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目的观察己酮可可碱(PTX)治疗慢性充血性心力衰竭(CHF)患者远期疗效。方法81例CHF患者在常规抗心衰治疗基础上被随机分成PTX组(PTX200mg,每日3次,n=41)和安慰剂组(n=40),共治疗12个月。观察治疗前后血浆细胞因子水平、NYHA心功能分级、心脏结构和功能、生活质量、运动耐量的变化以及PTX治疗对再住院率和病死率的影响。结果74例CHF患者完成随访。与安慰组比较,PTX可显著降低血浆中高敏C反应蛋白、肿瘤坏死因子-α和单核细胞趋化蛋白-1的水平(均P<0.05)。此外,PTX在降低左室舒张末内径[(56±9)mmvs(61±7)mm,P<0.05]、增加左室射血分数[(48±11)%vs(41±12)%,P<0.05]和降低再住院率(34%vs61%,P<0.05)等方面较安慰剂组更显著,但两组间病死率无显著差异。结论在常规抗心衰治疗基础上加用PTX可进一步改善CHF患者的临床状态,降低再住院率。
Objective To observe the long-term effect of pentoxifylline (PTX) in patients with chronic congestive heart failure (CHF). Methods Eighty-one patients with CHF were randomly divided into PTX group (PTX 200 mg, n = 41 three times a day, n = 40) and placebo group (n = 40) on the basis of conventional anti-heart failure treatment for 12 months. The levels of plasma cytokines, NYHA functional class, cardiac structure and function, quality of life, exercise tolerance and the effect of PTX on rehospitalization and mortality were observed before and after treatment. Results 74 patients with CHF were followed up. Compared with the placebo group, PTX significantly reduced the levels of plasma high-sensitivity C-reactive protein, tumor necrosis factor-α and monocyte chemoattractant protein-1 (all P <0.05). In addition, PTX decreased left ventricular end diastolic diameter [(56 ± 9) mm vs (61 ± 7) mm, P <0.05] and increased left ventricular ejection fraction [(48 ± 11) vs 41 ± 12 P <0.05] and reduce the rate of rehospitalization (34% vs61%, P <0.05) than the placebo group, but there was no significant difference in mortality between the two groups. Conclusions The addition of PTX to conventional anti-heart failure treatment can further improve the clinical status of CHF patients and reduce the rate of rehospitalization.