PDF(Pubmed)
Abstract：
UNASSIGNED: To explore the effect and safety of calcium dibutyryl adenosine cyclophosphate (dbcAMP-Ca) combined with metoprolol in the treatment of older adults with heart failure combined with arrhythmia.
UNASSIGNED: A total of 102 elderly patients with heart failure combined with arrhythmia were enrolled in our hospital between February 2021 and April 2023. The list of patients enrolled was entered into a random database by independent staffs not involved in the study and random assignment sequences were generated by the SAS9.4 software. Then, the 102 elderly patients were divided into a control group ( n=51) and an experimental group ( n=51). Patients in the control group were given metoprolol at an initial dose of 6.25 mg/d, which was gradually increased to the target dose of 25 mg/d. Patients in the experimental group were given 40 mg of dbcAMP-Ca once a day via intravenous drip in addition to the treatment given to the control group. Both groups were treated for 4 weeks. The rate of effective response to clinical treatment (the number of cases achieving significant effects and those achieving some effects divided by the total number of cases in the group) was defined as the main outcome index. Secondary indexes included cardiac function, heart rate variability, exercise ability, hemorheology, myocardial injury indexes, inflammatory indexes, and the occurrence of adverse reactions.
UNASSIGNED: The rate of effective response to clinical treatment was higher in the experimental group than that in the control group (94.12% [48/51] vs. 78.43% [40/51], P<0.05). After treatment, the left ventricular end-diastolic and end-systolic dimensions (LVEDD and LVESD) and the interventricular septal thickness (IVS) were lower in the experimental group than those in the control group, while the left ventricular ejection fraction (LVEF) and the stroke volume (SV) were higher in the experimental group than those in the control group ( P<0.05). In terms of heart rate variability after treatment, the standard deviation of all the normal-to-normal intervals/the average of all the normal-to-normal intervals (SDNN/SDANN), the percentage of NN50 in the total number of normal-to-normal intervals (PNN50%), and the root mean square of the differences between adjacent normal-to-normal intervals/root mean square differences of successive R-R intervals (RMSSD) were higher in the experimental group than those in the control group ( P<0.05). In terms of exercise capacity after treatment, the subjects in the experimental group covered more distance in the 6-min walk test than those in the control group did ( P<0.05). In terms of the hemorheology indexes after treatment, the levels of platelet aggregation rate (PAgT), fibrinogen (FIB), erythrocyte sedimentation rate (ESR), and whole blood viscosity (ηb) were lower in the experimental group than those in the control group ( P<0.05). In terms of the myocardial injury indexes after treatment, the levels of serum N-terminal pro-brain natriuretic peptide (NT-pro BNP) and cardiac troponin I (cTnI) were lower in the experimental group than those in the control group, while the levels of insulin-like growth factor 1 (IGF-1) and cardiotrophin 1 (CT-1) were higher in the experimental group than those in the control group ( P<0.05). In terms of the inflammatory indexes after treatment, the levels of interleukin-6 (IL-6), high-sensitive C-reactive protein (hs-CRP), and tumor necrosis factor-α (TNF-α) were lower in the experimental group than those in the control group ( P<0.05). The incidence of adverse reactions in the experimental group (9.80%) and that in the control group (7.84%) were comparable ( P>0.05).
UNASSIGNED: The use of dbcAMP-Ca in addition to metoprolol can effectively improve cardiac function, heart rate variability, and exercise tolerance, while inhibiting inflammatory response in elderly patients with heart failure combined with arrhythmia, with high medication safety. The combination medication shows better safety and therapeutic effects than those of metoprolol used alone.
UNASSIGNED: A total of 102 elderly patients with heart failure combined with arrhythmia were enrolled in our hospital between February 2021 and April 2023. The list of patients enrolled was entered into a random database by independent staffs not involved in the study and random assignment sequences were generated by the SAS9.4 software. Then, the 102 elderly patients were divided into a control group ( n=51) and an experimental group ( n=51). Patients in the control group were given metoprolol at an initial dose of 6.25 mg/d, which was gradually increased to the target dose of 25 mg/d. Patients in the experimental group were given 40 mg of dbcAMP-Ca once a day via intravenous drip in addition to the treatment given to the control group. Both groups were treated for 4 weeks. The rate of effective response to clinical treatment (the number of cases achieving significant effects and those achieving some effects divided by the total number of cases in the group) was defined as the main outcome index. Secondary indexes included cardiac function, heart rate variability, exercise ability, hemorheology, myocardial injury indexes, inflammatory indexes, and the occurrence of adverse reactions.
UNASSIGNED: The rate of effective response to clinical treatment was higher in the experimental group than that in the control group (94.12% [48/51] vs. 78.43% [40/51], P<0.05). After treatment, the left ventricular end-diastolic and end-systolic dimensions (LVEDD and LVESD) and the interventricular septal thickness (IVS) were lower in the experimental group than those in the control group, while the left ventricular ejection fraction (LVEF) and the stroke volume (SV) were higher in the experimental group than those in the control group ( P<0.05). In terms of heart rate variability after treatment, the standard deviation of all the normal-to-normal intervals/the average of all the normal-to-normal intervals (SDNN/SDANN), the percentage of NN50 in the total number of normal-to-normal intervals (PNN50%), and the root mean square of the differences between adjacent normal-to-normal intervals/root mean square differences of successive R-R intervals (RMSSD) were higher in the experimental group than those in the control group ( P<0.05). In terms of exercise capacity after treatment, the subjects in the experimental group covered more distance in the 6-min walk test than those in the control group did ( P<0.05). In terms of the hemorheology indexes after treatment, the levels of platelet aggregation rate (PAgT), fibrinogen (FIB), erythrocyte sedimentation rate (ESR), and whole blood viscosity (ηb) were lower in the experimental group than those in the control group ( P<0.05). In terms of the myocardial injury indexes after treatment, the levels of serum N-terminal pro-brain natriuretic peptide (NT-pro BNP) and cardiac troponin I (cTnI) were lower in the experimental group than those in the control group, while the levels of insulin-like growth factor 1 (IGF-1) and cardiotrophin 1 (CT-1) were higher in the experimental group than those in the control group ( P<0.05). In terms of the inflammatory indexes after treatment, the levels of interleukin-6 (IL-6), high-sensitive C-reactive protein (hs-CRP), and tumor necrosis factor-α (TNF-α) were lower in the experimental group than those in the control group ( P<0.05). The incidence of adverse reactions in the experimental group (9.80%) and that in the control group (7.84%) were comparable ( P>0.05).
UNASSIGNED: The use of dbcAMP-Ca in addition to metoprolol can effectively improve cardiac function, heart rate variability, and exercise tolerance, while inhibiting inflammatory response in elderly patients with heart failure combined with arrhythmia, with high medication safety. The combination medication shows better safety and therapeutic effects than those of metoprolol used alone.
摘要：
■探讨二丁酰腺苷环磷酸钙（dbcAMP-Ca）联合美托洛尔治疗老年心力衰竭合并心律失常的疗效和安全性。
■在2021年2月至2023年4月期间，我院共纳入102例心力衰竭合并心律失常的老年患者。由不参与研究的独立人员将入选患者名单输入随机数据库，并通过SAS9.4软件生成随机分配序列。然后，将102例老年患者分为对照组(n=51)和实验组(n=51)。对照组患者给予美托洛尔,初始剂量为6.25mg/d,逐渐增加至目标剂量25mg/d。实验组患者在对照组治疗的基础上，每天一次静脉滴注40mgdbcAMP-Ca。两组均治疗4周。对临床治疗的有效反应率（达到显着效果的病例数和达到某些效果的病例数除以该组中的总病例数）被定义为主要结果指标。次要指标包括心功能，心率变异性,锻炼能力,血液流变学,心肌损伤指标,炎症指标，以及不良反应的发生。
■实验组临床治疗有效率高于对照组(94.12%[48/51]vs.78.43%[40/51]，P<0.05)。治疗后,实验组左心室舒张末期和收缩末期尺寸（LVEDD和LVESD）和室间隔厚度（IVS）均低于对照组，实验组左室射血分数(LVEF)和每搏输出量(SV)均高于对照组(P<0.05)。在治疗后的心率变异性方面，所有正常到正常间隔的标准偏差/所有正常到正常间隔的平均值(SDNN/SDANN)，NN50在正常到正常间隔总数中的百分比(PNN50%)，试验组相邻正常与正常间期之间的差异均方根/连续R-R间期的均方根差异（RMSSD）均高于对照组（P<0.05）。在治疗后的运动能力方面，实验组受试者在6min步行试验中的距离大于对照组（P<0.05）。在治疗后的血液流变学指标方面,血小板聚集率（PAgT），纤维蛋白原（FIB），红细胞沉降率（ESR），实验组全血黏度(ηb)低于对照组(P<0.05)。治疗后的心肌损伤指标,实验组血清N末端脑钠肽前体(NT-proBNP)和肌钙蛋白I(cTnI)水平低于对照组,实验组胰岛素样生长因子1(IGF-1)和心肌营养素1(CT-1)水平高于对照组(P<0.05)。在治疗后的炎症指标方面，白细胞介素-6（IL-6）的水平，高敏C反应蛋白(hs-CRP),实验组肿瘤坏死因子-α(TNF-α)水平低于对照组(P<0.05)。试验组不良反应发生率(9.80%)与对照组(7.84%)比较,差异无统计学意义(P>0.05)。
■除美托洛尔外，使用dbcAMP-Ca可有效改善心功能，心率变异性,和运动耐力，同时抑制老年心力衰竭合并心律失常患者的炎症反应,用药安全性高。与单独使用美托洛尔相比，联合用药显示出更好的安全性和治疗效果。
■在2021年2月至2023年4月期间，我院共纳入102例心力衰竭合并心律失常的老年患者。由不参与研究的独立人员将入选患者名单输入随机数据库，并通过SAS9.4软件生成随机分配序列。然后，将102例老年患者分为对照组(n=51)和实验组(n=51)。对照组患者给予美托洛尔,初始剂量为6.25mg/d,逐渐增加至目标剂量25mg/d。实验组患者在对照组治疗的基础上，每天一次静脉滴注40mgdbcAMP-Ca。两组均治疗4周。对临床治疗的有效反应率（达到显着效果的病例数和达到某些效果的病例数除以该组中的总病例数）被定义为主要结果指标。次要指标包括心功能，心率变异性,锻炼能力,血液流变学,心肌损伤指标,炎症指标，以及不良反应的发生。
■实验组临床治疗有效率高于对照组(94.12%[48/51]vs.78.43%[40/51]，P<0.05)。治疗后,实验组左心室舒张末期和收缩末期尺寸（LVEDD和LVESD）和室间隔厚度（IVS）均低于对照组，实验组左室射血分数(LVEF)和每搏输出量(SV)均高于对照组(P<0.05)。在治疗后的心率变异性方面，所有正常到正常间隔的标准偏差/所有正常到正常间隔的平均值(SDNN/SDANN)，NN50在正常到正常间隔总数中的百分比(PNN50%)，试验组相邻正常与正常间期之间的差异均方根/连续R-R间期的均方根差异（RMSSD）均高于对照组（P<0.05）。在治疗后的运动能力方面，实验组受试者在6min步行试验中的距离大于对照组（P<0.05）。在治疗后的血液流变学指标方面,血小板聚集率（PAgT），纤维蛋白原（FIB），红细胞沉降率（ESR），实验组全血黏度(ηb)低于对照组(P<0.05)。治疗后的心肌损伤指标,实验组血清N末端脑钠肽前体(NT-proBNP)和肌钙蛋白I(cTnI)水平低于对照组,实验组胰岛素样生长因子1(IGF-1)和心肌营养素1(CT-1)水平高于对照组(P<0.05)。在治疗后的炎症指标方面，白细胞介素-6（IL-6）的水平，高敏C反应蛋白(hs-CRP),实验组肿瘤坏死因子-α(TNF-α)水平低于对照组(P<0.05)。试验组不良反应发生率(9.80%)与对照组(7.84%)比较,差异无统计学意义(P>0.05)。
■除美托洛尔外，使用dbcAMP-Ca可有效改善心功能，心率变异性,和运动耐力，同时抑制老年心力衰竭合并心律失常患者的炎症反应,用药安全性高。与单独使用美托洛尔相比，联合用药显示出更好的安全性和治疗效果。
