氯沙坦对老年缺血性心力衰竭患者神经激素-细胞因子水平的影响

Effects of losartan on the levels of neurohormones-cytokine in elderly patients with ischemic heart failure

目的 :探讨氯沙坦对老年缺血性心力衰竭患者部分神经激素 细胞因子水平的影响。方法 :5 0例老年缺血性心衰患者 (心衰组 )服用氯沙坦 (5 0mg/d) 1个月 ,采用放免法测定其治疗前后血浆肾素 (PRA)、血管紧张素Ⅱ(AgⅡ )、内皮素 (ET)和血清肿瘤坏死因子 (TNF)水平 ,超声心动图测定治疗前后心功能 ,并以 30例健康老人为对照(对照组 )。结果 :心衰组治疗前PRA、AgⅡ、ET、TNF水平与对照组比较均显著升高 ,且ET、TNF水平与AgⅡ正相关(分别为 0 .4 30 ,0 .4 1 7) ;治疗后PRA、AgⅡ水平明显上升 ,ET、TNF水平显著下降 ;左室短轴缩短率 (FS) ,E峰速度(PEV) ,E/A比值亦明显改善。结论 :AgⅡ、ET、TNF等神经激素 细胞因子参与了老年缺血性心衰的发生、发展过程 ,氯沙坦可抑制肾素 血管紧张素系统、调节内皮细胞舒缩功能 。

Aim: To evaluate the effects of losartan on neurohormones cytokine levels in elderly patients with ischemic heart failure. Methods: Fifty elderly patients with ischemic heart failure were administered losartan orally 50 mg per day for 1 month. The plasma levels of renin activity (PRA), angiotensin Ⅱ (AgⅡ), endothelin (ET), and the serum level of tumor necrosis factor (TNF) were determined by radioimmunoassay, and the changes of cardiac function were measured by echocardiography in the patients before and after the treatment. Thirty elderly healthy volunteers were choosen as normal control. Results: The levels of PRA, AgⅡ, ET, and TNF in heart failure patients before the treatment were significantly increased compared with those of normal control. The levels of ET, and TNF were positively correlated with the level of AgⅡ( r =0.43, 0.417, respectively). The levels of PRA and AgⅡwere significantly increased, the levels ET and TNF were significantly decreased, and the left ventricular fractional shortening(FS), peak E wave velocity(PEV), E/A ratio ameliorated after treatment. Conclusion: AgⅡ, ET, and TNF play an important role in the development of ischemic heart failure in the elderly. Losartan could suppress the activity of renin angiotensin, regulate the contracting function of endothelial cell, and improve cardiac function.