慢性心力衰竭患者心钠素、脑钠素浓度改变及卡维地洛对其影响

Changes of Brain Natriuretic Peptide in Chronic Heart Failure and Effects of Carvedilol on Them

目的 :观察慢性心力衰竭患者心钠素、脑钠素浓度改变及卡维地洛对其影响。 方法 :选择观察组慢性心力衰竭患者 42例和对照组 2 0例 ,采用放射免疫法测定治疗前后血浆心钠素、脑钠素浓度 ;彩色超声心动图测定左心室射血分数、左心室舒张末期内径 ;临床慢性心力衰竭采用NYHA心功能分级 ;将观察组随机分为常规治疗者 2 1例和加用卡维地洛治疗者 2 1例 ,满 2周复查心钠素和脑钠素 ;满 3个月复查彩色超声心动图。 结果 :观察组血浆心钠素、脑钠素浓度均高于对照组 (P均 <0 0 0 1) ;临床慢性心力衰竭程度越重 ,血浆心钠素、脑钠素浓度越高 (P均 <0 0 0 1) ;卡维地洛治疗者与常规治疗者治疗满 2周后均有血浆心钠素、脑钠素浓度下降 ,卡维地洛治疗者血浆心钠素、脑钠素浓度下降更明显 (P <0 0 5 ) ;而满 3个月时卡维地洛治疗者左心室射血分数、左心室舒张末期内径均比常规治疗者明显改善 (P均 <0 0 5 )。 结论 :心钠素、脑钠素浓度可以反映心功能状态 ;卡维地洛可以降低心钠素、脑钠素浓度及改善心脏重构及心功能。

Objective:To observe changes of brain natriuretic peptide (BNP) in chronic heart failure(CHF) and effects of carvedilol on the changes. Methods: The subjects were divided into CHF group ( n =42) and healthy control group ( n =20). Plasma atrial natriuretic peptide (ANP) and BNP concentrations were measured by immunoradiometric assay immediately after admission. Severity of CHF was based on NYHA heart functional classes. Left ventricular ejection fraction (LVEF) and left ventricular internal dimension at end-diastole (LVED) were measured by M-mode Echocardiography. The CHF group was further subdivided into either or plus carvedilol conventionally. ANP and BNP concentrations were re-checked two weeks later. LVEF and LVED were re-checked three months later. Results: ANP and BNP concentrations of CHF group were higher than those of control group. The concentrations increased with the severity of heart failure ( p <0.001).Two weeks later, there was no difference of NYHA heart functional classes between groups wheather plus carvedilol or not ( p >0.05),but ANP and BNP concentrations were more decreased in carvedilol group. Carvedilol significantly improved LVEF and LVED three months later ( p <0.05). Conclusions: ANP and BNP concentrations can reflect the state of cardiac function; Carvedilol can not only improve cardiac function but also lower the ANP and BNP concentrations.