体外反搏对冠心病患者肾素血管紧张素系统的影响

The effect of enhanced external counterpulsation on circulating renin angiotensin system in patients with coronary heart disease

目的:观察增强型体外反搏(EECP)对冠心病患者治疗前后肾素血管紧张素系统的变化,探讨EECP防治冠心病的机制。方法:20例冠心病患者接受EECP治疗,于反搏前、第1次反搏后、3个疗程结束时采血。检测血液中肾素活性、血管紧张素Ⅱ(AⅡ)浓度及血管紧张素转换酶(ACE)活性。17例健康体检者为对照。结果:冠心病患者血液中肾素活性、AⅡ水平及ACE活性均高于对照组水平。第一次反搏后三者均呈不同程度升高,随后持续下降,1个疗程后,ACE降至反搏前水平;2个疗程后,AⅡ降至反搏前水平;3个疗程后,肾素活性降至反搏前水平,ACE降至正常水平,AⅡ低于反搏前,但仍高于正常水平。结论:体外反搏对肾素血管紧张素系统起抑制作用,降低AⅡ水平,这可能是EECP保护缺血心肌的机制之一。

Objective:To investigate the effect of enhanced external counter pulsation(EECP) on circulating rennin angiotensin system(RAS) of patients with coronary heart disease(CHD).Method:20 patients with CHD and 17 health people were tested.Patients with CHD were treated with three courses of EECP.The circulating RAS,including plasma rennin activity(PRA),angiotensinⅡ(AⅡ) level and serum angiotensin converting enzyme(ACE) activity,were determined before EECP,after the first hour of EECP and at the end of third course of EECP. Result: PRA,AⅡlevel and ACE activity in plasma of patients with CHD were higher than those of health people.Compared to the level before EECP,AⅡincreased after the first hour treatment of EECP and then kept dropping.At the end of the second course, AⅡreduced to the level before EECP.then became even lower. But it didn′t reach the normal level at the end of treatment. ACE activity also showed a little increase with the treatment of first hour EECP.At the end of the first course,it reduced to the level before EECP, and dropped to normal level at the end of the third course of EECP.PRA also increased after the first hour EECP and showed a decreasing tendency through the three courses.Conclusion:Effects of EECP on ACE and RAS lead to the reduce of AⅡlevel. These effects maybe one of the mechanism of EECP protecting ischemic myocardium.