培哚普利与坎地沙坦对慢性心力衰竭患者ET-1,IL-6,MMP-9及左室重塑的影响.docVIP

培哚普利与坎地沙坦对慢性心力衰竭患者ET-1、IL-6、MMP-9及左室重塑的影响 李莹,宋耀明,黄岚，任可 (第三军医大学新桥医院心血管内科,全军心血管病研究所,重庆 400037) 摘　要:目的　探讨慢性心力衰竭（CHF）患者应用培哚普利和（或）坎地沙坦对血清内皮素-1（ET-1）、白介素-6（IL-6）、基质金属蛋白酶-9（MMP-9）干预以及改善心室重构作用。方法　90例CHF患者在常规治疗基础上随机分为3组,每组30例。A组：培哚普利组 4mg/d；B组：坎地沙坦 4-8mg/d；C组：培哚普利4mg+坎地沙坦4-8mg/d。疗程均为8周。26例健康体检者为正常对照组。采用放射免疫法分别测定治疗前、后患者血清ET-1、IL-6、MMP-9的浓度。采用心脏彩色多普勒测定左室射血分数(LVEF)、左室舒张末内径(LVEDd)。结果　(1) CHF患者ET-1、IL-6、MMP-9、LVEDd显, LVEF则显著降低 ( P ﹤0.01) ；CHF患者ET-1、IL-6、MMP-9与LVEDd呈正相关( r = 0.436, P﹤0.01),与LVEF呈负相关( r = - 0.481, P﹤0.01)。(2) 3组患者经治疗后血清ET-1、IL-6、MMP-9、LVEDd均较治疗前减少, LVEF较治疗前均升高，差异有统计学意义( P﹤0.05) 。(3) C组患者经治疗后ET-1、IL-6、MMP-9、LVEDd显著低于A、B组, LVEF高于A、B组，差异有统计学意义( P﹤0.05) ; A、B两组ET-1、IL-6、MMP-9及LVEF、LVEDd比较, 差异均无统计学意义( P﹥0.05)。结论　CHF患者血清ET-1、IL-6、MMP-9、LVEDd水平显著升高，LVEF显著降低，且与心衰严重程度相关。培哚普利与坎地沙坦均能降低ET-1、IL-6、MMP-9水平，且疗效两者联合治疗明显优于单用培哚普利或坎地沙坦治疗。 关键词: 培哚普利;坎地沙坦; 心力衰竭; 内皮素-1、基质金属蛋白酶-9 、左室重塑 Effect of perindopril and candesartan on Left Ventricular Remodeling and Endothelin-1、Endothel in-6、MMP-9 Level in Patients with Chron in Heart Failure　 LI Ying, SONG Yao-ming, REN Ke,(Department of CardiovascularDiseases, Xinqiao Hospital, ThirdMilitaryMedicalUniversity, Chongqing 400037, China) Abstract Objective To evaluate the effects of perindopril and (or) candesartan on the the level changes of Serum endothelin-1 ( ET-1) , Endothel in-6（IL-6）、MMP-9 and the improvement of myocardial remodeling in patients with chronic heart failure (CHF).Methods 　 Serum concentrations of ET-1, IL-6, MMP-9 in normal controls ( n = 26) and patients with CHF ( n = 90) , who were randomized into perindopril group (4mg/d of perindopril) , candesartan group (4-8 mg/d of candesartan) , and combined group (4mg/d of perindopril and 4-8mg/d of candesartan), were measured before and 8 weeks after treatment respectively. left ventricularend-diastolic dimension (LVEDd),Left ventricular ejective fractions (LVEF) were measured before and after the treatment. Result : The serum ET-1，IL-6, MMP-9 、LVEDd levels in patients were much