅳ groups,and they Were highest in NYHA class Ⅲ-Ⅳ group,there Was significant difference in serum NGAL level betWeen any tWo groups among the four groups (P0.05). Pearson correlation analysis indicated that serum NGAL and Cys-C levels Were positively correlated With NT-proBNP (r=0.842,0.718,P<0.01 both),and negatively correlated With eGFR (r=-0.689,-0.448,P<0.01 both), and serum NGAL level had closer correlation With NT-proBNP and eGFR.Area under ROC of serum NGAL and Cys-C Were 0.884 and 0.744 respectively in diagnosing renal insufficiency.Conclusion:Serum NGAL and Cys-C lev-els have good correlation With cardiac and renal function in aged CHD patients,Which are sensitive and accurate in-dexes for diagnosing early renal damage.
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Objective To study the clinical efficacy of intensive insulin therapy (IIT) on patients with severe heart failure,pulmonary infection and hyperglycemia.Methods A retrospective analysis was studied on 104 patients with severe heart failure,pulmonary infection and hyperglycemia from January 2009 to August 2012,and 48 cases were treated by insulin conventional treatment (control group),while 56 cases were treated by IIT treatment (observation group).The blood glucose changes at each time and time of antibiotic using,pulmonary infection control situation and mortality rate between the two groups were observed and compared.Results The blood glucose before treatment in observation group and control group were (15.8 ± 4.3) and (15.3 ± 5.1) mmol/L,and there was no statistical difference (P ＞ 0.05).The blood glucose levels at 24,48,72 h and 1 week after treatment in observation group were (8.3 ± 2.1),(8.0 ± 1.2),(7.9 ± 1.3) and (7.9 ± 1.1) mmol/L,in control group were (12.5 ± 3.2),(11.7 ± 2.1),(11.3 ± 1.5) and (11.2 ± 1.7) mmol/L.The blood glucose levels after treatment in the two groups were significantly lower than those before treatment,but in observation group were significantly lower than those in control group,and there were statistical differences (P ＜0.01).The time of antibiotic using in observation group was significantly shorter than that in control group [(14.3 ± 2.5) d vs.(20.1 ± 3.2) d],and there was statistical difference(t =10.368,P ＜ 0.01).The total effective rate of pulmonary infection in observation group was significantly higher than that in control group [87.5％(49/56) vs.68.8％(33/48)],and there was statistical difference (x2 =5.448,P ＜ 0.05).The mortality rate in observation group was significantly lower than that in control group [8.9％ (5/56) vs.22.9％ (11/48)],and there was statistical difference (x2 =6.423,P ＜ 0.05).Conclusion The IIT used in the treatment of patients with severe heart failure,pulmonary infection and hyperglycemia can significantly improve the prognosis of patients and reduce mortality rate,which is worthy of clinical application.