摘要
目的观察慢性心力衰竭(CHF)患者血浆N端脑钠素原(NtproBNP)水平和肾素血管紧张素系统的动态变化及其临床意义。方法选择CHF病人44例,随机接受β阻滞剂比索洛尔或卡维地洛治疗共7个月。测定血管紧张素原、肾素、血管紧张素Ⅱ、醛固酮水平和NtproBNP水平。结果基线血管紧张素原、肾素、血管紧张素Ⅱ、醛固酮水平在正常参考值范围内;NtproBNP明显高于正常参考值上限,且随着心功能分级的增加而明显增加。与用药前相比,血管紧张素原、肾素、血管紧张素与醛固酮药后各时点无显著变化(P值均>0.05);用药后达标时的血浆NtproBNP水平明显减低(P<0.01)。事件组NtproBNP明显高于非事件组。多元回归结果显示:基线时左室射血分数与NtproBNP水平负相关(β=-0.389,P=0.009),与血管紧张素Ⅱ正相关(β=0.341,P=0.020),用药后左室射血分数剂量与调整期结束后NtproBNP水平明显负相关(β=-0.424,P=0.020),与NYHA分级呈正相关(β=0.410,P=0.024)。结论NtproBNP水平比肾素血管紧张素醛固酮系统在定量评价心功能受损程度、疗效及预后判定等方面更加敏感及准确。
Objectives The aims of this study were to evaluate the effects of β-blockers on neurohormonal factors in patients with chronic left heart failure (CHF) . Methods 44 patients, 33 men and 11 women, with age of 60.1 ± 10.6 years with chronic left heart failure (ejection fraction less or equal to 40% by UCG) were included in this study. All patients received conventional therapy and were randomly assigned either to a bisoprolol or carvedilol group. The dosage of β-blockers were increased gradually to target or the tolerant dosages (bisoprolol 10 mg qd, carvedilol 25 mg bid) during 3 months in 36 patients. Maintenance dose was continued for 4 months. Plasma concentrations of renin activity(PRA), angiotensin Ⅱ(AngⅡ), aldosterone(Ald) and the N-terminal portion of brain natriuretic(NT-proBNP) were assessed with RIA and ELISA at baseline and 3 and 7 months after staring β-blocker therapy. Left ventricular ejection fraction (LVEF, Modify SIMPSON) was assessed at baseline and 7 months after starting therapy. Results((1) In patients) with left heart failure, the baseline plasma level of PRA, Ang Ⅱ and Ald were at normal range. N-terminal BNP concentration was much higher than 200 pg/ml as a result of impaired systolic function, as it elevated with increasing of NYHA grade. (2) The plasma level of NT-proBNP decreased significantly, as compared with that before therapy, but there is no significant change of plasma level of PRA, AngⅡand Ald. (3) There were no significant differences between the event group and non-event group for the plasma level of renin-angiotensin and aldosterone during 7 months after starting β-blocker. The Plasma levels of NT-proBNP were much higher in the event group than non-event group. (4) Multi regression analysis showed that the value of LVEF increased with the decreasing of NT-proBNP levels (β=-0.389,P=0.009) and increasing of AngⅡlevel (β=0.341, P=0.020) at baseline. After-therapyLVEF increased with the decreasing of NT-proBNP levels at titration-end (β=-0.424, P=0.020). Conclusions The plasma level of NT-proBNP is more sensitive and accurate than the plasma level of PRA, AngⅡand Ald in evaluation of severity and prognosis of CHF. β-Blocker administration in patients with CHF decreases circulating levels of NT-proBNP and thus improves left ventricular function, but there is no significant effect on plasma level of PRA, AngⅡand Ald.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2005年第7期490-494,共5页
Chinese Journal of Internal Medicine
基金
"十五"重大科技专项课题资金资助(2002AA2Z341A)
