不同剂量的血管紧张素转换酶抑制剂对心力衰竭患者脑钠肽和去甲肾上腺素的作用

Effect of the various dose of angiotensin converting enzyme inhibitor on brain natriuretic peptide and norepinephrine in patients with chronic heart failure

目的:探讨不同剂量血管紧张素转换酶抑制剂(ACEI)对慢性心力衰竭(CHF)患者脑钠肽(BNP)和去甲肾上腺素(NE)的影响和较大剂量ACEI的可行性与安全性。方法:将66名临床症状稳定的CHF患者在接受基础治疗基础上随机分为较小剂量组(培哚普利2～4mg/d),较大剂量组(8～10mg/d),治疗12周,治疗前后测定2组患者血浆NE、BNP浓度,左室舒张末内径(LVEDd),左室射血分数(LVEF),心率,血压,观察治疗前后各项指标的变化及组间差异。并且选择30例年龄相仿的正常对照者,分别测定基础血浆NE、BNP浓度。结果:CHF患者血浆中BNP浓度随着纽约心脏病协会心功能分级(NYHA)分级增加而升高,与LVEF呈显著负相关(r=-0.327,P=0.012;);BNP与LVEDd和血浆NE呈显著正相关(r=0.42,P=0.015;r=0.402,P=0.002)。较大剂量组较较小剂量组能更明显降低血浆中BNP、NE浓度。较大剂量组患者采用小剂量逐渐递增剂量方式给药,且耐受性良好。结论:CHF时血浆BNP浓度与心衰严重程度密切相关,而且BNP与血浆NE浓度呈正相关。在CHF患者中采用小剂量逐渐递增剂量的方式给予培哚普利可明显降低BNP、NE,患者耐受性良好。

Objective To investigate the effect of various dosage of angiotensin converting enzyme inhibitor （ACEI） on plasma brain natriuretic peptide （BNP） and norepinephrine （NE） and the feasibility and security of high dosage of ACEI. Methods Sixty-six patients with stable chronic heart failure （CHF） who were receiving basic therapy for heart failure were randomly assigned to the low-dose group （ perindopril 2-4 mg/d） and the high-dose group （gradually increase up to perindopril 8 - 10 mg/d）. All indices （including plasma NE and BNP levels, LVEF, LVEDd, HR,BP） were measured before and after 12w treatment, and then compared the differences between the two groups. 30 healthy subjects were selected as control group. They also were examined with the plasma levels of NE and BNP. Results The plasma BNP level was correlated closely with NYHA classes of heart failure, LVEF（ r = - 0. 327, P = 0. 012）, plasma NE level （ r = 0. 402, P = 0. 002 ） and LVEDd （ r = 0. 42, P = 0.015 ） in patients with CHF. Both of plasma BNP and NE levels in the high-dose group （perindopril 8 - 10 mg/d） were decreased more than those in the low-dose group. Patients in the high-dose group received perindopril at low dosage initially and gradually increasing to the high dosage and tolerated well. Conclusion Plasma BNP level in patients with CHF is correlated closely with the severity of CHF and plasma NE. Giving perindopril to patients in the heart failure at low dosage initially and gradually increasing to the high dosage could decrease the plasma BNP and NE levels. Patients tolerated it well.