摘要
Abstract
Objective To evaluate the efficacy and safety of different dosage of spironolactone on normal renal func -tion in patients with congestive heart failure .Methods From 2011 December to 2012 December , 148 patients with systolic heart failure and normal renal function were enrolled , on the basis of conventional therapy , they were randomly divided into spironolactone 20 mg group with 72 cases, spironolactone 60 mg group with 76 cases.B-type natriuretic peptide (BNP) level were measured in all patients before and after 12 months of treatment , and ultrasound were performed to assess the change of left ventricular end diastolic volume index (LVEDVI), left ventricular end systolic volume index (LVESVI), left ventricular mass index (LVMI) and left ventricular ejection fraction (LVEF).And the serum potassium, renal function and adverse events were monitored in all of these patients .Results After 12 months of treatment, 2 groups of LVEDVI, LVESVI, LVMI, LVEF and BNP were significantly improved than before treatment ( P <0.05), 60 mg group were more significant than the 20 mg group, the difference was statistically significant ( P <0.05).The increase of hyperkalemia (potassium is more than or equal to 5.5 mmol/L) in the 60 mg group was not significant as in the 20 mg group (7.9%vs.2.8%), no significant diffe-rence was found ( P >0.05).Severe hyperkalemia (potassium is more than or equal to 6 mmol/L) were not detected in both of the 2 groups.The incidence of hypokalemia in 20 mg group was significantly than in 60 mg group (2.6% vs.11.1%), and the difference was statistically significant ( P <0.05).Breast development and breast pain were significantly higher in 60 mg group than in 20 mg group (13.2%vs.2.8%), and the difference was statistically significant ( P <0.05).2 cases with serum creatinine increased >50%than previous test were found in each of the 2 group, no significant difference were found ( P >0.05), there was no serum creatinine increase >180 μmol/L case was found in both of the two gruops .Conclusion On the basis of conventional therapy , spironolactone 60 mg under close monitoring is safe and can further improve ventricular remodeling , reduce the level of BNP and reduce the hypokalemia occurred in patients with congestive heart failure and normal renal function .关键词
心力衰竭,收缩性/螺内酯/剂量/心室重构/安全性Key words
Heart failure ,congestive/Spironolactone/Different doses/Ventricular remodeling/Safety
