2019 年第 1 期 第 14 卷

生物瓣膜置换术联合托拉塞米治疗心脏瓣膜病的效果及对B型脑钠肽和脂蛋白相关磷脂酶A2水平的影响

Effect of biological valve replacement combined with torasemide on heart valve disease and levels of brain natriuretic peptide and lipoprotein-associated phospholipase A2

作者：周子凡王龙飞董松坡潘旭东刘宁宁许尚栋孙立忠

英文作者：

单位：100029首都医科大学附属北京安贞医院心脏外科

英文单位：

关键词：心脏瓣膜病；生物瓣膜置换术；托拉塞米；B型脑钠肽；脂蛋白相关磷脂酶A2

英文关键词：

• 摘要：

• 【摘要】目的    探究生物瓣膜置换术联合托拉塞米治疗心脏瓣膜病的效果及对B型脑钠肽（BNP）和脂蛋白相关磷脂酶A2（Lp-PLA2）水平的影响。方法    选取2014年5月至2017年5月在首都医科大学附属北京安贞医院治疗的118例心脏瓣膜病患者为研究对象，按照随机数字表法分为观察组和对照组，各59例。观察组给予生物瓣膜置换术联合托拉塞米进行治疗，对照组给予生物瓣膜置换术进行治疗。观察2组患者的治疗效果，治疗前后心脏功能、血清炎症因子及BNP和Lp-PLA2水平的变化。结果    观察组治疗有效率高于对照组［96.6%（57/59）比78.0%（46/59）］，差异有统计学意义（P<0.05）。治疗后，2组患者的心排血量、心排血指数和左心室射血分数均大于治疗前，且观察组大于对照组［（6.18±0.83）L/min比（5.23±0.78）L/min、（3.28±0.16）L/(min·m2)比（2.97±0.14）L/(min·m2)、（55.2±3.8）%比（42.2±3.2）%］；2组患者的肿瘤坏死因子α、白细胞介素1β和白细胞介素6水平均低于治疗前，且观察组低于对照组［（9.3±1.3）pmol/L比（14.0±2.3）pmol/L、（0.16±0.07）μg/L比（0.23±0.08）μg/L、（92±8）ng/L比（109±9）ng/L］；2组患者的BNP水平高于治疗前、Lp-PLA2水平低于治疗前，且观察组BNP水平高于对照组、Lp-PLA2水平低于对照组［（837±38）ng/L比（538±32）ng/L、（141±10）μg/L比（166±10）μg/L］，差异均有统计学意义（均P<0.05）。结论    生物瓣膜置换术联合托拉塞米能够显著改善患者心脏功能，降低机体炎症反应，增加血浆BNP水平，降低血清Lp-PLA2水平，达到有效治疗心脏瓣膜疾病的目的。    

• 【Abstract】Objective    To explore the effect of biological valve replacement combined with torasemide on patients with heart valve disease and the levels of brain natriuretic peptide（BNP） and lipoprotein-associated phospholipase A2（Lp-PLA2）. Methods    From May 2014 to May 2017, 118 patients with heart valve disease admitted to Beijing Anzhen Hospital, Capital Medical University were randomly divided into observation group and control group, with 59 cases in each group. The control group was treated with biological valve replacement. The observation group had biological valve replacement combined with intravenous administration of torasemide. Clinical efficiency, heart function, serum levels of inflammatory factors, BNP and Lp-PLA2 were analyzed. Results    Therapeutic effective rate in the observation group was significantly higher than that in the control group［96.6%(57/59) vs 78.0%(46/59)］(P<0.05). After treatment, cardiac output, cardiac index and left ventricular ejection fraction were improved compared to those before treatment in both groups; these indicators in the observation group were significantly higher than those in the control group［（6.18±0.83）L/min vs （5.23±0.78）L/min, （3.28±0.16）L/(min·m2) vs （2.97±0.14）L/(min·m2), （55.2±3.8）% vs （42.2±3.2）%］; levels of tumor necrosis factor-α, interleukin-1β and interleukin-6 significantly decreased; the levels in the observation group were significantly lower than those in the control group［（9.3±1.3）pmol/L vs （14.0±2.3）pmol/L, （0.16±0.07）μg/L vs （0.23±0.08）μg/L, （92±8）ng/L vs （109±9）ng/L］; BNP level increased and Lp-PLA2 level decreased compared to those before treatment; BNP level in the observation group was significantly higher and Lp-PLA2 level was significantly lower than those in the control group［（837±38）ng/L vs （538±32）ng/L, （141±10）μg/L vs （166±10）μg/L］(all P<0.05). Conclusion    Biological valve replacement combined with torasemide treating heart valve disease can significantly improve heart function, reduce inflammatory reaction, increase the level of serum BNP and decrease serum Lp-PLA2.