比索洛尔治疗慢性心力衰竭对外周血中血浆肾素活性及利钠肽水平的影响

Effects of bisoprolol on plasma renin activity,atrial natriuretic peptides and aminoterminal B-type natriuretic peptides in patients with chronic heart failure

目的探讨β受体阻滞剂比索洛尔治疗慢性心力衰竭时对外周血中血浆肾素活性(PRA)、心钠肽(ANP)及脑钠肽(N-BNP)水平的影响。方法120例慢性心衰患者随机分为常规治疗组(血管紧张素转换酶抑制+利尿剂+地高辛)和比索洛尔组(常规治疗药物+比索洛尔),随访12周,采用放射免疫法测定两组治疗前后和60例健康体检者(正常对照组)外周血中PRA、ANP及N-BNP水平。同时使用核素心室显像测定心衰患者左心室射血分数(LVEF)。结果心衰患者外周血中PRA、ANP及N-BNP水平较正常对照组显著升高,其中ANP及N-BNP水平在比索洛尔治疗前与LVEF负相关,在比索洛尔治疗后与LVEF密切相关,但PRA水平与LVEF无关。治疗后比索洛尔组外周血中PRA、ANP及N-BNP水平较常规治疗组下降更明显。结论外周血中ANP及N-BNP水平在慢性心衰的病理生理机制中起着重要作用,甚至在β受体阻滞剂治疗后仍可用于指导心衰患者的治疗。β受体阻滞剂能抑制心衰患者神经内分泌的过度激活。

[Objective] To investigate the levels of plasma renin activity,atrial natriuretic peptides and aminoterminal B-type natriuretie peptides in patients with chronic heart failure and to evaluate the beneficial effects of betablockers on the above variables. [Methods] We studied 120 patients with chronic heart failure randomly treated with routine drugs （digitalis, diuretics and vasodilating drugs, n =60） or additional beta-blocker bisoprolol （n =60）. Plasma renin activity,atrial natriuretie peptides,aminoterminal B-type natriuretie peptides and left ventrieular ejective fraction （LVEF） were measured at baseline and 12 weeks after the treatment. Sixty age-matched subjects with no cardiac disease served as control group. [Results] Baseline levels of plasma renin activity, atrial natriuretie peptides and aminoterminal B-type natriuretie peptides were significantly higher in patients with heart failure than in controls （P 〈0.05）. There was a significant negative correlation between atrial natriuretie peptides, aminoterminal B-type natriuretie peptides and LVEF at 12 weeks after the treatment. Plasma levels of renin activity, atrial natriuretie peptides and aminoterminal B-type natriuretie peptides were decreased more significantly in the bisoprolol group than in the routine group （P 〈0.05）. [ Conclusion] Plasma levels of atrial natriuretie peptides AN P and aminoterminal B-type natriuretie peptides play an important role in the pathophysiologie mechanism of patients with HF.Natriuretie peptide levels can still guide treatment for HF even after beta-blocker therapy. Beta-blocker can suppress neurohumoral over activation in patients with HF.