苯那普利对心力衰竭的疗效及其神经-体液机理

Effects of benazepril on congestive heart failure and its neuro humoral mechanism

目的：探讨苯那普利（Ｂｅｎａｚｅｐｒｉｌ，ＢＮＺ）对心衰的疗效及其神经－体液机理。方法：对３２例心衰病人（心功能Ⅱ级１９、Ⅲ级１０、Ⅳ级３），停用β受体阻滞剂和钙拮抗剂，在继续使用标准抗心衰治疗基础上，给予ＢＮＺ１０ｍｇ口服，１／ｄ，共２０～３０ｄ。给药前、后测定血浆肾素活性（ＰＲＡ）、血管紧张素Ⅱ（ＡＴ－Ⅱ）、去甲肾上腺素（ＮＥ）、肾上腺素（Ｅ）、内皮素（ＥＴ）和心钠肽（ＡＮＰ），以及ＵＣＧ左室功能和心机械图检查。结果：全组的心衰症状明显改善，运动耐量增加（Ｐ＜０．０１），左心功能（ＳＶ、ＣＯ、ＥＦ和ＰＥＰ／ＬＶＥＴ）显著改善（Ｐ＜０．０５～０．０１），其中高心病组（ｎ＝１１）的血压平均由２２．７／１３．８ｋＰａ下降至１８．８／１１．２ｋＰａ。治疗后全组的ＰＲＡ水平升高（Ｐ＜０．０５），ＡＴ－Ⅱ、ＮＥ、Ｅ、ＥＴ及ＡＮＰ水平显著降低（Ｐ＜０．０１）。结论：肯定了ＢＮＺ对心衰的疗效，并对心衰时交感系统、肾素血管紧张素系统和内皮系统激活起抑制作用。

Objective: To investigate the effects of benazepril (BNZ) on congestive heart failure (CHF) and its neuro humoral mechanism. Methods: Anti CHF trratment (digoxin+diuretic) was given to 32 cases of CHF (NYHA class:Ⅱ,n=19;Ⅲ,n=10;Ⅳ,n=3), but the β adrenergic blooking agents and calcium antagonist were withdrawn. Benazepril (BNZ) 10mg/d for 20～30 d were added. Plasma renin activity (PRA), the coutents of angiotensin Ⅱ(AT Ⅱ), ventricular functions (SV, CO, EF, and PEP/LVET) were determined. Results: In all patients, the symptom of CHF was considerably alleviated and exercise time significantly increased (P<0.01). Consequently, the left ventricular function was markedly improved. The mean blood pressure in patients of the hypertensive heart disease group(n=11) were decreased from 22.7/13.8 kPa to 18.8/11.2 kPa. After the treatment with BNZ, PRA was significantly increased (P<0.05) and the contents of AT Ⅱ, NE, E, ET and ANP significantly decreased (P<0.01). Conclusion: BNZ definitely exerts therapeutic effects on CHF through inhibiting the activation of sympathetic system, renin angiotensin system and endothelial system.