依普利酮对慢性心力衰竭患者血浆转化生长因子β1水平的影响

Effect of eplerenone on plasma TGF-β1 level in patients with chronic heart failure

目的观察依普利酮对慢性心力衰竭患者血浆转化生长因子β1(TGF-β1)水平的影响,探讨其治疗心力衰竭的可能机制。方法将85例慢性心力衰竭患者随机分为依普利酮组(n=43)和常规治疗组(n=42),常规治疗组为基础治疗,依普利酮组在常规治疗基础上加服依普利酮25mg/d,持续1个月后,无明显不良反应者增至50mg/d,治疗1年后复查心脏超声,ELISA法测外周血脑钠肽(BNP)、TGF-β1水平,比较两组治疗前后各指标变化,分析TGF-β1水平与BNP及心功能的相关性。结果依普利酮治疗1年后,患者左心室射血分数(LVEF)及6min步行距离增加,左心室后壁厚度(LVP)、左心室舒张末期内径(LVEDD)、室间隔厚度(IVS)、TGF-β1水平、BNP水平均减少,血压降低,且各项指标改善均优于常规治疗组,差异有统计学意义(P<0.05);TGF-β1水平与BNP呈正相关,与LVEF呈负相关(P<0.05)。结论在常规抗心力衰竭治疗基础上,加用依普利酮能降低心力衰竭患者血浆TGF-β1水平,逆转心肌重构,改善心功能。

Objective To observe the effect of eplerenone on plsma transforming growth factor beta 1 （TGF- β1 ） level in patients with chronic heart failure, and discuss the possible mechanism. Methods 85 chronic heart failure patients were randomly divided into eplerenone group （ n = 43 ） and conventional treatment group （ n = 42 ）, -conventional treatment group received conventional drugs, eplerenone group received conventional drugs and -vplerenone（25 mg/d for 1 month followed by 50 rag/d）. The levels of plasma TGF-β1 and BNP were measured before and after the trial by ELISA,and the myocardial structure and function were obtained by ultrasonography, each index between the two groups were compared and the correlation between TGF-β1 level and BNP and cardiac function were analyzed. Results Compared with conventional treatment, left ventricular ejection fraction （LVEF）and the six minutes walk distance increased, left ventricular wail thickness （LVP）, left ventricular end-diastolic diameter （LVEDD） ,ventricular septal thickness （IVS）, TGF-β1 level, BNP levels and the blood pressure all reduced in patients received eplerenone （P 〈 0. 05 ）, TGF-β1 level were inversely correlated with LVEF, and positively correlated with BNP level （ P 〈 0. 05 ）. Conclusions Eplerenone can reduce plasma TGF-~I level, reverse myocardial remodeling and improve cardiac function in heart failure patients.