EPO Combined With Xinmailong Treatment Of Chronic Congestive Heart Failure Patients With Anemia

Objective:Chronic congestive heart failure(CHF) is the final outcome of the most cardiovascular diseases, its pathogenesis is complex,now that the main and ventricular structure reconstruction,various humoral cytokines activation and nerve endocrine disorders.CHF in the occurrence and development process is often complicated with anemia,and its severity is associated with CHF,be regarded as predictors of poor prognosis of CHF,so the correction of anemia has a positive effect on the treatment of CHF.The clinical curative effect and adverse reaction of this study is to investigate the effects of EPO combined with Xinmailong injection on treating chronic congestive heart failure complicated with anemia,effective value and safety evaluation of two drugs in clinical application.Methods:1 Research objectSelect 2013 October to 2015 January in Depart-ment of Cardiology of Xingtai People’s Hospital hospitalized CHF patients with mild anemia. Inclusion criteria:(1) met the diagnostic criteria of CHF,referring to the 2002 China "Chronic systolic heart failure diagnosis and treatment guideline",the main performance is the difficulty in breathing,weakness, anorexia and edema, combining with the history,physical examination,echocardiography and chest X-ray film and BNP make a definite diagnosis.(2)adults, left ventricular end diastolic diameter(LVEDD) increased >,male,55 female mm,>,50 mm, resting left ventricular ejection fraction(LVEF) less than or equal to 40%,the Hb concentration of male is larger than 90g/L,lessrthan 120g/L,the female is larger than 90g/L,less than 110 g/L.(3)The patients is willing to cooperate with the treatment,voluntary and signed informed consent. Exclusion criteria:(1) That are not willing to cooperate with the treatment of the patients.(2) suffered from valvular heart disease, congenital heart disease, acute viral myocarditis, pacemaker implantation, angina, myocardial infarction, multiple organ failure, malignant tumor,secondary anemia,gastrointestinal bleeding,Ju You hong cell anemia disease.2 Methods of treatmentAccording to the inclusion and exclusion criteria for the selection of appropriate patients 80 cases,were randomly divided into two groups,namely control group and EPO plus Xinmailong injecttion group,and each group had 40 cases,in the control group,there are 23 cases of male patients,and there are 26 cases of coronary heart disease,cardiomyopathy in 6 cases,8 cases of hypertension on the basis of disease,in the EPO plus Xinmailong injecttion group,there are 25 cases of male patients,and there are 28 cases of coronary heart disease, cardiomyopathy in 7 cases,5 cases of hypertension on the basis of disease.(1) thecontrol group using conventional triple therapy with iron treatment.Diuretic therapy: the use of spironolactone(40 ~ 60)mg/d, hydrochlorothiazide 25 mg, qd,were administered orally, effective reduction of maintenance after.The strong heart treatment: the use of digoxin(0.125 ~ 0.25)mg/d,oraladministration.Vasodilator therapy:the use of nitroglycerin(10 ~20)mg/d,using 250 ml 5% glucose liquid dilution after intravenous infusion,enalapril(10~ 20)mg, bid,oral administration.Correction of anemia:the use of Ferrous Succinate Tablets 0.2g, bid, oral administration.(2)EPO added Xinmailong injection group is based on conventional triple therapy plus Xinmailong injecttion and EPO treatment.Usage:Xinmailong(5~10)mg/kg,with glucose fluid 250 ml 5% dilution of the intravenous drip,each minute 20 ~ 30 drops,two times a day,the first drug to do skin allergy test,two weeks for a course of trea-ment.EPO usage:by subcutaneous injection of route of administration,once a week,one time according to the condition of 2000 IU,the amount of increase or decrease,up to 3 times a week,until it reaches or exceeds the 110g/l hemoglobin.3 The main research targets and measuring methodMain research goal and the method for the determination of Record be- fore and after treatment, cardiac function of patients in each group classification(NYHA),left ventricular ejection fraction,minnesota heart survey,left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVED),N-terminal pro-brain natriuretic peptide(NT-pro BNP)and the level of hemoglobin(Hb)concentration,observation of adverse reaction.The NYHA cardiac functional grading and the Minnesota heart failure quality of life score by 2 with a professional qualification physician joint assessment,blood routine test,ultrasonic Heartbeat graph(LVEDD,LVEF),chest X-ray,ECG detection, NT-pro BNP were measured by qualified physician.4 Statistical processingStatistical analyses were performed using software SPSS13.0.The measurement data with the mean standard deviation(`c±s)to represent,before and after treatment were compared by paired samples t test,two groups were compared with t test group compared with grade;rank sum test data.Using P<0.05 as a statistical difference.5 Observing the inflammatory response of renaltissue dynamically: Renal tissue was separated at different phases(2,4,8 and12w) after the onset of diabetes.Real-time PCR was used to examine the TLR4,TNF-α and IL-1β m RNA expression in the renal tissue.Renallesions were observed after HE staining and FN expression was detected with immunohistochemistry.Results:1 Combined therapy with EPO and Xinmailong group and the control group had no statistical differences in age,weight,duration,etc.2 Combined therapy with EPO and Xinmailong group and the controll group obviously after treatment for heart function than before treatment improved,and the former is improved more significantly.EPO added Xinmailong group and the control group treatment effect is better than.3 Combined therapy with EPO and Xinmailong group and control group after treatment for heart failure quality of life quality of life scores were decreased significantly,and EPO decreased with Xinmailong group than in the control group was more obvious.4 Combined therapy with EPO and Xinmailong group and control group after treatment echocardiography showed LVEF compared with those before treatment increased,and EPO added Xinmailong group showed more obvious, while LVEDD after treatment decreased, and the decrease of EPO added Xinmailong group than in the control group was more obvious.5 Combined therapy with EPO and Xinmailong group and the controll group after treatment compared with before treatment significantly.Reduce variation, and EPO added Xinmailong group decreased more obviously.6 Combined therapy with EPO and Xinmailong group and control group after treatment compared before treatment,the blood Significantly increased the content of Hb,and EPO added Xinmailong group than in the control group increased more obviously.7 Observation of treatment after January, carried out on 6min EPO added Xinmailong group and the control group of patients walk test, the results showed that after treatment, two groups of patients to walk through the distance is extended,exercise tolerance increased,but EPO with Xinmailong group changes more significantly.8 The two group had no serious adverse reactions,the control group of 3 patients with oral bloating,indigestion and other gastrointestinal symptoms, the treatment group 1 patients had dizziness and headache feeling when in transfusion,infusion speed by slow remission after.Conclusions:1 From the observation of clinical curative effect of Xinmailong group, combination of EPO reached 68.6%, the total effective up to 88.7%, with obvious therapeutic effect.2 Observation of EPO combined with CHF in the process of Xinmailong adjuvant therapy,cardiac functional classification,quality of life scores,NTpro BNP, Hb and other indexes were improved.3 Two groups during the treatment,the control group had 3 cases occur bloating,indigestion and other gastrointestinal discomfort,eased after stopping,consideration may be a side effect of iron.EPO combined with Xinmai- long group there were 1 cases of dizziness,headache,after slowing the infusion speed after mitigation,for reasons that are not clear.4 The related research at home and abroad show that Xinmailong,is a new drug is effective, safe for CHF treatment,EPO also has very important clinical application value for CHF complicated with anemia, treatment of CHF complicated with anemia was significantly associated with this study,observation of curative effect of the two, but its security needs further exploration and confirmation.