氨力农治疗充血性心力衰竭时血浆环核苷酸水平变化的临床研究

Effects of Amrinone on Plasma Cyclic Nucleotides Level in Patients with Congestive Heart Failure

观察33例充血性心力衰竭(CHF)患者用氨力农治疗前后血浆环核苷酸水平及血管紧张素Ⅱ(AngⅡ)浓度变化,同时观测左室功能改善情况。结果显示,治疗后血浆环核苷酸水平在心功能Ⅱ级组升高,在心功能Ⅲ～Ⅳ级组降低。而后者左室功能改善程度较前者明显,并伴AngⅡ显著下降。提示氨力农发挥作用的主要途径确实是以增加细胞内环磷酸腺苷浓度来实现。但在严重CHF中由于神经体液因素的参与,使其能更好地发挥作用,表明氨力农对CHF的治疗是合理有效的,更适合用于重症患者。

Plasma concentrations of cyclic nucleotides and angiotensin Ⅱ(Ang Ⅱ) were determined by ra-dioimmunoassay,and the changes of left ventricular function were measured by pulsed Doppler echocar-diography before and after amrinone was given to 33 patients with congestive heart failure (CHF). The results revealed that the improvement degree of left ventricular function and the reducing of Ang Ⅱ in patients with CHF of NYHA class Ⅲ and Ⅳ were more notable than those in class Ⅱ, and plasma cyclic nucleotides concentration increased in the latter and decreased in the former after treatment. The results suggested that the mechanism of action of amrinone was largely by increasing intracellular cAMP,but in severe CHF it was capable of including effects of neurohumoral factors and the drug activities of cAMP-dependent was exerted better. Therefore,amrinone treatment for patients with CHF is rational and effective,especially in patients in NYHA class Ⅲ and Ⅳ.