心力衰竭患者血浆sTRAIL和sDR5的水平及培哚普利对其影响

Effects of perindopril on plasma soluble TRAIL and receptor soluble DR5 in patients with congestive heart failure

目的 :探讨充血性心力衰竭 (CHF)患者血浆可溶型TNF相关的凋亡诱导配体 (sTRAIL)和死亡受体DR5水平的变化及与培哚普利对心脏保护的关系。方法 :用ELISA法检测治疗前后 30例服用培哚普利的CHF患者、2 8例常规治疗的CHF患者及 2 0例健康人对照血浆中sTRAIL及sDR5的水平。结果 :① 5 8例CHF患者血浆sTRAIL的平均含量为 (1.4 3± 0 .4 7)μg/L ,健康人为 (0 .93± 0 .12 ) μg/L ,两者无显著性差异(P >0 .0 5 ) ;sTRAIL水平与心功能损害程度亦无明显关系。CHF患者血浆sDR5的平均含量为 (39.6 7± 6 .78)ng/L ,较健康人 (<6ng/L)明显升高 ,且随着心功能损害程度的加重而升高。②培哚普利组与常规心衰治疗组治疗后 ,血浆中sTRAIL的水平均有所降低 ,但无显著性差异。治疗前后培哚普利组血浆sDR5的平均水平 ,分别为 (31.2 3± 10 .16 )ng/L和 (8.5 0± 2 .14 )ng/L(P <0 .0 5 ) ;常规治疗组分别为 (48.81± 8.74 )ng/L和 (2 6 .6 4± 6 .2 7)ng/L(P <0 .0 5 )。培哚普利组与常规治疗组相比较 ,前者降低更明显 (分别下降 72 .7%和 4 5 .4 % )。③与其他病因所致CHF患者相比较 ,高血压心脏病所致CHF患者血浆sDR5的水平明显升高。结论 :sDR5可能在CHF患者心肌细胞凋亡的发生、发展中起着重要作用。

AIM: To explore the levels of soluble TRAIL and DR5 in plasma of patients with congestive heart failure (CHF) and the effects of perindopril. METHODS: 58 CHF patients were randomly divided into two groups, namely perindopril treatment group (30 cases) and routine treatment group (28 cases). The levels of sTRAIL and sDR5 in 58 plasma of 30 CHF patients treated with perindopril, 28 CHF patients treated with routine method before and after treatment and 20 healthy persons were detected by ELISA. RESULTS: ①The mean levels of sTRAIL in plasma of 58 CHF patients and 20 healthy persons were (1.43±0.47) μg/L and (0.93±0.12) μg/ L, respectively, the comparison between the patients and healthy persons had no notable difference ( P >0.05), suggesting that plasma sTRAIL level had no significant relation to injured level of cardiac function. As for sDR5 level, the mean level in plasma of 58 CHF patients was (39.67±6.78) ng/L, this value was significantly higher than that of healthy control group, and the level of sDR5 was increased with the injured level of cardic function. ②The plasma levels of sTRAIL in both perindopril group and conventional treatment group decreased after treatment, but there was no significant difference. The mean levels of plasma sDR5 in perindopril group were (31.23±10.16 ) ng/L and (8.50±2.14) ng/L; the levels in conventional group (48.81±8.74) ng/L and (26.64±6.27) ng/L, respectively, the perindopril group was far lower than the conventional group descending rates were 72.7% and 45.3% respectively. ③The level of plasma sDR5 in CHF patients resulting from hypertensive cardiopathy was far higher than that in CHF patients resulting from any other etiological factors. CONCLUSION: DR5 may play an important role in the occurrence and progress of myocardium apoptosis of CHF patients. Perindopril can down regulate the level of plasma sDR5, therefore, it may has the great effect on retarding course of ventricular remodeling, protecting and improving cardial function of CHF patients.