螺内酯对心力衰竭患者血管内皮功能的影响

The effects of Spironolactone on vascular endothelium function in patients with CHF

目的研究醛固酮拮抗剂-螺内酯对纽约心脏病协会(NYHA)分级Ⅱ-Ⅳ级慢性心力衰竭(CHF)患者血管内皮功能的影响。方法选择148例CHF患者,分为螺内酯治疗组77例与常规治疗组71例,比较两组患者于入选时及治疗6个月时肱动脉反应性充血管径变化(FMD)。结果在NYHA分级Ⅱ级、Ⅲ级、Ⅳ级的CHF患者均较正常对照组反应性充血时内径舒张率降低(P<0.01);常规治疗组NYHAⅡ、Ⅲ级CHF患者治疗后反应性充血时内径舒张率较治疗前增加(P<0.05～0.01);螺内酯治疗组NYHAⅡ级、Ⅲ级、Ⅳ级心力衰竭患者均较治疗前增加反应性充血时内径舒张率(P<0.05～0.01),同时较常规治疗组显著增加反应性充血时内径舒张率(P<0.01)。结论CHF患者均存在血管内皮功能障碍;以常规治疗基础上应用螺内酯治疗后对于NYHAⅡ级、Ⅲ级、Ⅳ级各级心力衰竭患者均能显著增加,FMD进一步改善血管内皮功能,而在慢性心力衰竭的的治疗过程中起着重要作用。提示螺内酯除了可以用于治疗重度心力衰竭(NYHAⅣ级),用于治疗轻中度心力衰竭(NYHAⅡ级、Ⅲ级)可以同样获益。

Objective To investigate the effects of Spironolactone, an aldosterone receptor blocker, on vascular endothelium function in chronic heart failure patients with NYHA class Ⅱ - Ⅳ. Methods The 148 cases patients with heart failure ranked with New York Heart Association （ NY- HA） class Ⅱ to Ⅳ were randomly divided into two groups： spironolactone greup（77 cases）and control group （71 cases）. After 6 months＇therapy, the endothelium dependent blood tube bore dilatation was measured. Results In either patients with NYHA class IV or patients with NYHA class Ⅱ and Ⅲ： the endothelium dependent blood tube bore dilatation was significantly improved in comparison with those before treatment and those of controls. Conclution Spironolactone can significantly improve the vascular endothelium function in patients with NYHA class IV or patients with NYHA class Ⅱ and Ⅲ.