充血性心衰ACEI治疗中醛固酮逃逸现象与心率变异的研究

Aldosterone Escape and Heart Rate Variability in Patients with Congestive Heart Failure After ACEI Treatment

【目的】探讨充血性心衰常规血管紧张素转化酶抑制剂(ACEI)治疗后,血浆肾素、血管紧张素Ⅱ(Ang Ⅱ)、醛固酮(Ald)活性变化,及醛固酮逃逸程度与预后因素密切相关的心率变异各能谱范围之间的关系。【方法】采用放射免疫法测定106例充血性心衰ACEI治疗前。治疗1个月、3个月后血浆肾素(PRA)Ang Ⅱ、Ald的活性,把血浆醛固酮升高超过基线水平20％(组1,n=46)和超过基线水平但达不到20％(组2,n=60)分为2组,比较两组间心率变异各能谱范围及其昼夜规律的变化。【结果】①全部心衰患者ACEI治疗1个月、3个月后PRA差别无显著性。②与基线水平相比较ACEI治疗后1个月血浆Ang Ⅱ活性明显降低(P<0.05);治疗3个月后Ang Ⅱ有所回升。③ACEI治疗后1个月血浆Ald明显下降(P<0.01);继续治疗到3个月时明显升高,高于基线水平(P<0.01)。④组1与组2比较心率变异总能谱(TF)、极低能谱(VLF)、低能谱(LF)明显下降;高能谱(HF)及HF/LF两组差别无显著性;醛固酮逃逸严重组(组1)心率变异各能谱24h昼夜规律消失,各能谱呈低平曲线。【结论】①充血性心衰患者ACEI治疗后,确实可观察到醛固酮逃逸现象,且这一现象在治疗3个月时表现已很突出;②醛固酮逃逸明显的病人,与预后因素密切相关的心率变异各能谱TF、VLF、LF明显下降,且昼夜规律消失。提示?

[ Objective] To explore the changes of plasma rennin, angiotensin Ⅱ and aldosterone activity in patients with congestive heart failure after treatment with angiotensin converting enzyme inhibitor (ACEI) and to analyze the relationship between the degree of aldosterone escape and the power spectral components of heart rate variability (HRV) in the patients. [Methods] The activities of plasma rennin, angiotensin II and aldosterone were determined by radioimmunoassay in 106 consecutive patients with congestive heart failure before and after 1 month and 3 months of ACEI treatment. According to the plasma aldosterone concentration, the patients were divided into two groups: group 1, the concentration of aldosterone increased ≥20% over baseline level, and group 2, aldosterone increased <20% above baseline level. The power spectral components of HRV were compared and its circadian rhythm was observed in the two groups. [ Results ] (1) The plasma activity of rennin declined mildly after 1 month and 3 months treatment but the difference were not significant. (2)The activity of angiotensin II was significantly lower after 1 month treatment with ACEI than that of the baseline level (P < 0. 05), but it gradually increased after 3 months treatment.(3)The concentration of aldosterone was declined significantly after 1 month treatment with ACEI (P < 0. 01). It was dramatically elevated after 3 months treatment and higher than the baseline level (P <0. 01). (4) The group one had significantly low total frequency power spectral component (TF), very lower frequency power spectral component (VLF), and lower frequency spectral component (LF). There were no significant differences in high power spectral component (HF) and HF/LF between two groups. Patients with apparent aldosterone escape in group 1 showed fading in circadian rhythm of all those power spectral components over 24 hours and the curves of TF, VLF and LF appeared to be flat. [Conclusions] (1) Aldosterone escape does appear after ACEI treatment especially after 3 months treatment in patients with congestive heart failure. (2) Patients with obvious aldosterone escape in group 1 have significantly low TF, VLF and LF which present fading in circadian rhythm in terms of TF, VLF and LF. The results suggest that severe adosterone escape may predict poor prognosis in patients with congestive heart disease after ACEI treatment.