目的 探討胸腺五肽治療老年擴(kuò)張型心肌病的臨床療效及可能機(jī)制。方法 上海市同仁醫(yī)院2013年8月—2014年3月收治的擴(kuò)張型心肌病患者96例, 隨機(jī)分為對(duì)照組和治療組, 每組48例。對(duì)照組患者給予常規(guī)治療。治療組在對(duì)照組基礎(chǔ)上肌肉注射注射用胸腺五肽, 10 mg/次, 1次/d。15 d為1個(gè)療程, 1個(gè)療程完成后停止胸腺五肽15 d后開(kāi)始下個(gè)療程。兩組共治療3個(gè)療程。治療后, 評(píng)價(jià)兩組的臨床療效, 同時(shí)觀察兩組患者心功能相關(guān)指標(biāo)、淋巴細(xì)胞亞群和IgG的變化。結(jié)果 治療后, 對(duì)照組和治療組的有效率分別為68.75%、85.42%, 兩組比較差異有統(tǒng)計(jì)學(xué)意義(P<0.01)。治療后, 兩組患者左心室射血分?jǐn)?shù)(LVEF)、左心室舒張末期容積(LVEDV)、左心室收縮末期容積(LVESV)、左心室質(zhì)量(LV)、左室內(nèi)壓最大上升速率(+dp/dtt_max)、左室內(nèi)壓最大下降速率(-dp/dt_max)、舒張?jiān)缙谘鞣逯邓俣?EPFV)、舒張晚期血流峰值速度(APFV)、充盈早期速率/晚期速率(E/A)均得到較好改善, 與治療前比較差異具有統(tǒng)計(jì)學(xué)意義(P<0.01)。且治療后, 治療組LVEF、LVEDV、+dp/dt_max、-dp/dt_max、EPFV、APFV、E/A的改善程度優(yōu)于對(duì)照組, 兩組比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05、0.01)。治療后兩組CD⁴⁺、CD⁸⁺、CD⁴⁺/CD⁸⁺、NK、IgG水平與治療前差異具有統(tǒng)計(jì)學(xué)意義(P<0.01);且治療組與對(duì)照組CD⁴⁺、CD⁴⁺/CD⁸⁺、IgG差異具有統(tǒng)計(jì)學(xué)意義(P<0.05、0.01)。結(jié)論 胸腺五肽治療老年擴(kuò)張型心肌病具有較好的臨床療效, 可以調(diào)節(jié)患者淋巴細(xì)胞亞群失衡, 改善體液免疫, 值得臨床推廣應(yīng)用。

Objective To investigate the curative efficiency and possible mechanism of thymopentin in treatment of elderly dilated cardiomyopathy. Methods The patients with dilated cardiomyopathy (96 cases) of Shanghai Tongren Hospital from August 2013 to March 2014 were randomly divided into control and treatment groups, and each group had 48 cases. The patients in the control group were given conventional therapy. The patients in the treatment group were im administered with thymopentin for injection, 10 mg/time, once daily. After one course of treatment (15 d), thymopentin was stopped 15 d when one course completed, then the next course started. Two groups were treated for three courses. After treatment, the efficacy was evaluated, while the changes of cardiac function indexes, lymphocyte subsets and IgG were observed. Results The efficacies in the control and treatment groups were 68.75% and 85.42%, respectively, and there were differences between the two groups (P < 0.05). After treatment, LVEF, LVEDV, LVESV, LV, +dp/dt_max, -dp/dt_max, EPFV, APFV, and E/A were improved better, with statistically significant difference before treatment (P < 0.01). And after treatment, improvement degrees of LVEF, LVEDV, +dp/dt_tmax, DP/dt_max, EPFV, APFV and E/A in the treatment group were better than those in the control group, and there were differences between two groups (P < 0.05, 0.01). After treatment CD⁴⁺, CD⁸⁺, CD⁴⁺/CD⁸⁺, NK and IgG in the two groups were statistically significant difference before treatment (P < 0.01). And the differences of CD⁴⁺, CD⁴⁺/CD⁸⁺, and IgG in the treatment group were statistically significant compared with the control group (P < 0.05, 0.01). Conclusion Thymopentin has the good clinical effect in the treatment of elderly dilated cardiomyopathy, and can regulate the imbalance of lymphocyte subsets, while can improve the humoral immune, which is worth clinical promotion.