摘要
目的 观察慢性心力衰竭 (心衰 )患者外周血中血浆肾素活性 (PRA)、心钠肽 (ANP)及脑钠肽 (N BNP)水平的变化及卡维地洛对其影响。方法 6 0例慢性心衰患者随机分为常规治疗组 (血管紧张素转换酶抑制 +利尿剂 +地高辛 )和卡维地洛组 (常治疗药物 +卡维地洛 ) ,随访 12w ,采用放射免疫法测定二组治疗前后和 30例健康体检者 (正常对照组 )外周血中PRA、ANP、及N BNP水平。同时使用核素心室显像测定心衰患者左心室射血分数 (LVEF)。结果 心衰患者外周血中PRA、ANP及N BNP水平较正常对照组显著升高 ,其中ANP及N BNP水平在卡维地洛治疗前与LVEF负相关 ,在卡维地洛治疗后与LVEF密切相关 ,但PRA水平与LVEF无关。治疗后卡维地洛组外周血中PRA、ANP及N BNP水平较常规治疗组下降更明显。结论 外周血中ANP及N BNP水平在慢性心衰的病理生理机制中起着重要作用 ,甚至在 β受体阻滞剂治疗后仍可用于指导心衰患者的治疗。β受体阻滞剂能抑制心衰患者神经内分泌的过度激活。
Objectives To investigate the levels of plasma renin activity,atrial natriuretic peptides and aminoterminal B-type natriuretic peptides in patients with chronic heart failure and to evaluate the beneficial effects of beta-blockers on the above variables. Methods We studied 60 patients with chronic heart failure randomly treated with routine drugs (digitalis,diuretics and vasodilating drugs,n=30)or additional beta-blocker carvedilol(n=30).Plasma renin activity,atrial natriuretic peptides,aminoterminal B-type natriuretic peptides and left ventricular ejection fraction(LVEF) were measured at baseline and 12 weeks after the treatment. Thirty age-matched subjects with no cardiac disease served as control group.Results Baseline levels of plasma renin activity,atrial natriuretic peptides and aminoterminal B-type natriuretic peptides were significantly higher in patients with heart failure than in controls(P<0.05). There was a significant negative correlation between atrial natriuretic peptides, aminoterminsl B-type natriuretic peptides and LVEF at 12 weeks after the treatment. Plasma levels of renin activity,atrial natriuretic peptides and aminoterminal B-type natriuretic peptides were decreased more significantly in the carvedilol group than in the routine group(P<0.05).Conclusions Plasma levels of atrial natriuretic peptides and aminoterminal B-type natriuretic peptides play an important role in the pathophysiologic mechanism of patients with HF. Natriuretic peptide levels can still guide treatment for HF even after beta-blocker therapy. Beta-blocker can suppress neurohumoral over activation in patients with HF.
出处
《岭南心血管病杂志》
2004年第5期324-326,共3页
South China Journal of Cardiovascular Diseases
