关键词: 慢性阻塞性肺疾病, 射血分数保留的心衰, 伊伐布雷定, 心肺运动试验, 心率变异性, 预后

Abstract:

Objective： To investigate the effect of ivabradine on cardiopulmonary exercise testing parameters， heart rate variability （HRV）， high-sensitivity C-reactive protein （hs-CRP） and N-terminal pro-brain natriuretic peptide （NT-proBNP） in patients with chronic obstructive pulmonary disease （COPD） and heart failure with preserved ejection fraction （HFpEF）.Methods： 97 patients with COPD and HFpEF were divided into the control group （n=48， conventional symptomatic treatment combined with bisoprolol fumarate tablets） and the ivabradine group （n=49， ivabradine treatment on the basis of the treatment of control group） using the random number table method. The rapeutic effects in the two groups were compared. The changes in cardiopulmonary exercise testing parameters， HRV， hs-CRP， NT-proBNP， St. George's respiratory questionnaire （SGRQ） scores， COPD assessment test （CAT） scores and 6-minute walking distance after treatment were observed. Adverse cardiac events and drug reactions in the two groups were compared.Results： After treatment， the total effective rate of the ivabradine group was 91.30%，which higher than that of the control group （76.09%，P<0.05）. After treatment， the peak oxygen consumption （Peak VCO₂）， anaerobic threshold （AT）， standard deviation of RR intervals （SDNN）， root mean square of successive RR interval differences （RMSSD） and percentage of adjacent RR intervals differing by more than 50 milliseconds （RNN50） of the two groups of patients were increased （P<0.05）， and increase in the ivabradine group was better than that in the control group （P<0.05）. After treatment， the ventilatory equivalent for carbon dioxide （VE/VCO₂）， hs-CRP， NT-proBNP， SGRQ scores and CAT scores in both groups were decreased （P<0.05）， and decrease in the ivabradine group was better than that in the control group （P<0.05）. After treatment， 6-minute walking distance of the two groups increased， and 6-minute walking distance of the ivabradine group was longer than that in the control group （P<0.05）. Compared with the control group， the readmission rate of the ivabradine group was lower （P<0.05）. The mortality rate and total incidence of adverse reactions in the ivabradine group were slightly lower （P>0.05）.Conclusion： Applying ivabradine in the treatment of patients with COPD and HFpEF can improve their cardiopulmonary exercise function， HRV， prognosis and quality of life， and reducing the levels of hs-CRP and NT-proBNP and the readmission rate， with high safety.

［Key Words］ 

Key words:  , Chronic obstructive pulmonary disease； , Heart failure with preserved ejection fraction； , Ivabradine； , Cardiopulmonary exercise testing； , Heart rate variability； , Prognosis