通讯作者: 叶懿萱, lww5731@126.com

DOI：10.12201/bmr.202408.00002

• 摘要：目的探究伊伐布雷定对慢性阻塞性肺疾病（COPD）合并左心室射血分数保留的心衰（HFpEF）患者心肺运动试验参数、心率变异性（HRV）及超敏C反应蛋白（hs-CRP）、氨基末端脑钠肽前体（NT-proBNP）的影响。方法97例COPD合并HFpEF患者随机数字表法分组为对照组（n=48，常规对症处理联合富马酸比索洛尔片治疗）及伊伐布雷定组（n=49，在对照组基础上联合伊伐布雷定治疗），比较两组疗效，观察治疗前后两组心肺运动试验参数、HRV、hs-CRP、NT-proBNP、圣乔治呼吸问卷(SGRQ)评分、慢性阻塞性肺疾病评估测试（CAT）评分、6min步行距离变化，比较两组心脏不良事件及药物不良反应。结果伊伐布雷定组3例脱落、对照组2例脱落。治疗后伊伐布雷定组总有效率（91.30%）明显高于对照组（76.09%）（P＜0.05）。治疗后，伊伐布雷定组、对照组峰值氧耗量（Peak VCO2）、无氧代谢阈值时氧耗量（AT）、24h窦性心律RR间期标准差（SDNN）、24h相邻正常RR间期差值均方根（RMSSD）、24h相邻正常RR间期差值＞50ms百分比（RNN50）较治疗前明显增高，且前者明显高于后者（P＜0.05）。治疗后两组二氧化碳通气当量斜率（VE/VCO2）、hs-CRP、NT-proBNP、SGRQ评分、CAT评分较治疗前明显降低，且伊伐布雷定组较对照组明显低（P＜0.05）。治疗后两组6min步行距离较治疗前明显延长，且伊伐布雷定组较对照组明显长（P＜0.05）。与对照组比较，伊伐布雷定组再住院率明显低（P＜0.05），死亡率及不良反应总发生率略低（P＞0.05）。结论 伊伐布雷定在COPD合并HFpEF患者治疗中，可明显改善患者心肺运动功能和心率变异性，有效改善患者预后存活质量，同时明显降低hs-CRP、NT-proBNP水平及再入院率，安全性高。

  关键词： 慢性阻塞性肺病; 射血分数保留的心衰; 伊伐布雷定; 心肺运动试验; 心率变异性1

   

  Abstract: Objective? To investigate the effect of ivabradine on cardiopulmonary exercise testing parameters, heart rate variability (HRV), high-sensitivity C-reactive protein (hs-CRP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with chronic obstructive pulmonary disease (COPD) and heart failure with preserved ejection fraction (HFpEF). Methods? A total of 97 patients with COPD and HFpEF were divided into the control group (n=48, conventional symptomatic treatment combined with bisoprolol fumarate tablets) and the ivabradine group (n=49, ivabradine treatment on the basis of the treatment of control group) using the random number table method. Therapeutic effects in the two groups were compared. The changes in cardiopulmonary exercise testing parameters, HRV, hs-CRP, NT-proBNP, St. Georges Respiratory Questionnaire (SGRQ) scores, COPD Assessment Test (CAT) scores and 6-minute walking distance after treatment were observed. Adverse cardiac events and drug reactions in the two groups were compared. Results? 3 cases in the ivabradine group and 2 cases in the control group dropped out of the study. After treatment, the total effective rate of the ivabradine group (91.30%) was significantly higher than that of the control group (76.09%) (P<0.05). After treatment, there were significant decreases in peak oxygen consumption (Peak VCO2), anaerobic threshold (AT), standard deviation of RR intervals (SDNN), root mean square of successive RR interval differences (RMSSD) and percetange of adjacent RR intervals differing by more than 50 milliseconds (PNN50) in the ivabradine group and the control group. Moreover, above parameters in the former group were significantly higher (P<0.05). After treatment, there were significant decreases in ventilatory equivalent for carbon dioxide (VE/VCO2), hs-CRP, NT-proBNP, SGRQ scores and CAT scores in both groups. Meanwhile, above parameters in the ivabradine group were significantly lower (P<0.05). After treatment, 6-minute walking distance of the two groups increased significantly, and 6-minute walking distance of the ivabradine group was significantly longer (P<0.05). Compared with the control group, the readmission rate of the ivabradine group was significantly lower (P<0.05). The mortality rate and total incidence of adverse reactions in the ivabradine group were slightly lower (P>0.05). Conclusion? Applying ivabradine in the treatment of patients with COPD and HFpEF can significantly improve their cardiopulmonary exercise function, HRV, prognosis and quality of life, and significantly reducing the levels of hs-CRP and NT-proBNP and the readmission rate, with high safety.

  Key words: Chronic obstructive pulmonary disease; Heart failure with preserved ejection fraction; Ivabradine; Cardiopulmonary exercise testing; Heart rate variability

  提交时间：2024-08-01

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• 序号	提交日期	编号	操作
  1	2024-07-01	bmr.202408.00002V1	下载

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