简介：　　摘要：目的 探讨联合应用培哚普利和坎地沙坦治疗慢性充血性心力衰竭 (CHF)的疗效及对心室重构的影响。方法将 160例 CHF患者随机分为对照组、培哚普利组、坎地沙坦组和联合治疗组，每组 40例，共治疗 16周。对照组采用常规治疗；培哚普利组在常规治疗基础上加用培哚普利治疗；坎地沙坦组在常规治疗基础上加用坎地沙坦治疗；联合治疗组在常规治疗基础上加用培哚普利、坎地沙坦治疗。治疗中，观察评价各组患者左心功能和左心室形态［左室射血分数（ LVEF）、左室收缩末期内径 (LVESD)、左室后壁厚度 (LVPWT)、左室舒张末期内径 (LVEDD)、室间隔厚度 (IVST)］、心肌重塑相关细胞因子［白介素 6（ IL6）、基质金属蛋白酶（ MMP） 3、 MMP 9］以及药物治疗安全性。结果联合治疗组总有效率为 100.0%高于培哚普利组（ 90.0%）、坎地沙坦组（ 87.5%）、对照组（ 65.0%），差异有统计学意义（ P＜ 0.05）。与对照组比较，其他 3组 LVESD、 LVEDD、 IVST、 LVPWT与 IL6、 MMP3、 MMP9均显著下降， LVEF显著升高，差异有统计学意义（ P＜ 0.05），且联合治疗组各上述指标均优于培哚普利组和坎地沙坦组（ P＜ 0.05）。 4组治疗安全性差异无统计学意义（ P＞ 0.05）。结论培哚普利与坎地沙坦均能够改善患者心功能的改善，抑制心室重塑 ,且两者联合治疗疗效更好。  　　关键词：慢性心力衰竭；培哚普利；坎地沙坦；心室重塑  ABSTRACT: Objective To investigate the efficacy of perindopril and candesartan in the treatment of chronic congestive heart failure (CHF) and its effect on ventricular remodeling. Methods 160 patients with CHF were randomly divided into control group, perindopril group, candesartan group and combined treatment group, 40 cases in each group for 16 weeks. The control group was treated with routine treatment; the perindopril group was treated with perindopril on the basis of routine treatment; the Candesartan group was treated with candesartan on the basis of routine treatment; the combined treatment group was treated with perindopril and candesartan on the basis of routine treatment. During the treatment, left ventricular function and left ventricular morphology [left ventricular ejection fraction (LVEF), left ventricular end systolic diameter (LVESD), left ventricular posterior wall thickness (LVPWT), left ventricular end diastolic diameter (LVEDD), interventricular septal thickness (IVST)], cytokines related to myocardial remodeling [interleukin 6 (IL6), matrix metalloproteinase (MMP) were observed and evaluated. (MMP) 3, MMP 9 and drug safety. Results The total effective rate of combined treatment group was 100.0% higher than that of perindopril group (90.0%), candesartan group (87.5%) and control group (65.0%). The difference was statistically significant (P < 0.05). Compared with the control group, LVESD, LVEDD, IVST, LVPWT, IL6, MMP3 and MMP9 in the other three groups decreased significantly, and LVEF increased significantly (P < 0.05), and the above indexes in the combined treatment group were better than those in perindopril group and candesartan group (P < 0.05). There was no significant difference in treatment safety between the four groups (P > 0.05). Conclusion Both perindopril and candesartan can improve cardiac function and inhibit ventricular remodeling, and the combined treatment of perindopril and candesartan is more effective.

简介：　　 [摘要 ] 目的 探究在治疗妊娠期糖尿病孕妇中应用盐酸二甲双胍 +门冬胰岛素治疗对孕妇血清胱抑素 C、同型半胱氨酸及母婴结局的影响。方法 随机抽取 2016年 6月— 2018年 6月该院收治的 84例妊娠期糖尿病孕妇，并根据入院顺序将其分为对照组与观察组两组（ n=42）。对照组采用门冬胰岛素治疗，观察组采用盐酸二甲双胍 +门冬胰岛素治疗。比较两组治疗前后临床各项情况。结果 治疗前，两组血糖指标水平与血清 CysC、 Hcy水平比较差异无统计学意义（ P>0.05）；治疗后，观察组血糖指标水平与血清 CysC、 Hcy水平优于对照组，差异有统计学意义（ P<0.05）；观察组婴巨大、早产、剖宫产等不良母婴结局发生率低于对照组，差异有统计学意义（ P<0.05）。结论 在治疗妊娠期糖尿病孕妇中应用盐酸二甲双胍 +门冬胰岛素治疗可有效控制孕妇血糖水平与血清 CysC、 Hcy水平，并改善其母婴结局，故具有更高临床应用价值。  　　 [关键词 ] 盐酸二甲双胍；门冬胰岛素；妊娠期糖尿病孕妇；血清 CysC；母婴结局  　 [Abstract] Objective To explore the effect of metformin hydrochloride plus insulin aspart on serum cystatin C, homocysteine and maternal and infant outcome in the treatment of gestational diabetes. Methods 84 pregnant women with gestational diabetes were randomly selected from June 2016 to June 2018, and divided into control group and observation group according to the order of admission (n = 42). The control group was treated with aspartic insulin, and the observation group was treated with metformin hydrochloride + aspartic insulin. The clinical conditions of the two groups before and after treatment were compared. result Before treatment, there was no significant difference between the two groups in blood glucose index level and serum CysC, Hcy level (P>0.05); after treatment, the observation group was better than the control group in blood glucose index level and serum CysC, Hcy level, and the difference was statistically significant (P<0.05); the observation group was lower than the control group in the incidence of adverse maternal and infant outcomes, such as fetal macrosomia, premature delivery, cesarean section, and the difference was statistically significant (P<0.05) ) Conclusion metformin hydrochloride plus insulin aspart can effectively control the blood glucose level, serum CysC and Hcy levels in pregnant women with gestational diabetes mellitus, and improve the maternal and infant outcomes, so it has a higher clinical application value.