螺内酯对急性心肌梗死患者胶原代谢标志物和左室重构的影响

The effects of spironolactone on plasma concentration of amino-terminal propetide of type Ⅲ procollagen and left ventricular remodeling in patients with acute myocardial infarction

目的:观察螺内酯对急性心肌梗死(AMI)患者胶原代谢标志物及左室重构的影响。方法:将60例AMI患者分为常规治疗组与螺内酯治疗组,应用放射免疫法测定血浆Ⅲ型前胶原氨基末端肽(PⅢNP)、血清透明质酸(HA)含量,用超声心动图测量左室结构及舒缩功能参数。结果:常规治疗组与螺内酯治疗组AMI后第2天血浆PⅢNP分别为(5.24±1.09)、(5.14±1.21)μg/L与正常组[(5.01±1.18)μg/L]相比差异无统计学意义(均P>0.01)。螺内酯治疗组第4周、第12周血浆PⅢNP含量分别为(7.25±1.97)、(6.82±1.98)μg/L较常规治疗组同时间点含量[(10.23±2.25)、(8.36±2.11)μg/L]均显著下降(均P<0.01)。第4周、第12周螺内酯治疗组血清HA含量[(136.4±28.7)、(109.2±30.5)ng/L]与常规治疗组[(167.5±31.5)、(134.5±36.1)ng/L]比较均显著下降(P<0.01)。螺内酯治疗组第12周左室舒张期末容积指数[(57.2±5.8)ml/m2]和收缩期末容积指数[(29.2±5.3)ml/m2]与常规治疗组[(65.9±6.3),(35.7±6.8)]相比均显著降低(P<0.01);二尖瓣血流舒张早期流速(VE)与心房收缩期流速(VA)比值(VE/VA)与常规治疗组相比均显著增加(P<0.01),射血分数虽有增加,但无明显变化(P>0.05)。结论:螺内酯可降低AMI患者血浆PⅢNP、HA含量,阻抑左室重构,改善左室功能。

Objective：To observe the effects of spironolactone on plasma markers of collagen and left ventricular remodeling in patients with acute myocardial infarction （AMI）. Method：Sixty patients with AMI were randomly divided into control group （ n = 30） which treated with routine therapy and spironolactone group （ n = 30） which treated with spironolactone based on routine therapy. The plasma of Amino-Terminal Propetide of Type Ⅲ Proeollagen （P Ⅲ NP） and the serum HA were measured by specific radioimmunoassay. Two-dimensional , Mmode and Doppler ultrasound recordings were abtained to determine serveral parameters relating to the left ventricular anatomy and function. Result： In comparison with control group, the level of plasma PⅢNP were significantly decreased in spironolactone group at the 4th and the 12th week after treatment The serum HA levels were significantly decreased in spironolactone group at the 4th and the 12th week [（134.5±36.1 vs 167.5±31.5 ） ng/L, （109.2±30.5 vs 134.5±36. 1） ng/L respectivily , （all P〈0. 01）. At the 12th week left ventricular end-disatolic volume index （LVEDVI） and left ventircular end- systolic volume index （LVESVI） in the spironolactone group were lower than that in the control group ,[E（57. 2±5. 8） vs （65.9±6.3） ml/m^2,（ 29.2±5.3）vs （35.7±6.8） ml/m^2] （ P〈0.05, P〈0.01 respectively ）, but there were no difference in left ventricular fraction （EF） between control group and spironolactone group （46.1 ±4.3 vs 44.5 ± 3. 2, P〉0.05） . Conclusion： Spironolactone decreased plasma P Ⅲ NP ,inhibited left ventricular remodeling and improved left ventricular function in post -AMI patients.