| Objective: Impairment of kidney is the common complication of chronic cardiac failure.In the occurrence of CHF,the activation of renin-angiotensinaldosterone system(RAAS)plays an important role.Under the pathology condition of renal blood flow decreasing resulting from heart failure,RAAS is activated and kidney reabsorbs water and sodium showing hyperfunction,forming water sodium retention,which can increases heart load,result in decreasing cardiac output and form a vicious cycle of heart kidney disease.Study shows that Merger of renal dysfunction in patients with CHF illness severity and mortality increased significantly and the kidney condition was to evaluate the prognosis of patients with CHF treatment measures to one of the important factors.Serum(inhibition C(CysC)?2 microglobulin(?2MG)is an sensitive index of early renal damage,urea nitrogen(BUN)and creatinine(Scr),compared to CysC ?2MG rarely influenced by age,gender Muscle volume,express in the body constant,can better reflect the renal function.RAAS plays a significant role in the treatment of heart failure.Study abroad for patients with chronic heart failure with impaired renal function,the renin-angiotensin aldosterone system(RAAS)inhibitors ACEI and ARB therapy,prompt the effectiveness But the domestic to this kind of report is less,the purpose of this paper is to explore RAAS inhibitors ACEI and ARB therapy in patients with chronic heart failure with early renal damage effectiveness and the effect of differencesMethod: Choice during March 2014 to September 2014 hospitalized patients with chronic heart failure with impaired renal function of 80 cases of chronic heart failure diagnostic criteria,according to the Framingham DCM 35 cases,30 cases of ischemic cardiomyopathy hypertensive heart disease in 15 patients with cardiac function NYHA classification level 35 cases,cardiac function NYHA classification level of 45 patients with record Scr levels on admission,using the improved simplified MDRD formula in patients with glomerular filtration rate(GFR),mild damage to kidney function: 60 GFR< 1.73 m-2,90 ml min-1 renal insufficiency: GFR < 60 ml min-1 1.73 m-2 exclusion criteria: hospital Scr>265 umo,Allergic to ACEI and ARB,rheumatic valvular heart disease hypertrophic obstructive cardiomyopathy,acute infections anemia,malignant tumor autoimmune disease Hyperkalemia hypotension(90/60 mmHg)with liver or kidney primary disease.Patients were randomly divided into two groups A and B,40 cases in each group: group A basic treatment of heart failure with hydrochloric acid that split(Beijing novartis)starting dose of 5 mg/d,double dose every 2 weeks until 20 mg/d,or blood pressure 90/60 mmHg stop adding quantity group B: basic treatment of heart failure combined with valsartan(Beijing novartis),began to dose of 40 mg/d,double dose every 2 weeks until 160 mg/d,or blood pressure 90/60 mmHg stop adding quantity collection age,gender,weight of chronic heart failure cause on admission NYHA heart function classification In before taking the medicine Medication after 1 month,3 months and 6 months in the early morning quiet condition on an empty stomach pumping elbow venous blood determination blood CysC blood ?2MG Scr BuN UA,and the medicine before taking the medicine after 1 month,3 months and 6 months to determine left ventricular end-diastolic diameter(LVEDD),end systolic diameter(LVESD)and left ventricular ejection fraction(LVEF),the indicators measuring three cardiac cycle and averaged between before and after treatment group and comparison,the statistical analysis of the change of heart function indexes before and after treatment.Result :1 The general compared situation for group A and group BIn the two groups before treatment,patients with heart failure causes,sex,age,weight and NYHA heart function classification were no significant difference,comparable(P>0.05)2 The cardiac function indexes before and after treatment in group A and group B by comparisonBefore the treatment,LVEF and LVEDD and LVESD in group A were 32.32 ±3.20%,57.59 ±4.21 mm and 47.45 ± 2.75 mm,LVEF and LVEDD and LVESD in group B were 32.52± 4.21%,56.98±3.26 mm and 48.39±3.55mm;1 month after treatment,LVEF and LVEDD and LVESD in group A was 34.63±2.56%?55.36±3.27 mm and 45.20±1.36 mm,in group B LVEF and LVEDD LVESD were 35.26±3.15%?55.58±2.54 mm and 46.27±3.20mm;3 months after treatment,the indexes of group A were 36.75±3.46%?50.38±2.59 mm and 40.54±2.19 mm;group B were 37.87±4.12%?49.40±3.29 mm and 39.49±2.43mm;Six months after treatment,the indexes of group A were46.46±3.56%?45.69±3.10 mm and 35.49±3.23 mm,group B were44.63 ±4.86%?46.28±3.19 mm and 36.49±4.23 mm.1 month after treatment in the two groups compared with before treatment showed no significant rise,LVED and LVESD showed no significant decrease(P>0.05).3 months after treatment in the two groups compared with before treatment showed significantly increase,(P<0.05),LVEDD and LVESD significantly reduced(P<0.05).6 months after the treatment in the two groups compared with before treatment showed significantly increase more than before LVEF(P<0.01),LVEDD and LVESD more significantly reduced(P<0.01).As the extension of treatment time,cardiac function improved significantly more,over the same period there was no significant difference between the two groups(P >0.05).3 Renal function indexes before and after treatment in group A and group BGroup A: BUN,Scr,before treatment were 9.35±3.19 mmol/L ?126.39±37.49 umol/L,1 month,3 months after treatment were 10.05±4.12 mmol/L?134.89±42.49 umol/L and 9.08±3.32mmol/L?116.26±36.78umol/L,compared before treatment there was no significant difference(P>0.05),and 6 months after treatment were 7.02±3.09 mmol/L?94.43±32.28 umol/L,which was significantly lower than before treatment(P<0.05);UA 1,3,6 months after treatment than before treatment,there was no significant difference(P > 0.05);CysC,?2MG before treatment were1.92±0.34 mg/Land 5.93±2.22 mg/L,1,3 months after treatment were 1.49±0.22 mg/L?1.01±0.16 mg/L and 3.89±1.82mg/L?2.83±1.20 mg/L,respectively,compared with before treatment significantly lower(P<0.05),and 6 months after treatment were0.86±0.14 mg/L and 1.86±1.12 mg/L,which respectively is more significantly reduced compared with before treatment(P < 0.01).Group B: BUN,Scr,before treatment were 9.56±3.22mmol/L ?130.40±39.28umol/L,1 month,3 months after treatment were 10.54±4.22 mmol/L?137.40±40.19 umol/L and 9.04±3.52 mmol/L?121.24±39.58 umol/L,respectively compared before treatment there was no significant difference(P> 0.05),and 6 months after treatment were 7.04±3.12 mmol/L?96.40±33.29 umol/L,which was significantly lower than before treatment(P < 0.05);UA 1,3,6 months after treatment than before treatment,there was no significant difference(P>0.05);Before CysC,?2MG treatment were 1.94±0.38 mg/L and 6.02±2.32 mg/L,1,3 months after treatment were 1.50±0.24 mg/L,3.93±1.90 mg/L,1.02±0.17 mg/L and 2.89±1.24 mg/L,respectively,compared with before treatment significantly lower(P<0.05),and 6 months after treatment were0.84±0.15 mg/L and 1.93±1.19 mg/L,which respectively is more significantly reduced compared with before treatment(P<0.01).There was no significant difference between the two groups.Results suggest that cases of renal function were improved after treatment in both groups,and for early kidney damage indicator of CysC,?2MG improve sooner and more prominent.Conclusion:1 ACEI Benazepril Hydrochloridec and ARB valsartan hydrochloride for the treatment of patients with chronic heart failure with impaired renal function,may be elevated in patients with LVEF and LVEDd reduction and LVESD,improve heart function.And long-term treatment is better.ACEI hydrochloric acid that split and ARB valsartan can reduce the patients with chronic heart failure with impaired renal function BUN,Scr,UA,CysC and ?2MG,improve renal function.And prompt early kidney damage indicator of CysC,?2MG improve sooner and more prominent.2 Benazepril Hydrochloridec and valsartan hydrochloride by comparison,there was no significant difference in both the action above. |
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