充血性心力衰竭患者内皮素、肿瘤坏死因子-α、一氧化氮的变化及卡维地洛对其影响

Endothelin-1 tumor necrosis factor-α and nitric oxide in congestive heart failure and their changes after dilatrend treatment

目的探讨充血性心力衰竭(CHF)患者的血浆内皮素(ET-1)、一氧化氮(NO)和肿瘤坏死因子-α(TNF-α)的变化及卡维地洛对其影响。方法采用放射免疫法和比色法分别测定66例CHF患者和24例健康者(对照组)的血浆内皮素(ET-1)、肿瘤坏死因子-α(TNF-α)和一氧化氮(NO)浓度。66例CHF患者随机分为两组:A组30例,给予常规抗心力衰竭治疗;B组在常规治疗的基础上加用卡维地洛。两组治疗3个月。结果CHF组ET-1、TNF-α、NO水平显著高于对照组(P<0.01);CHF患者治疗后心功能均有改善,而B组治疗后ET-1、TNF-α、NO下降明显(P<0.01)。结论ET-1、TNF-α、NO与心力衰竭的发生发展有关,卡维地洛可降低CHF患者的ET-1、NO、TNF-α,从而改善心功能。

[Objective] To study the levels changes of plasma tumor necrosis factor-alpha （TNF-α）, endothelin- 1 （ET-1） and nitric oxide （NO） and the interv-ention role of dilatrend in patients with congestive heart failur （CHF）. [Methods] TNF-α, ET-1 and NO levels were measured in 62 patients with CHF and 20 healthy subjects served as normal controls. 62 patients with CHF were randomized into to A group of 32 cases and B group of 30 cases. A group were given cardiotonic, diuretic and extending blood vessel drugs; B group were given dilatrend 6.25 mg twice a day in the duration of three months, besides the medications admini-stered by A group. [Results] The serum TNF-α,ET-1 and NO levels in patients of CHF were much higher than those in normal subjects （P 〈0.01）. Both of the therapies were effective in improving the symptoms of CHF, but only the atients treated with dilatrend lowered serum TNF-α, ET-1 and NO levels （P 〈0.01 or P 〈0.05）. [Conclusion] These findings indicate that INF-α, ET-1 and NO play an important role in the pathophysiologic changes of CHF. Dilatrend may decrease the levels of TNF- α, ET-1 and NO in patients with heart failure and improve the dysfunction of endothel/al system.