螺内酯对慢性心力衰竭患者心功能及血清脑利钠肽水平的影响

中国临床药理学与治疗学 ›› 2004, Vol. 9 ›› Issue (4): 447-450.

螺内酯对慢性心力衰竭患者心功能及血清脑利钠肽水平的影响

陈协兴, 洪华山, 陈良龙, 王一波, 叶明芳, 江琼

福建医科大学附属协和医院心内科, 福建省冠心病研究所, 福州350001, 福建

收稿日期:2003-11-24 修回日期:2003-12-20 出版日期:2004-04-26 发布日期:2020-11-20
通讯作者: 陈协兴, 通迅作者, 男, 医学硕士, 主治医师, 研究方向:心血管病临床与基础研究。Tel:0591-3357896-8422/8475 E-mail:chenxiexing@medmail.com.cn
作者简介:洪华山, 男, 医学博士, 副教授, 硕士生导师, 研究方向:冠心病及其心肌纤维化的临床与基础研究。Tel:0591-3357896-8455/8475 E-mail:honghuashan@hotmail.com

Effects of spironolactone on cardiac function and serum brain natriuretic peptide levels in patients with chronic heart failure

CHEN Xie-Xing, HONG Hua-Shan, CHEN Liang-Long, WANG Yi-Bo, YE Ming-Fang, JIANG Qiong

Department of Cardiology, Union Hospital of Fujian Medical University, Fujian Institute of Coronary Heart Disease, Fuzhou 350001, Fujian, China

Received:2003-11-24 Revised:2003-12-20 Online:2004-04-26 Published:2020-11-20

摘要/Abstract

摘要： 目的:观察螺内酯对慢性心力衰竭患者心功能及血清脑利钠肽(BNP) 水平的影响。方法:心衰患者42 例, 心功能(NYHA) 分级为Ⅱ ～ Ⅳ级, 均接受利尿剂、洋地黄、血管转换酶抑制剂类药物治疗, 随机分为2 组:螺内酯组21 例, 在上述治疗基础上每日给予螺内酯20 mg;对照组21 例, 除不给予螺内酯外, 余处理与治疗组相同。动态观察心衰患者治疗前和治疗后1 个月NYHA 分级变化和采用酶联免疫吸附法测定心衰患者治疗前和治疗后3 个月血清BNP-32 浓度。同时使用超声心动图测定左心室射血分数和左心室舒张末期内径。结果:螺内酯组和对照组治疗1 个月后临床综合疗效总有效率分别为85.7 %和76.2 %(P <0.05), 显效率分别为61.9 %和42.9 %(P <0.05) 。两组患者治疗1 个月后,NYHA分级均有所改善, 但螺内酯组治疗后改善显著(P <0.05) 。治疗后螺内酯组患者左心室射血分数显著升高(P <0.05), 左心室舒张末期内径显著降低(P <0.05) 。治疗后2 组血清BNP 水平均显著下降(P <0.05), 但螺内酯组对照组下降更显著(P <0.01) 。螺内酯组治疗前后血清BNP 水平降低值与左心室射血分数增加呈负相关(r =-0.42, P <0.05), 而与左心室舒张末期内径缩小呈正相关(r =0.60, P <0.05) 。结论:螺内酯能明显改善慢性心衰患者的心室重构及心功能, 降低血清BNP 水平;血清BNP 水平可作为评价螺内酯治疗慢性心衰患者疗效评估指标。

关键词: 螺内酯, 心力衰竭, 左心室射血分数, 脑利钠肽, 疗效评价

Abstract: AIM: To investigate the effects of spironolactone on cardiac function and serum brain natriuretic peptide (BNP) level in patients with chronic heart failure (CHF).METHODS: 42 patients with CHF, defined as New York Heart Association (NYHA) functional classes Ⅱ-Ⅳ, received medication of diuretic, digitalis and angiotensin-converting enzyme inhibitor.The patients were randomly divided into the treatment group (extra spironolactone 20 mg daily, n =21) and the control group (n =21).The changes of NYHA functional class were evaluated before and after the treatment for 1 mon.The levels of BNP-32 in serum were measured by immunoradiometric assay immediately after administration.Left ventricular ejection fraction (LVEF) and left ventricular internal dimension at end-diastole (LVED) were measured by M-mode Echocardiography.BNP, LVEF and LVED were re-checked 3 mon later.RESULTS: The total effective rates were 85.7 % in the spironolactone group and 76.2 % in the control group (P <0.05), and the evident effective rates were 61.9 % in the spironolactone group and 42.9 %in the control group (P <0.05).Spironolactone significantly decreased NYHA functional class (P <0.05) after 1 mon therapy in patients of the treatment group, which had no difference from the control group.Spironolactone significantly increased LVEF (P < 0.05), and decreased LVED (P <0.05) after 3 mon therapy in patients of the treatment group, but had no difference in those of the control group.There were significantly attenuated BNP levels in patients with CHF between two groups (P <0.05), but were more decreased in the spironolactone group (P <0.01).Changes in BNP levels were significant negative correlation with CHF patients in the spironolactone group after medication in LVEF (r =-0.42, P <0.05), and significant positive correlation with those in LVED (r =0.60, P <0.05). CONCLUSION: Spironolactone can not only improve left ventricular remodeling and cardiac function but also lower BNP levels in CHF patients.Serum BNP level may serve as a therapeutic indicator for spironolactone treatmemt in CHF patients.

Key words: spironolactone, heart failure, left ventricular ejection fraction, brain natriuretic peptide, evaluating curative effect

中图分类号:

R9694
R972

陈协兴, 洪华山, 陈良龙, 王一波, 叶明芳, 江琼. 螺内酯对慢性心力衰竭患者心功能及血清脑利钠肽水平的影响[J]. 中国临床药理学与治疗学, 2004, 9(4): 447-450.

CHEN Xie-Xing, HONG Hua-Shan, CHEN Liang-Long, WANG Yi-Bo, YE Ming-Fang, JIANG Qiong. Effects of spironolactone on cardiac function and serum brain natriuretic peptide levels in patients with chronic heart failure[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2004, 9(4): 447-450.

参考文献

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