目的 探讨胸腺五肽治疗老年扩张型心肌病的临床疗效及可能机制。方法 上海市同仁医院2013年8月—2014年3月收治的扩张型心肌病患者96例, 随机分为对照组和治疗组, 每组48例。对照组患者给予常规治疗。治疗组在对照组基础上肌肉注射注射用胸腺五肽, 10 mg/次, 1次/d。15 d为1个疗程, 1个疗程完成后停止胸腺五肽15 d后开始下个疗程。两组共治疗3个疗程。治疗后, 评价两组的临床疗效, 同时观察两组患者心功能相关指标、淋巴细胞亚群和IgG的变化。结果 治疗后, 对照组和治疗组的有效率分别为68.75%、85.42%, 两组比较差异有统计学意义(P<0.01)。治疗后, 两组患者左心室射血分数(LVEF)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室质量(LV)、左室内压最大上升速率(+dp/dtt_max)、左室内压最大下降速率(-dp/dt_max)、舒张早期血流峰值速度(EPFV)、舒张晚期血流峰值速度(APFV)、充盈早期速率/晚期速率(E/A)均得到较好改善, 与治疗前比较差异具有统计学意义(P<0.01)。且治疗后, 治疗组LVEF、LVEDV、+dp/dt_max、-dp/dt_max、EPFV、APFV、E/A的改善程度优于对照组, 两组比较差异有统计学意义(P<0.05、0.01)。治疗后两组CD⁴⁺、CD⁸⁺、CD⁴⁺/CD⁸⁺、NK、IgG水平与治疗前差异具有统计学意义(P<0.01);且治疗组与对照组CD⁴⁺、CD⁴⁺/CD⁸⁺、IgG差异具有统计学意义(P<0.05、0.01)。结论 胸腺五肽治疗老年扩张型心肌病具有较好的临床疗效, 可以调节患者淋巴细胞亚群失衡, 改善体液免疫, 值得临床推广应用。

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.