缬沙坦对急性冠脉综合征患者脑钠肽及高敏C反应蛋白的影响

Effect of Valsartan on Brain Natriuretic Peptide and High Sensitivity C-Reactive Protein in Patients With Acute Coronary Syndrome

目的:观察急性冠脉综合征患者缬沙坦治疗前后血浆脑钠肽(BNP)及高敏C反应蛋白(hsCRP)的变化,探讨缬沙坦抑制心室重构的作用机制。方法:急性冠脉综合征患者66例(急性心肌梗死43例,不稳定性心绞痛23例),随机分为治疗组(n=32)和对照组(n=34),分别检测两组治疗前、治疗1个月、治疗6个月,血浆BNP、hsCRP水平及心室结构功能的变化。结果:治疗后治疗组、对照组的急性心肌梗死患者、不稳定性心绞痛患者血浆BNP和hsCRP水平均呈下降趋势,治疗组治疗1个月下降明显、治疗6个月降低速度减慢,治疗组治疗1个月、6个月与同时间段对照组相比下降,对照组、治疗组与同组前一时间段相比亦下降,差异均有统计学意义(P<0.05～0.01)。治疗1个月,两组患者左心室射血分数、左心室收缩末期内径及左心室舒张末期内径均无明显变化(P>0.05);治疗6个月,治疗组左心室射血分数较对照组明显升高(P<0.01),左心室收缩末期内径及心室舒张末期内径较对照组明显减小(P均<0.01),差异均有统计学意义。结论:血管紧张素Ⅱ受体拮抗剂缬沙坦能够抑制急性冠脉综合征患者血浆BNP及hsCRP的分泌,降低炎性反应,抑制心室重构,改善心功能。

Objective：To observe the effects of valsartan on plasma brain natriuretic peptide （BNP） and high sensitivity C-reactive protein （hsCRP） in patients with acute coronary syndrome （ACS） and to examine the possible inhibition mechanism of valsartan for ventricular remodeling. Methods ： Sixty-six ACS patients were randomly divided into two groups. Valsartan therapy group （ n = 32） and the regular medication group designed as control group（ n = 34）. The levels of BNP, hsCRP and the structural function of left ventricle were measured at the baseline. 1 month and 6 months after valsartan treatment. Results：The levels of BNP and hsCRP were decreased in both groups after the medication; the therapy group had obviously decreased BNP and hsCRP for 1 month of valsartan treatment than 6 months of valsartan treatment （ P 〈 0. 05 - 0.01 ）. Compared with the control group, the treatment group had decreased BNP and hsCRP in 1 month and 6 months respectively （ P 〈 0.05- 0. 01 ）. The left ventricular ejection fraction （ LVEF）, left ventricular end systolic diameter （LVESD） and left ventricular end diastole diameter （LVEDD） had not changed in both groups for 1 month medication （P 〉 0. 05 ） ; while for 6 months medication, compared with control group, LVEF was significantly increased （P 〈 0.01 ） , LVESD and LVEDD were significantly decreased（ P 〈0. 01 ） in treatment group. Conclusion ： Angiotensin Ⅱ receptor antagonist valsartan could decrease the level of plasma BNP and hsCRP in patients with ACS, it could decrease the inflammation reaction, inhabit the ventricular remodeling and therefore improve the heart function.