血管紧张素转化酶抑制剂对风湿性心脏病换瓣术后患者血浆中s-ICAM-1、s-VCAM-1和vWF含量的影响

Effects of angiotensin coverting enzyme inhibitor on s-ICAM-1, s-VCAM-1and vWF expression in plasm of rheumatic heart disease patients after valve surgery

目的观察血管紧张素转化酶抑制剂(ACEI):雅施达和卡托普利对风心病换瓣术后患者血浆中可溶性黏附分子含量及心功能的影响。方法风湿性心脏病患者90人,术前心功能(NYHA分级)Ⅲ￣Ⅳ级,换瓣术后分为雅施达组(30人)、卡托普利组(30人)和对照组(30人),分别给予雅施达、卡托普利和安慰剂治疗。分别于术后4周、8周抽血测定血浆可溶性细胞间黏附分子-1(s-ICAM-1)、可溶性血管细胞间黏附分子-1(s-VCAM-1)和血管性血友病因子(vWF)含量并同时作心功能测定。结果给予雅施达和卡托普利治疗的风心病患者血浆中s-ICAM-1、s-VCAM-1和vWF浓度都低于对照组(P<0.05),术后4周心功能恢复也好于对照组(P<0.05),雅施达组和卡托普利组间差异无显著性(P>0.05)。结论血管紧张素转化酶抑制剂能降低风心病术后患者血浆中可溶性黏附分子水平,尽早改善内皮功能和心肌功能,加强术后心脏功能的恢复,而与血管紧张素转化酶抑制剂(ACEI)的种类无明显相关。

[Objective] To measure the effects of angiotensin-coverting enzyme inhibitor （ACEI）： perindopril and captopril on some soluble cell adhesion molecules expression in the plasma and cardiac function of rheumatic heart disease patients after valve surgery. [Methods] The consecutive patients with RHD （NYHA： Ⅲ-Ⅳ; n=90） were divided into three groups after valvesurgery, and given perindopril, captopril and placebo respectively. All blood samples were taken and the patients cardiac function were monitored at the fourth and eighth week after valve surgery. The levels of s-ICAM-1, s-VCAM-1 and vWF in all samples were measured by enzyme-linked immunosorbent as- say. [Results] sICAM-1, s-VCAM-1, vWF levels were significantly decreased in the plasma of patients with the treatment of prindropril and captopril （P 〈0.01）. and the patients cardiac function were ameliorated at the fourth week （P 〈0.05）, but there were no statistic differences between two groups treated by perindopril and coptopril （P 〉 0.05）. [Conclusion] Angiotensin-coverting enzyme inhibitor （ACEI） can decrease the levels of some soluble cell adhesion molecules in the plasma of patients with valve surgery, improve the function of endothelium and myocardi- urn. But the categories of ACEI have no significant influence to the plasma levels of some soluble cell adhesionmolecules.