As the eventual end of the cardiovascular disease, heart failure is aggravated or results in cachexia when the patient is under malnutrition or exposes to certain risk factors of diet mode during the long disease duration. Researches reveal that the diet has effects on patho-physiology, energy metabolism, inflammation and oxidative stress of heart failure. This article conducts a literature review on the association between diet and heart failure.
Objective To assess the effectiveness and safety of meglumine adenosine cyclophosphate (MAC) for chronic heart failure. Methods The databases such as Cochrane Central Register of Controlled Trials (Issue 3, 2011), MEDLINE (1950 to March 2011), EMbase (1980 to March 2011), CNKI (1995 to March 2011), and VIP (1989 to March 2011) were searched, and the relevant journals and conference proceedings were also manually retrieved. Then the studies were screened according to predefined inclusion and exclusion criteria, and their quality was evaluated. Meta-analyses were performed by using RevMan 5.0 software. Results Seventeen randomized controlled trials (RCTs) involving 1 281 patients were included. All of the included RCTs were Grade C in methodological quality. The results of meta-analyses showed that MAC plus routine treatment was superior to routine treatment in improving the left ventricular ejection fraction (WMD=5.75, 95%CI 3.61 to 7.89), stroke volume (SV) (WMD=5.55, 95%CI 3.71 to 7.38), E/A (WMD=0.09, 95%CI 0.05 to 0.14) and 6 min walk test (WMD=43.52, 95%CI 21.00 to 66.04). But MAC plus routine treatment was similar to routine treatment in regulating cardiac index (CO) (WMD=0.20, 95%CI –0.31 to 0.71) and heart rate (WMD=0.64, 95%CI –7.49 to 8.77). No significant adverse effects or allergic reactions were reported. Conclusion The current evidence shows that MAC may improve the left ventricular ejection fraction, stroke volume, E/A and 6 min walk test. Due to a high risk of selection bias and detection bias in the included studies, the evidence is insufficient to determine the effectiveness of MCA. Further large-scale trials are required to define the role of MAC in the treatment of chronic heart failure.
Objective To evaluate the efficacy and safety of trimetazidine (TMZ) for chronic congestive heart failure. Methods We searched The Cochrane Library (Issue 3, 2006), MEDLINE (1990-2006), EMBASE (1990-2004), and the Chinese Biomedicine Database (1990- 2006 ) for parallel group randomized controlled trials (RCTs) and cross-over design trials comparing TMZ and placebo or open controls for patients with heart failure.We used The Cochrane Collaboration’s RevMan 4.2 software for data analyses. Results Four RCTs and two cross-over design trials were included. Meta-analyses showed that: compared with the control group, TMZ may improve the NYHA cardiac functional grade (RR 0.85, 95%CI 0.76 to 0.95), increase the total exercise time (WMD 51.40 seconds, 95%CI 15.56 to 87.25), the maximal metabolic equivalents (WMD 0.82, 95%CI 0.28 to 1.37), and the ejection fraction (WMD 7.29%, 95%CI 6.28 to 8.31), but may decrease the left ventricular end-diastolic volume (WMD –12.19 ml, 95%CI –15.29 to –9.09), the left ventricular end-diastolic diameter (WMD –6.05 mm, 95%CI –7.10 to –4.99), the left ventricular end-systolic volume (WMD –16.94 ml, 95%CI –20.34 to –13.55), the left ventricular end-systolic diameter (WMD –5.42 mm, 95%CI –5.98 to –4.86), and the serum brain natriuretic peptide (WMD –239.59 pg/ml, 95%CI –276.53 to –202.65). TMZ may also improve the quality of life (WMD 12.36, 95%CI 5.16 to 19.55). Conclusions TMZ plus standard medical therapy has a beneficial effect on the indices of cardiac function, and may also improve the patient’s quality of life. However, because available RCTs for this systematic review are too small and poor quality, (mainly focusing on the heart failure induced by ischemic heart diseases and merely taking intermediate indices as outcome measures), further high-quality large-scale RCTs with death as the endpoint and which include subgroup analysis of non-ischemic heart failure, are required in order to provide more reliable evidence.
目的 评价参附注射液治疗老年人心力衰竭疗效和安全性。 方法 计算机检索Cochrane图书馆，Medline（1950年－2013年10月），Embase（1980年－2013年10月），中国知网（1979年1月－2013年10月）、万方（1986年1月－2013年10月）、维普（1989年1月－2013年10月）数据库，全面收集参附注射液联用西药常规治疗（试验组）与西药常规治疗疗效（对照组）比较的随机对照试验（RCT），分别由2名研究者根据纳入与排除标准，独立筛选文献、提取资料并评价文献质量，采用Revman 5.1软件进行Meta分析。 结果 共纳入8个研究559例患者，研究质量均为C级。Meta分析结果显示：与对照组比较，试验组临床疗效明显提高、症状改善[RR=1.20，95%CI（1.11，1.29），P＜0.000 01]，左室舒张末期内径减小明显[MD=5.90，95%CI（3.97，7.84），P＜0.000 01]、6 min步行试验距离增加[MD=62.48，95%CI（43.12，81.84），P＜0.000 01]，但左室射血分数两组差异无统计学意义[MD=4.79，95%CI（－0.07，9.65），P=0.05]。 结论 参附注射液与西药常规治疗联用能进一步提高老年心力衰竭患者的临床疗效，且安全性较好。
目的 探讨血浆脑钠肽（BNP）及血清肌钙蛋白I（cTNI）含量改变在老年患者发生充血性心力衰竭时的临床意义。 方法 选择2010年7月－2012年8月住院的各种老年心脏病患者117例，根据纽约心功能分级分为4组（心功能Ⅰ级组、Ⅱ级组、Ⅲ级组、Ⅳ级组），分别检测血浆BNP、血清cTNI及心肌酶[肌酸磷酸激酶（CK）、肌酸磷酸激酶同工酶（CK-MB）]进行组间比较，同时与健康老年组进行对比。 结果 ① 老年慢性充血性心力衰竭各组（心功能Ⅱ～Ⅳ级）血浆BNP水平均高于健康对照组及心功能正常组（心功能Ⅰ级组）；且心功能Ⅳ级组BNP水平＞心功能Ⅲ级组＞心功能Ⅱ级组。各组之间比较差异有统计学意义，但心功能Ⅰ级组与健康对照组血浆BNP水平无明显差异。② 各组之间CK及CK-MB水平差异均无统计学意义。③ 充血性心力衰竭各组（心功能Ⅱ～Ⅳ级组血清cTNI水平均高于健康对照组及心功能正常组（心功能Ⅰ级组）；且心功能Ⅳ级组cTNI水平＞心功能Ⅲ级组＞心功能Ⅱ级组。各组之间比较差异有统计学意义，而心功能Ⅰ级组及健康对照组血清cTNI水平差异无统计学意义。 结论 血浆BNP水平及血清cTNI水平在老年患者发生心力衰竭时随心力衰竭程度加重而逐渐升高，两者均对慢性充血性心力衰竭的临床诊断具有重要参考意义。
目的:检测不同心脏病所致的心力衰竭(CHF)患者心脏β1和M2受体的自身抗体,探讨心功能发生病理变化时,这两种自身抗体的产生与疾病发生、发展的相关性。方法:以细胞外第二环表位肽段的合成肽作为抗原,应用酶联免疫吸附测定(ELISA) 技术,随机检测265 例受试者血清中心脏β1 和M2 受体的自身抗体。结果:CHF 组β1受体自身抗体的阳性率为457% (86/188),明显高于对照组的104% (8/77) (Plt;001);CHF组M2 受体自身抗体的阳性率为495% (93/188),明显高于对照组的117% (9/77) (Plt;001);心功能Ⅱ~Ⅲ级(NYHA心功能分级)的患者自身抗体的阳性率及抗体滴度明显高于Ⅳ级;CHF组β1受体自身抗体阳性血清中高达561%的患者同时具有M2 受体的自身抗体。结论:心脏β1和M2 受体自身抗体存在于多种心脏病所致心力衰竭患者的血清中,可能与心力衰竭时心肌结构变化和功能下降有关;β1 和M2 受体的双抗体阳性可能是自身免疫反应的多重性表现,提示免疫学机制参与心力衰竭和/ 或心肌重构的病理生理过程,参与的程度在疾病的早、中期大于晚期。
摘要:目的：探讨β受体阻滞剂在慢性心力衰竭急性失代偿情况下的正确应用。方法：对我院2005年1月～2006年12月收治的104例确诊慢性心力衰竭急性失代偿并使用β受体阻滞剂患者的治疗措施及预后转归进行回顾性分析。结果：104例患者男性61例，女性43例，平均年龄64.4±17.5岁，其中45～70岁占6792。好转占85%，死亡占10%，建议外出心脏移植5%。停止使用β受体阻滞剂的19人中17人重新恢复了使用，减量的65人中，59人的β受体阻滞剂重新加量至入院前的水平。结论：慢性心力衰竭在急性失代偿期合理使用β受体阻滞剂对患者预后有重要意义。心力衰竭急性失代偿控制后，β受体阻滞剂应恢复使用并逐渐增量至一个合理的剂量长期使用。
Objective To evaluate the diagnostic value of brain natriuretic peptide (BNP) for cardiac dyspnea.Methods Plasma BNP levels were measured by radioimmunoassay in dyspnea patients with chronic heart failure (CHF) (n=52) or without CHF (n=30) and normal control group (n=28).Results The BNP level in dyspnea patients with CHF was significantly higher than that of dyspnea patients without CHF and normal control group [(649.80±141.72) pg/mL vs (59.08±18.60) pg/mL and (65.20±16.32) pg/mL，respectively,Plt;0.05].There was no significant difference of BNP level between dyspnea patients without CHF and normal group (Pgt;0.05).The plasma BNP level elevated with the worsening of heart failure (NYHA Classiffication).The BNP level in dyspnea patients with CHF was negatively correlated with left ventricle ejection fraction (r=－0.673，Plt;0.001).The receiver operating characteristic (ROC) curve analysis showed that the area under the ROC curve (AUC) is 0.91(0.88-0.98，Plt;0.001) with a sensitivity of 87.2% and a specificity of 86.8% at the cutoff value of 206 pg/mL.Conclusion Measurement of plasma BNP is a rapid diagnostic method for cardiac dyspnea.
慢性心力衰竭发生率和死亡率均较高，夜间睡眠中反复发生的呼吸暂停和缺氧是促进心力衰竭恶化的因素之一。中枢性睡眠呼吸暂停（central sleep apnea ,CSA）为起源于脑干呼吸控制中枢障碍的呼吸暂停，表现为呼吸减弱或停止。在普通人群中CSA患病率很低，但在慢性心力衰竭患者中则很高，且常常以陈-施呼吸（Cheyne-Stokes respiration，CSR），即CSR-CSA形式出现。CSA可进一步加重心力衰竭，因此越来越受到重视[1]。