| 1.BackgroudHeart failure (HF for short) is a clinical syndrome, which caused by a variety of reasons that lead to the changes of cardiac structure and function and create abnormal pump function, thereby can not meet the needs of the tissue oxygen [1]. The end-stage of cardiovascular disease is chronic heart failure (CHF), which is the major complication of a variety of structural heart disease.The incidence of CHF increased year by year. In1988, FHS study found that the annual incidence of chronic heart failure was2.3‰in the male and1.4‰in the female[2]. American Heart Association (AHA) had analyzed the disease in2005and the results showed that there were5,000,000patients with chronic heart failure in the United States, and an annual increase of55million new patients[3] Currently, domestic relative researches show that there are400million CHF patients, an incidence rate of0.9%, and among them women are slightly more than men, northern cities slightly higher than southern cities, and urban areas slightly higher than rural areas. The prevalence of CHF increases with the years. Related studies have shown that people older than45years of age have significantly increased incidence of chronic heart failure, to7.2%for men, and4.7‰for women[5]Studies have shown[6-7]that N-terminal pro-brain natriuretic peptide(NT-proBNP),tumor necrosis factor-a (TNF-a),interleukin-6(IL-6),and cardiac troponin I (cTnI) have involved in the development and progression of heart failure, and its concentration in the serum was positivly correlated with the degree of heart failure. The above factors are all involved in muscle remodeling, thereby reducing the systolic and diastolic function of heart. Echocardiography by measuring the changes in each heart chamber diameters and capacity was used to detect the systolic and diastolic function changes.Myocardial remodeling is the basic mechanism of the development of CHF[18]. The sympathetic-adrenergic system (SAS) and the renin-angiotensin activation (RAS) are the basic causes of myocardial remodeling. Adrenergic receptor blockers (beta-blockers) and angiotensin II receptor inhibitors (ARB) can antagonize the excitement of the neuroendocrine system, reduce serum hormones and serum factors, and improve ventricular remodeling, so as to improve cardiac function and the prognosis. In the treatment of CHF, ARB and beta-blockers have been widely used, however, there is a lack of studies about the effect of the two drugs on the CHF serum factor TNF-alpha, IL-6and NT-proBNP, cTnI and cardiac function changes.Therefore, the discussion of the difference of the two drugs on the effects of these factors have important clinical significance.2.PurposeEvaluate the NT-proBNP, cTnI, TNF-alpha, IL-6and changes in left ventricular systolic and diastolic function of CHF patients before and after treatment of irbesartan and carvedilol. Changes by the above indicators were used to evaluate the therapeutic effect of irbesartan and carvedilol in patients with CHF.3.MethodsSelected84cases of patients with heart failure (except patients with pulmonary heart disease)from2012.06-2013.02in our hospital, among which the irbesartan group were28patients,16are males and12are females; aged35to78years (mean61.8±9.9) years;17cases are Ⅲ cardiac function,11cases are IVcardiac function; carvedilol group were26patients,14are males and are12females; aged36to79years, mean (63.7±11.4) years old;17cases are Ⅲ cardiac function,9cases are IVcardiac function; combined treatment group of30patients,17males and13females; aged37to80years, mean (39.9±11.2) years old; center function Ⅲ18cases, NYHA IV in12cases.Patients in three groups during treatment were given the corresponding basic treatment, including anti-platelet drugs, blood-pressure drugs, anticoagulants, and lipid-lowering drugs. Treatment time was30days, and after30days, detected the clinical efficacy and the corresponding detection indicators. SPSS17.0was used for statistical analysis.4.Results4.1The former general clinical data of patients in irbesartan group, carvedilol group and combined treatment group were compared by mean value and chi-square test. The risk factors, gender, age, and pathogenic factors were not statistically significant (P>0.05).4.2The pre-treatment serum TNF-alpha and IL-6levels in three groups of patients had no statistical difference (P>0.05); after treatment, the TNF-alpha and IL-6were significantly reduced compared with before treatment, which were statistically significant, and the effect in combined treatment group was(P<0.05) better.4.3Before trestment,the NT-proBNP in three groups had no difference(p>0.05); After treatment,the NT-proBNP was significantly decreased compared with before treatment, which was statistically significant, and the effect in combination therapy group was(P<0.05) better.4.4Before trestment,39.2%of the patients with elevated cTnI, the cTnl in three groups had no difference(p>0.05). After treatment,the cTnI was significantly decreased compared with before treatment, which was statistically significant, and the effect in combination therapy group was(P<0.05) better.4.5Before treatment, the LV, LVEF, LVEDV, LVESV, E/A had no difference (P>0.05),but after treatment, LVEDV, LVESV reduced and LVEF, E/A increased, and they were statistically significant (P<0.05). Though LV was slightly lower than before treatment, the difference was not statistically significant, which may be related to shorter treatment and observation.4.6Evaluate according to the improvement of cardiac function and clinical symptoms. The patients in three groups after treatment all have improve the clinical efficacy. The total effective rate was92.8%in irbesartan group; in carvedilol group, the total effective rate was88.46%; and in combination group,the total efficiency was100%. Combination therapy group had better advantage,and compared with other two groups, the difference of combined treatment group was statistically significant (P<0.05). 5.Conclusions5.1Both irbesartan and carvedilol can improve the clinical symptoms of patients with chronic heart failure, the combined treatment group gained better result compared to single-agent treatment group.5.2Both irbesartan and carvedilol can reduce the concentration of TNF-alpha and IL-6in the serum of patients with chronic heart failure, combined treatment group decreased more significantly.compared with irbesartan group or carvedilol treatment group.5.3Both irbesartan, carvedilol can reduce the serum NT-pro BNP and CTnl of patients with chronic heart failure, concentration of CTnI, combined treatment group decreased more significantly.compared with irbesartan group or carvedilol treatment group.5.4Both irbesartan and carvedilol can improve the systolic and diastolic function of patients with chronic heart failure. |
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