螺内酯治疗后心衰患者红细胞Mg^(2+)/Na^+交换速率与心律失常的研究

Study on erythrocyte Mg^(2+)/Na^+ exchange rate and arrhythmia in patients with congestive heart failure after spironolectone therapy

目的 探讨充血性心力衰竭加用螺内酯治疗 ,血浆镁浓度 (PMC)、红细胞镁含量 (EMC)和红细胞Mg2 + /Na+ 交换速率与心律失常的关系。方法 116例慢性充血性心力衰竭连续病例随机分为两组 ,常规治疗加螺内酯 (组 1,n =5 8)和不加螺内酯 (组 2 ,n =5 8) ,采用原子吸收光谱火焰法测定两组治疗前、6个月后PMC、EMC以及加镁负荷后红细胞在含钾或含钠介质中 5h时间的镁外流 ,并计算总镁外流最大速率 (VTmax)、非钠依赖性镁外流最大速率 (VNImax)和钠依赖性镁外流最大速率 (VNDmax) ;以Holter检测治疗 6个月时心律失常发生率 ,探讨红细胞Mg2 + /Na+ 交换速率与心律失常的相关性。结果 ①治疗前两组PMC、EMC、VTmax、VNimax、VNDmax差异无显著性 (P>0 0 5 )。②治疗 6个月后 ,组 1PMC与治疗前比较呈显著性升高 (83 0 1± 5 9 9vs79 0 1± 5 5 9)mmol/L(P <0 0 5 ) ,与组 2 (78 4 6± 5 6 3)mmol/L比较呈显著性升高 (P <0 0 5 ) ;组 1EMC与治疗前比较呈显著性升高 (2 18± 0 0 5vs2 0 7± 0 0 4 )mmol/L(P <0 0 5 ) ,与组 2 (1 93± 0 0 5 )mmol/L比较明显升高 ,差异有高度显著性 (P <0 0 1) ;组 1VTmax与治疗前比较呈显著性降低 (2 70 11± 2 0 1vs 2 89 2 0± 2 0 1) μmol/(L·h) (P <0 0

Objective To explore plasma magnesium concentration(PMC), erythrocyte magnesium content (EMC), erythrocyte Mg 2+ /Na + exchange rate and arrhythmia in patients with congestive heart failure with or without spironolectone treatment. Methods 116 consecutive patients with congestive heart failure were randomly divided into two groups. Group one(n=58): standard treatment with spironolectone therapy; Group two(n=58): standand treatment without spironolectone therapy. Plasma magnesium concentration(PMC) and erythrocyte magnesium content(EMC) were measured by flame assay of atomic absorption spectrophotometer. Every hour interval of magnesium efflux was examined for five hours; by applying magnesium loaded erythrocyte in either potassium or sodium-mediated solution respectively. Maximum rate of total magnesium efflux(V Tmax ), sodium-independent magnesium efflux (VNImax) and sodium-dependent magnesium efflux(V NDmax ) were calculated. Results ①There were no significant difference in PMC, EMC, VTmax,VNImax,VNDmax between groups(P>0.05) before treatment. ② After 6 months of treatment, there was significant difference in PMC compared to before treatment(83.01±59.9 vs 79.01±55.9)mmol/L(P<0.05) in group one, compared to group two after 6 months therapy there was significantly different(83.01±59.9 vs 76.46±61.3)mmol/L(P<0.05). EMC in group one was higher comparing with before treatment(2.18±0.05 vs 2.07±0.04)mmol/L(P<0.05), and comparing with group two after 6 months therapy(2.18±0.05 vs 1.93±0.05)mmol/L(P<0.05). V Tmax in group one was lower than before treatment and group two after 6 months therapy(270.11±20.1 vs 289.20±20.1, 311.4±18.6)μmol/(L·h)(P<0.05, P<0.01). There was no significant difference in V NImax between the two groups(P>0.05). V NDmax was significantly lower in group one than before treatment and than group two after 6 months therapy(106.2±18.3 vs 126.2±18.3, 157.3±14.8)μmol/(L·h)(P<0.05, P<0.01). ③In the circumstance of the same serum potassium, the mean sinus heart rate and the average ventricular premature ectopy for 24 hours in group one was lower than those in group two after 6 months therapy(P<0.05). Non-persistence ventricular tachycardia, atria fibrillation/flutter, atria premature ectopy in group one was significantly lower than those of in group two(P<0.05). Conclusion Decreased V NDmax caused by inhibition of Mg 2+ /Na + exchange rate in patients with congestive heart failure treated by spironolactone may prevent from magnesium lose in blood or erythrocyte and inhibits the occurrence of some kinds of arrhythmia. The anti-arrhythmia action of spironolaction may relate to enhancing magnesium stability in myocardial cells, inhibiting early after depolarization arrhythmia concerning to trigger mechanism, and inhibiting automatic arrhythmia connecting to calcium overload.