心力衰竭患者中脑钠肽作用及不同剂量血管紧张素转换酶抑制剂.doc

心力衰竭患者中脑钠肽作用及不同剂量血管紧张素转换酶抑制剂 　 作者：宋浩明 张佳 邓兵 罗明 【摘要】 目的 研究慢性心力衰竭(CHF)患者中血浆脑钠素(BNP)浓度与心力衰竭严重程度、血浆去甲肾上腺素(NE)浓度的相关关系，探讨不同剂量血管紧张素转换酶抑制剂(ACEI)对CHF患者BNP和NE的影响和较大剂量ACEI的可行性与安全性。方法 将66例临床症状稳定的CHF患者在接受基础治疗基础上随机分为较小剂量组(培哚普利2～4mg/d)，较大剂量组(8～10mg/d)，治疗12周，治疗前后测定两组患者各项指标(血浆NE、BNP浓度，左室舒张末内径(LVEDd)，左室射血分数(LVEF)，心率，血压)，观察治疗前后各项指标的变化及组间差异。并且选择30例年龄相仿的正常对照者，分别测定基础血浆NE、BNP浓度。结果 CHF患者血浆中BNP浓度随着纽约心脏病协会心功能分级(NYHA)分级增加而升高，与LVEF呈显著负相关(r=-0.327，P=0.012)；BNP与LVEDd和血浆NE呈显著正相关(r=0.42，P=0.015；r=0.402，P=0.002)。较大剂量组比较小剂量组能更明显降低血浆中BNP、NE浓度。较大剂量组患者采用小剂量逐渐递增剂量方式给药，且耐受性良好。结论 CHF时血浆BNP浓度随着心衰严重程度密切相关，而且BNP与血浆NE浓度呈正相关。血浆BNP浓度是心力衰竭诊断、治疗和预后评估的很好的指标。在CHF患者中采用小剂量逐渐递增剂量的方式给予培哚普利安全可行，患者耐受性良好。 【关键词】 慢性心力衰竭 血管紧张素转换酶抑制剂 培哚普利 脑钠素 去甲肾上腺素 The effect of BNP in patients with chronic heart failure and the intervene by the various dose of angiotensin converting enzyme inhibitor 【Abstract】 Objective We studied the relationship of plasma BNP level and severity of heart failure and plasma NE level and investigated the influence of various dosage of angiotensin converting enzyme inhibitor(ACEI) on plasma BNP and norepinephrine(NE).We discussed the feasibility and security of high dosage of ACEI.Methods 66 patients with stable CHF who were receiving basic therapy for heart failure were randomly assigned to the low-dose group(perindopril 2～4mg/d) and the high-dose group(initiate at low dosage of perindopril and gradually increase up to perindopril 8～10mg/d).All indices(including plasma NE and BNP levels，LVEF，LVEDd，BP，HR) were measured before and after 12w treatment，then compared the differences between the two groups.30 healthy subjects were selected as control group.They were also examined with the plasma levels of NE and BNP.Results The plasma BNP level was correlated closely with NYHA classes of heart failure，LVEF(r=-0.327，P=0.012)，plasma NE level(r=0.402，P=0.002) and LVEDd(r=0.42，P=0.015) in patients with CHF.Both of plasma BNP and NE levels in the high-dose group(perindopril 8～10mg/d) were decreased more than tho