厄贝沙坦对慢性心衰患者血清脑利钠肽及心功能的影响

目的:探讨厄贝沙坦对慢性心力衰竭(CHF)患者血清脑利钠肽(BNP)水平及心功能的影响。方法:选择CHF患者(NYHA心功能Ⅱ～Ⅳ级)76例,随机分为两组:常规治疗对照组(36例),给予常规的利尿、强心、扩血管治疗;试验组(40例),在常规治疗基础上,加用厄贝沙坦,75～150mg,每日1次口服,连用12周。对比分析治疗前后两组患者血清BNP水平、NYHA分级、心率、心胸比例、超声心动图等指标的变化。结果:试验组较常规治疗对照组心胸比例、左室舒张末期内径(LVEDd)显著下降[(0.58±0.05):(0.62±0.09),(56.1±9.4)mm:(60.0±8.7)mm,P均0.05]。左室射血分数(LVEF)显著升高[(0.50±0.09):(0.42±0.12),P0.05],血清BNP水平显著降低[(676.8±226.3)mg/L:(878.6±119.8)mg/L,P0.05]。且血清BNP的降低程度与LVEF呈负相关(r=-0.920,P0.01)。结论:厄贝沙坦结合常规抗心衰治疗能够有效抑制慢性心力衰竭患者神经内分泌的过度激活,逆转心室重构,改善心功能,疗效优于单纯常规药物治疗。而BNP水平与心功能密切相关,可作为治疗CHF的监测指标之一。

Influence of irbesartan on serum brain natriuretic peptide and heart function in patients with chronic heart failure

Objective： To study the influence of irbesartan on serum brain natriuretic peptide （BNP） and heart function in patients with chronic heart failure （CHF）. Methods： The 76 CHF patients （NYHA Ⅱ -Ⅳ class） were divided into therapy group （treated with irbesartan 75-150 mg every day and routine anti-CHF therapy, 40 cases） and routine therapy control group （treated with routine anti CHF therapy, 36 cases） . Therapeutic course was 12 weeks all. Resuits： After therapy of 12 weeks, the left ventricular end-diastolic dimension [LVEDd （56.1±9.4） mm vs. （60.0± 8.7） mm, P〈0.05] and serum BNP level [ （676.8±226.3） mg/L vs. （878.6±119.8） mg/L, P〈0. 05] significantly decreased, the left ventricular ejection fraction [LVEF, （0.50±0.09） vs. （0.42±0.12）, P〈0.05] significantly increased in therapy group compared with control group, P〈0.05 all. The BNP level was negatively correlated with LVEF （r=-0.920, P〈0.01）. Conclusion： Irbesartan combine routine anti-CHF therapy may further and safely improve therapeutic effect of CHF patients.