雷米普利和比索洛尔对心力衰竭患者心室重构和血浆神经激素水平的影响

Effects of ramipril and bisoprolol on cardiac remodeling and plasma levels of neurohormones in heart failure patients

目的:探讨单独或联合应用雷米普利和比索洛尔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96例心力衰竭患者随机分为雷米普利组、比索洛尔组和联合用药组,分别在入院和治疗后6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6个月后3组LVEF增加、LVEDD缩小(P<0.05,P<0.01);雷米普利组与比索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及ET-1水平降低及NO含量增加(P<0.05,P<0.01),雷米普利组与比索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)。结论:雷米普利和比索洛尔能改善心力衰竭患者心脏功能,逆转左室重构,降低血浆AngⅡ及ET-1水平,增加NO水平,且二者之间存在协同作用。

Objective： To explore the effects of ramipril and bisoprolol on cardiac remodeiling and the plasma levels of angiotensin Ⅱ （ Ang Ⅱ ） , etdothelin-1 （ ET-1 ） and nitric oxide （NO） in patients with congestive heart failure（CHF）. Methods： A total of 96 patients with CHF were divided into 3 groups, ramipril group, bisoprolol group and combination group, and all were treated for 6 months, echocardiography including ejection fraction（EF） and left ventricular end diastolic diameter（LVEDD）was carried out, and plasma levels of the 3 neurohormones were detected with con- ventional methods at admission and 6 months after the treatment. Results： After 6 month＇s treatment,the LVEF of all groups were increased and the LVEDD of all groups were decreased （P 〈0.05 or P 〈0.01）. No significant difference was seen between ramipril and bisoprolol groups, but the LVEF and LVEDD of combination group were improved remarkably（P 〈 0.05） compard to ramipril group and bisoprolol group. The plasma levels of Ang Ⅱ and ET-1 of were decreased significantly in all groups and the plasma levels of NO of were increased significantly in all groups （ P 〈 0.05 or P 〈 0.01 ）. No significant difference was seen between ramipril and bisoprolol groups, but the plasma levels of Ang Ⅱ , ET-1 and NO of combination group were improved remarkably（P 〈 0.05） compard to ramipril group and bisoprolol group. Conclusin： Ramipril and bisoprolol can improve cardiac function, and revere cardiac remodeling , and can decrease the plasma levels of Ang Ⅱ , ET-1 and increase the plasma levels of NO. Thus there may exist a synergistic relation between sympathetic nervous system and rennin-angiotensin-aldosterone system.