福辛普利和美托洛尔对心力衰竭患者心肌重构和血浆神经激素水平的影响

Effects of fosinopril and metoprolol on cardiac remodeling and plasma levels of neurohormones in heart failure patients

目的探讨单独或联合应用美托洛尔和福辛普利对心力衰竭患者血浆血管紧张素Ⅱ(AngⅡ)、内皮素-1(ET-1)及一氧化氮(NO)含量的影响。方法将80例心力衰竭患者随机分为福辛普利组、美托洛尔组和联合用药组,分别在入院和治疗后12个月时检测心脏超声和外周血AngⅡ、ET-1及NO含量变化。结果治疗12个月后3组LVEF、LVEDD均显著改善(P<0.05,P<0.01);福辛普利组与美托洛尔组之间无明显差异,联合用药组较另外2组改善明显(P<0.05)。各组血浆AngⅡ、ET-1及NO含量变化显示治疗后福辛普利组与美托洛尔组各项指标间无明显差异,联合用药组AngⅡ和ET-1比福辛普利组明显降低(P<0.05),但与美托洛尔组比较无明显差异。结论美托洛尔和福辛普利能改善心力衰竭患者心脏功能,逆转左室重构,降低血浆神经激素水平,且二者之间存在协同作用。

Objective To explore the effects of fosinopril and metoprolol on cardiac remodeling and the plasma levels of angiotensin Ⅱ （ Ang Ⅱ ）, endothelin-1 （ ET-1 ） and nitric oxide （NO） in patients with congestive heart failure（CHF）. Methods A total of 80 patients with CHF were divided into 3 groups, fosinopril（20 mg/d） ,metoprolol （from 6.25 mg, twice a day to 100 mg, twice a day or the highest tolerant dose） and combination groups（ as in single use）, and all were treated for 12 months. Electrocardiography including ejection fraction（EF）and left ventricular end diastolic diameter（ LVEDD）was carried out, and plasma levels of the 3 neurohormones were detected with conventional methods at admission and 12 months after the treatment. Results Plasma levels of Ang Ⅱ , ET-1 and NO were decreased significantly in all groups. No significant difference was seen between fosinopril and metoprolol groups ,but the plasma levels was decreased remarkably（ P 〈 0. 01 ） compared to fosinopril group but not metoprolol group;LVEF and LVEDD of all groups were improved and especially in combination group. Conclusion Fosinopril and metoprolol can improve cardiac function, reverse cardiac remodeling and decrease the plasma levels of Ang Ⅱ , ET-1 and NO. Thus there may exist a synergistic relation between sympathetic nervous system and renin-angiotensin-aldosterone system.