JAMA Cardiol:心衰急性期该使用大剂量螺内酯吗?

2017-09-29 佚名 “中国循环杂志”微信号

对于急性心衰,指南推荐使用螺内酯,但在急性期时是该使用大剂量,还是小剂量螺内酯呢?美国进行了一项双盲对照研究,共有22家医院参与。结果发现,尽管患者对大剂量螺内酯耐受性良好,但与常规剂量螺内酯相比,并没有更大的获益。

对于急性心衰,指南推荐使用螺内酯,但在急性期时是该使用大剂量,还是小剂量螺内酯呢?

美国进行了一项双盲对照研究,共有22家医院参与。结果发现,尽管患者对大剂量螺内酯耐受性良好,但与常规剂量螺内酯相比,并没有更大的获益。



入选的患者之前未使用螺内酯或仅使用小剂量螺内酯(12.5 mg或25 mg),入院时NT-proBNP≧1000 pg/mL或BNP≧250 pg/mL,不考虑射血分数。

干预手段是给予高剂量(100 mg)或常规剂量(25mg)的螺内酯,持续96小时。主要终点是从基线到96小时时的NT-proBNP变化。次要终点是临床充血分数、胸闷症状、净尿量和体重变化,安全性终点包括高价血症和肾功能变化。

研究共随机360例患者,平均EF值是34%。高剂量组NT-proBNP下降 4601 (2697-9596) pg/mL,常规剂量组下降3753 (1968-7633) pg/mL,二者没有显着差别。两组的次要终点或30天全因死亡或心力衰竭住院没有差别。两组的安全性终点也没有差别。

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1781807, encodeId=71891e818072f, content=<a href='/topic/show?id=5db8409ed8' target=_blank style='color:#2F92EE;'>#Cardiol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4097, encryptionId=5db8409ed8, topicName=Cardiol)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8e886, createdName=仁者大医, createdTime=Tue Nov 07 23:06:00 CST 2017, time=2017-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1678262, encodeId=683416e8262b7, content=<a href='/topic/show?id=12025231333' target=_blank style='color:#2F92EE;'>#急性期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52313, encryptionId=12025231333, topicName=急性期)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Fri May 11 11:06:00 CST 2018, time=2018-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1578675, encodeId=e99f15e867509, content=<a href='/topic/show?id=fbf0436148a' target=_blank style='color:#2F92EE;'>#大剂量#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43614, encryptionId=fbf0436148a, topicName=大剂量)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cd6a16418535, createdName=ms7899726347904398, createdTime=Sun Oct 01 05:06:00 CST 2017, time=2017-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=248887, encodeId=7d9724888e5f, content=这个研究的样本量太小.应该扩大, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4a5105539, createdName=lovetcm, createdTime=Fri Sep 29 21:23:43 CST 2017, time=2017-09-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=248864, encodeId=4caf248864ce, content=这个研究可以观察更长时间.早期大剂量的螺内酯是不是真的有作用, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4a5105539, createdName=lovetcm, createdTime=Fri Sep 29 20:22:15 CST 2017, time=2017-09-29, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=1781807, encodeId=71891e818072f, content=<a href='/topic/show?id=5db8409ed8' target=_blank style='color:#2F92EE;'>#Cardiol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4097, encryptionId=5db8409ed8, topicName=Cardiol)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8e886, createdName=仁者大医, createdTime=Tue Nov 07 23:06:00 CST 2017, time=2017-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1678262, encodeId=683416e8262b7, content=<a href='/topic/show?id=12025231333' target=_blank style='color:#2F92EE;'>#急性期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52313, encryptionId=12025231333, topicName=急性期)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Fri May 11 11:06:00 CST 2018, time=2018-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1578675, encodeId=e99f15e867509, content=<a href='/topic/show?id=fbf0436148a' target=_blank style='color:#2F92EE;'>#大剂量#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43614, encryptionId=fbf0436148a, topicName=大剂量)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cd6a16418535, createdName=ms7899726347904398, createdTime=Sun Oct 01 05:06:00 CST 2017, time=2017-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=248887, encodeId=7d9724888e5f, content=这个研究的样本量太小.应该扩大, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4a5105539, createdName=lovetcm, createdTime=Fri Sep 29 21:23:43 CST 2017, time=2017-09-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=248864, encodeId=4caf248864ce, content=这个研究可以观察更长时间.早期大剂量的螺内酯是不是真的有作用, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4a5105539, createdName=lovetcm, createdTime=Fri Sep 29 20:22:15 CST 2017, time=2017-09-29, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=1781807, encodeId=71891e818072f, content=<a href='/topic/show?id=5db8409ed8' target=_blank style='color:#2F92EE;'>#Cardiol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4097, encryptionId=5db8409ed8, topicName=Cardiol)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8e886, createdName=仁者大医, createdTime=Tue Nov 07 23:06:00 CST 2017, time=2017-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1678262, encodeId=683416e8262b7, content=<a href='/topic/show?id=12025231333' target=_blank style='color:#2F92EE;'>#急性期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52313, encryptionId=12025231333, topicName=急性期)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Fri May 11 11:06:00 CST 2018, time=2018-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1578675, encodeId=e99f15e867509, content=<a href='/topic/show?id=fbf0436148a' target=_blank style='color:#2F92EE;'>#大剂量#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43614, encryptionId=fbf0436148a, topicName=大剂量)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cd6a16418535, createdName=ms7899726347904398, createdTime=Sun Oct 01 05:06:00 CST 2017, time=2017-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=248887, encodeId=7d9724888e5f, content=这个研究的样本量太小.应该扩大, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4a5105539, createdName=lovetcm, createdTime=Fri Sep 29 21:23:43 CST 2017, time=2017-09-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=248864, encodeId=4caf248864ce, content=这个研究可以观察更长时间.早期大剂量的螺内酯是不是真的有作用, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4a5105539, createdName=lovetcm, createdTime=Fri Sep 29 20:22:15 CST 2017, time=2017-09-29, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=1781807, encodeId=71891e818072f, content=<a href='/topic/show?id=5db8409ed8' target=_blank style='color:#2F92EE;'>#Cardiol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4097, encryptionId=5db8409ed8, topicName=Cardiol)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8e886, createdName=仁者大医, createdTime=Tue Nov 07 23:06:00 CST 2017, time=2017-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1678262, encodeId=683416e8262b7, content=<a href='/topic/show?id=12025231333' target=_blank style='color:#2F92EE;'>#急性期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52313, encryptionId=12025231333, topicName=急性期)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Fri May 11 11:06:00 CST 2018, time=2018-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1578675, encodeId=e99f15e867509, content=<a href='/topic/show?id=fbf0436148a' target=_blank style='color:#2F92EE;'>#大剂量#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43614, encryptionId=fbf0436148a, topicName=大剂量)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cd6a16418535, createdName=ms7899726347904398, createdTime=Sun Oct 01 05:06:00 CST 2017, time=2017-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=248887, encodeId=7d9724888e5f, content=这个研究的样本量太小.应该扩大, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4a5105539, createdName=lovetcm, createdTime=Fri Sep 29 21:23:43 CST 2017, time=2017-09-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=248864, encodeId=4caf248864ce, content=这个研究可以观察更长时间.早期大剂量的螺内酯是不是真的有作用, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4a5105539, createdName=lovetcm, createdTime=Fri Sep 29 20:22:15 CST 2017, time=2017-09-29, status=1, ipAttribution=)]
    2017-09-29 lovetcm

    这个研究的样本量太小.应该扩大

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1781807, encodeId=71891e818072f, content=<a href='/topic/show?id=5db8409ed8' target=_blank style='color:#2F92EE;'>#Cardiol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4097, encryptionId=5db8409ed8, topicName=Cardiol)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8e886, createdName=仁者大医, createdTime=Tue Nov 07 23:06:00 CST 2017, time=2017-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1678262, encodeId=683416e8262b7, content=<a href='/topic/show?id=12025231333' target=_blank style='color:#2F92EE;'>#急性期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52313, encryptionId=12025231333, topicName=急性期)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Fri May 11 11:06:00 CST 2018, time=2018-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1578675, encodeId=e99f15e867509, content=<a href='/topic/show?id=fbf0436148a' target=_blank style='color:#2F92EE;'>#大剂量#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43614, encryptionId=fbf0436148a, topicName=大剂量)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cd6a16418535, createdName=ms7899726347904398, createdTime=Sun Oct 01 05:06:00 CST 2017, time=2017-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=248887, encodeId=7d9724888e5f, content=这个研究的样本量太小.应该扩大, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4a5105539, createdName=lovetcm, createdTime=Fri Sep 29 21:23:43 CST 2017, time=2017-09-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=248864, encodeId=4caf248864ce, content=这个研究可以观察更长时间.早期大剂量的螺内酯是不是真的有作用, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4a5105539, createdName=lovetcm, createdTime=Fri Sep 29 20:22:15 CST 2017, time=2017-09-29, status=1, ipAttribution=)]
    2017-09-29 lovetcm

    这个研究可以观察更长时间.早期大剂量的螺内酯是不是真的有作用

    0

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