氯沙坦对老年心力衰竭患者血清细胞因子的影响

Effect of losartan on serum cytokines in the elderly with cardiac dysfunction

目的观察老年心力衰竭患者应用血管紧张素Ⅱ受体拮抗剂(ARB)氯沙坦对血循环中炎性细胞因子的影响。方法64例老年心力衰竭患者(心衰组)随机分为常规治疗组(32例)与氯沙坦组(32例),另设正常对照组(20例)。检测治疗前后血清各炎性细胞因子浓度,并测定其左室射血分数(LVEF)。分析LVEF与细胞因子相关性。结果治疗前与对照组比较,心衰组的细胞因子含量明显升高(P<0·05,P<0·01),心衰组间比较也有明显差别(P<0·01)。氯沙坦组治疗后细胞因子显著下降与常规治疗组比较有显著差异(P<0·01),2组治疗后LVEF较治疗前均有改善。而治疗后氯沙坦组LVEF与细胞因子呈负相关。结论老年心衰患者存在着细胞因子的过度激活,ARB治疗可使血细胞因子浓度降低,并与LVEF改善呈负相关,可能为ARB改善心衰患者预后的重要机制之一。

Objective To study the effect of angiotensin receptor blocker （ARB） losartan on serum cytokines in elderly patients with cardiac dysfunction, Methods Sixty-four elderly patients with cardiac dysfunction were randomly divided into 2 groups： losartan group （32 cases） and general treatment group （32 cases）. The serum level of cytokines and the left ventricular ejection fraction （LVEF） were observed before and after treatment. The relation between LVEF and cytokines was analyzed. Results The serum levels of cytokines in elderly patients increased more than those in control groups before treatment（ P 〈0.05 ,P 〈 0. 01 ）. There was significant difference between losartan group and general treatment group. After treatment the cytokines decreased more significantly in losartan group than those in general treatment group（ P 〈 0. 01 ）. LVEF improved in the elderly patients after treatment. LVEF in losartan group had significant negative correlation with eytokines. Conclusions There is an excess activation of eytokines in elderly patients with cardiac dysfunction. ARB depresses the levels of cytokines which plays an important role in improving prognosis of elderly patients with heart failure.