摘要
目的 :探讨螺内酯对严重心力衰竭 (心衰 )患者血浆脑钠素、心钠素、血管紧张素Ⅱ(angiotensinⅡ ,AngⅡ )、醛固酮水平及左心室功能的影响。方法 :137例严重心衰患者随机分为螺内酯组(70例 ,螺内酯 2 0~ 4 0mg/d)和常规治疗组 (6 7例 )。治疗前和治疗 3、 6个月时分别检测血浆脑钠素、心钠素、AngⅡ、醛固酮水平 ,心脏超声测量左心室功能参数的变化。结果 :①螺内酯组和常规治疗组在治疗 3、 6个月时血浆脑钠素水平 [(5 4 9± 170 )ng/L ,(4 98± 16 5 )ng/L对 (6 11± 174 )ng/L ,(5 79± 16 8)ng/L ;P <0 0 5、P <0 0 1]、心钠素水平 [(190± 2 8)ng/L ,(16 9± 2 6 )ng/L对 (2 0 9± 30 )ng/L ,(184± 2 7)ng/L ,P <0 0 1,P <0 0 1]均较治疗前脑钠素水平 [(6 6 1± 189)ng/L ,(6 75± 183)ng/L]及心钠素水平[(2 2 1± 31)ng/L ,(2 2 0± 30 )ng/L]明显下降 ,前者 2项指标在治疗 3、 6个月时较后者下降更明显 (均为P <0 0 5 ) ;螺内酯组治疗 3、 6个月时血浆AngⅡ [(2 74± 86 )ng/L ,(2 80± 92 )ng/L]、醛固酮水平 [(347± 71)pmol/L ,(345± 71)pmol/L]较治疗前 [(2 6 6± 10 4 )ng/L ,(339± 6 7)pmol/L]无明显下降 ,而常规治疗组治疗 3个月时均明显下降 [(2 36± 80 )ng/L ,(2 93± 5 4 )
Objective: To evaluate the effects of spironolactone on the plasma levels of brain natriuretic peptide (BNP), atrial natriuretic peptide (ANP), angiotensin Ⅱ (AngⅡ), aldosterone (ALD) and left ventricular function in patients with severe heart failure. Methods: One hundred and thirty seven patients with severe heart failure were randomly divided into spironolactone group (spironolactone 20~40 mg/d,n=70) and the routine treatment group(n=67). Plasma concentrations of BNP, ANP, AngⅡ, and ALD were measured, and left ventricular function was assessed with echocardiography at study entry, after 3 and 6 months of treatment. Results: ① In spironolactone group and in the routine treatment group after 3 and 6 months of treatment, the plasma levels of BNP [(549±170)ng/L, (498±165)ng/L and(611±174)ng/L,(579±168)ng/L, respectively; P<0.05, P<0.01] and ANP[(190±28)ng/L,(169±26)ng/L and (209±30)ng/L, (184±27)ng/L, respectively;P<0.01, P<0.01] were significantly decreased in comparison with the plasma levels of BNP [(661±189)ng/L, (675±183)ng/L] and ANP [(221±31)ng/L, (220±30)ng/L] before treatment. The reduction of plasma levels of BNP and ANP after 3 and 6 months of treatment were more remarkable in spironolactone group than that in the routine treatment group (P<0.05, P<0.05). After 3 and 6 months of treatment, the plasma levels of AngⅡ[(274±86)ng/L, (280±92)ng/L] and ALD [(347±71)pmol/L,(345±71)pmol/L] were not significantly decreased in comparison with the plasma levels of AngⅡ [(266±104)ng/L] and ALD [(339±67)pmol/L] before treatment in spironolactone group;while in the routine treatment group, AngⅡ and ALD were markedly decreased after 3 months of treatment [(236±80)ng/L, (293±54)pmol/L,P<0.05, P<0.01], and increased after 6 months of treatment [(262±88)ng/L, (337±51)pmol/L] near the levels before treatment[(271±97)ng/L, (326±55)pmol/L]. ②Before treatment, there were no significant difference between two groups in left ventricular diastole internal diameter (LVDd), left ventricular ejective fraction (LVEF), and heart rate (HR) (P>0.05,P>0.05,P>0.05).However, there were significant improvement of LVDd, LVEF, and HR in two groups(P<0.05,P<0.05,P<0.05)after 3 and 6 months of treatment, and the improvement of LVEF and cardia function in spironolactone group was more remarkable than in control group (P<0.05,P<0.05). Conclusion: Spironolactone administration in patients with severe heart failure can decrease the plasma level of BNP and ANP, improve cardiac function effectively.
出处
《新医学》
北大核心
2004年第6期332-334,共3页
Journal of New Medicine