中国全科医学2024，Vol.27Issue(21)：2578-2585,8.DOI:10.12114/j.issn.1007-9572.2023.0585
芪苈强心胶囊降低慢性心力衰竭急性失代偿患者发生利尿剂抵抗风险的回顾性研究
Retrospective Study on the Efficacy of Qi Li Qiang Xin Jiao Nang in Reducing the Risk of Diuretic Resistance in Patients with Acute Decompensated Chronic Heart Failure
摘要
Abstract
Background Diuretic resistance is associated with increased mortality in patients with heart failure(HF).Qi Li Qiang Xin Jiao Nang,a Traditional Chinese Medicine,are used in the treatment of HF.However,clinical evidence of their effectiveness in improving diuretic resistance is lacking.Objective To investigate whether Qi Li Qiang Xin Jiao Nang can reduce the risk of diuretic resistance and improve prognosis in patients with acute decompensated chronic heart failure(ADCHF).Methods This study included 374 HF patients treated in the CICU ward of Tianjin University Chest Hospital from January 2018 to June 2022.Patients were divided into diuretic resistance(118 patients)and non-diuretic resistance groups(256 patients)based on the occurrence of diuretic resistance.Patient data and laboratory results were collected.A 12-month follow-up was conducted to observe rehospitalization due to cardiovascular events or all-cause mortality.Kaplan-Meyer survival curves were plotted for each group,and the Log-rank test was used for comparison.Multivariate Logistic regression analysis was performed to explore factors influencing diuretic resistance.Multivariable Cox regression analysis was used to explore factors affecting the occurrence of endpoint events in ADCHF patients.Results The diuretic resistance group showed higher age,body mass,NT-proBNP,blood urea nitrogen,creatinine,uric acid,and international normalized ratio(INR)but lower 24-hour fluid intake,estimated glomerular filtration rate(eGFR),lymphocyte count,and usage of Qi Li Qiang Xin Jiao Nang.Multivariate Logistic regression analysis indicated that the use of Qi Li Qiang Xin Jiao Nang(OR=0.363,95%CI=0.186-0.708,P=0.003)and increased 24-hour fluid intake(OR=0.286,95%CI=0.177-0.461,P<0.001)were protective factors against diuretic resistance in ADCHF patients.Increased body mass(OR=1.064,95%CI=1.040-1.088,P<0.001)and elevated uric acid(OR=1.002,95%CI=1.000-1.004,P=0.027)were risk factors.Log-rank test results showed that the average survival time without endpoint events was shorter in the diuretic resistance group(χ2=11.866,P=0.001)and in patients not using Qi Li Qiang Xin Jiao Nang(χ2=6.502,P=0.011).Multivariable Cox regression analysis revealed that the use of Qi Li Qiang Xin Jiao Nang(HR=0.536,95%CI=0.308-0.933,P=0.027)and angiotensin receptor enkephalase inhibitors/angiotensin converting enzyme inhibitors/angiotensin receptor blockers(HR=0.435,95%CI=0.229-0.826,P=0.011)were protective factors against endpoint events,while increased total bilirubin(HR=1.019,95%CI=1.008-1.030,P=0.001)and total bile acids(HR=1.029,95%CI=1.002-1.058,P=0.036)were risk factors.Conclusion The use of Qi Li Qiang Xin Jiao Nang in addition to standard HF treatment can reduce the risk of diuretic resistance in patients with ADCHF and decrease the risk of rehospitalization due to cardiovascular events or all-cause mortality within one year.关键词
心力衰竭/利尿剂抵抗/芪苈强心胶囊/回顾性研究Key words
Heart failure/Diuretic resistance/Qi Li Qiang Xin Jiao Nang/Retrospective study分类
医药卫生引用本文复制引用
冯超,蒋汉涛,樊官伟,李澜,冯津萍..芪苈强心胶囊降低慢性心力衰竭急性失代偿患者发生利尿剂抵抗风险的回顾性研究[J].中国全科医学,2024,27(21):2578-2585,8.基金项目
国家自然科学基金资助项目(82204885) （82204885）
天津市科技计划项目(21JCZDJC00600) （21JCZDJC00600）
天津市重点学科建设项目(TJYXZDXK-055B) （TJYXZDXK-055B）
天津市卫生健康科技项目(ZC20011) （ZC20011）
