比较伊贝沙坦与培哚普利对充血性心力衰竭患者细胞因子和血管紧张素II的影响

Comparative study of the effects of Irbesartan and Perindopril on serum cytokine levels and angiotensin Ⅱ in patients with congestive heart failure

目的:比较伊贝沙坦与培哚普利对充血性心力衰竭(CHF)患者血清肿瘤坏死因子α(TNFα)、白细胞介素6(IL6)、血浆血管紧张素II(AngII)的影响。方法:测定健康对照者38例和CHF患者83例治疗前、后TNFα、IL6和AngII浓度。CHF患者83例随机分为伊贝沙坦组(n=43)和培哚普利组(n=36),4例不能耐受而退出。治疗前及治疗后8周用彩色多普勒二维超声显像仪测定左心室射血分数(LVEF)。结果:CHF组血清TNFα、IL6和血浆AngII水平显著高于健康对照组(P<0.01)。血清TNFα、IL6水平与CHF的原发病无相关,而与LVEF呈负相关(r=-0.56,r=-0.60,P<0.01),伊贝沙坦组、培哚普利组治疗8周后TNFα、IL6水平显著下降,伊贝沙坦降低IL6较培哚普利显著(P<0.05),LVEF显著提高(P<0.05)。结论:CHF患者血清TNFα、IL6、AngII水平显著升高,且与LVEF呈负相关。伊贝沙坦及培哚普利具有降低血清TNFα、IL6水平及改善LVEF的作用。伊贝沙坦降低IL6较培哚普利显著,且耐受性好。

AIM : To observe serum levels of tumor necrosis factor-α(TNF-α), interleukin-6(IL-6)and angiotensinⅡ( AngⅡ)in patients with congestive heart failure (CHF)and its changes with treatment of Irbesartan or Perindopril. METHODS: Serum concentrations of TNF-α,IL-6 and AngⅡ in normal controls (n=38)and patients with CHF(n=83),who were randomized into irbesartan group(n=43)and perindopril group(n=36),were measured before and 8 weeks after treatment respectively.Left ventricular ejective fractions(LVEF)were also estimated in those subjects. RESULTS: There was a significant increase in serum levels of TNF-α,IL-6 and AngⅡ in patients with CHF compared with normal controls(P<0.01).The serum levels of TNF-α and IL-6 were negative related to LVEF ( r= -0.56, r= - 0.60,P<0.05) but not related to primary disease of CHF.There was a significant decrease in serum levels of TNF-α and IL-6 and increase in LVEF(P<0.05)in both irbesartan group and perindopril group,but the decrease of IL-6 in the irbesartan group was significant bigger than that of perindopril group. CONCLUSION: There was a significant increase in serum levels of TNF-α,IL-6 and AngⅡ in patients with CHF,and the serum levels of TNF-α and IL-6 were negative related to LVEF.Irbesartan or perindopril decrease the serum levels of TNF-α and IL-6 and increase LVEF in patients with CHF, but the decrease of IL-6 in the irbesartan group was significant bigger than that of perindopril group and patients stand Irbesartan better than perindopril.