Comparative effects of levosimendan and dobutamine on right ventricular function in patients with biventricular heart failure

Severe heart failure represents a major source of morbidity and mortality. Poor right ventricular function is an independent prognostic marker for mortality in patients with chronic heart failure. In this study, levosimendan (L) and dobutamine (D) in patients with severe chronic biventricular failure were compared. Forty consecutive patients, who were judged for inotropic therapy by their primary physicians, with acutely decompensated systolic heart failure and having moderate-to-severe right ventricular dysfunction with right ventricular fractional area change of ≤24%m were randomized to L and D in a 2:1 fashion. Echocardiographic parameters including tricuspid annular motion and clinical issues were considered. Mean age and sex distribution were not different between the two groups. After the infusion, ejection fraction improved and systolic pulmonary artery pressure decreased significantly in both arms. Longitudinal systolic function of tricuspid annulus improved significantly better in patients with L compared to patients with D (15% ± 12% vs. 2% ± 6% improvement, P < 0.001). Furthermore, L improved both 24-h urine output and creatinine, whereas D showed only a small, but significant improvement in urine output without any improvement in the creatinine levels. Levosimendan seems to offer more beneficial effects compared to dobutamine in a specific group of patients with biventricular failure.     

Clinical outcomes of levosimendan versus dobutamine in patients with acute decompensated heart failure with reduced ejection fraction and impaired renal function

To assess the clinical outcomes of levosimendan and dobutamine in patients with acute decompensated heart failure with reduced ejection fraction and impaired renal function in Indian scenario. Cardiac, renal, electrolytes and hepatic parameters as well as the clinical outcomes were assessed. Levosimendan and dobutamine improved ejection fraction significantly. Levosimendan in comparison to dobutamine, increased cardiac output (0.76 vs. ?0.38 at 48 h, 1.15 vs. ?0.31 day 7, -2.02 vs. ?1.51 day 30), cardiac index (0.89 vs.-0.13 at 48 h, 1.16 vs. ?0.07 at day 7 and 1.05 vs. ?0.25 at day 30) and eGFR (?1.4 vs. ?0.75 at day 30) significantly. Levosimendan reduced ICU stay (p = 0.038) significantly whereas dobutamine decreased the hospital stay duration (p = 0.015). There was no major difference in re-hospitalization and mortality between groups. Ventricular tachyarrhythmia was the main adverse event noted in Levosimendan arm. Levosimendan showed improved cardiac as well as renal outcomes within a month when compared to dobutamine and it is the first study to determine the renal parameters of Levosimendan in an Indian setting.     

静脉注射左西孟旦治疗重度失代偿性心力衰竭患者的疗效分析

目的 评价对常规治疗(如利尿剂、血管紧张素转换酶抑制剂和洋地黄类药物等)疗效不佳的重度失代偿性心力衰竭患者,静脉注射左西孟旦的有效性及安伞性.方法 采用多中心、随机、平行、阳性药物对照临床研究.入选重度失代偿性心力衰竭患者随机接受左西孟旦或多巴酚丁胺治疗,试验组用左西孟旦注射液初始负荷量为12 μg/kg,注射时间10 min,随即以0.1 μg·kg~(-1)·min~(-1)静脉点滴,1 h后增加到0.2 μg·kg~(-1)·min~(-1)并持续23 h;对照组用多巴酚丁胺2 μg·kg~(-1)·min~(-1)初始静脉点滴,1 h后增加到4 μg·kg~(-1)·min~(-1)并持续23 h,综合评价药物的疗效和安全性.结果 12家临床医疗中心共入选病例试验组1 19例,对照组106例.至试验结束,共对225例患者进行了疗效和安全性评价.试验组临床有效率为31.9%(38/119),对照组临床有效率为17.9%(19/106)(P<0.01);治疗24 h后试验组和对照组的左心室射血分数(LVEF)上升均值分别为6.4%和4.6%(P>0.05);治疗24 h后试验组与对照组每搏心输出量(SV)上升均值分别为11.1 ml和2.8ml(P<0.05);试验组患者呼吸困难和全身临床状况显著改善.两组均未发生严重不良事件,试验组不良反应发生率显著低于对照组(P<0.05),常见的不良反应为低血钾、低血压以及室性早搏等.结论 与多巴酚丁胺相比,左西孟旦注射液治疗重度失代偿性心力衰竭疗效确切,安全性及患者耐受性良好.     

The prolonged lowering effect of levosimendan on brain natriuretic peptide levels in patients with decompansated heart failure: clinical implications

The release of brain natriuretic peptide (BNP) is increased in heart failure (HF). The plasma concentrations of BNP and N terminal pro-BNP (NT-proBNP) fall after effective pharmacologic treatment of HF, which suggests that measurements of plasma BNP may be helpful in evaluating therapy. Despite the initial reports that suggested a positive effect of levosimendan on short- and long-term survival in patients with severe HF, the results of the recently presented large-scale clinical trials provided rather controversial results. Further clinical studies are needed to end the confusion regarding the effects of levosimendan on prognosis in patients with decompansated HF.     

The importance of admission and discharge BNP assessment in patients hospitalized for acutely decompensated chronic systolic heart failure

IntroductionThe assessment of B-type natriuretic peptide (BNP) plasma levels is not only useful for the differential diagnosis of acute dyspnea, but also for the prognostic stratification of patients with heart failure. However, available studies that have addressed monitoring of hospitalized patients are burdened with significant limitations: (1) measurement of plasma BNP levels only at admission or at discharge, (2) lack of details regarding the cause of heart failure, and (3) small sample size. Therefore, we conducted a prospective study of all patients presenting to our hospital with acutely decompensated chronic systolic heart failure.AimTo determine the importance of admission and discharge values of BNP and its changes during hospitalization for identification of patients with acutely decompensated chronic systolic heart failure at higher risk of unfavorable course of the disease.MethodsA prospective monocentric study determining plasma BNP levels at admission and at discharge in patients hospitalized for acutely decompensated chronic systolic heart failure. Patients: 130 consecutive patients, 77% men, mean age 70 years, body mass index (BMI) 27.8 kg/m²; etiology of chronic heart failure—65.9% ischemic heart disease, 29.5% dilated cardiomyopathy, 4.6% others; signs and symptoms at admission—peripheral edema 58.9%, pulmonary rates 88.3%, orthopnea 53.1%, median of admission BNP 1101 pg/ml, median of discharge BNP 650 pg/ml, median left ventricular ejection fraction 26.5%, average length of hospitalization 9 days.ResultsDuring the follow-up (mean 15 months) the total mortality rate reached almost 40% and the annual mortality of our cohort was 29%. The most common causes of death included progression of heart failure and acute coronary syndromes. To evaluate the long-term risk of mortality, we used time-dependent ROC curves for the definition of cut-off values of BNP at admission and discharge. The relationship of BNP levels and the survival of patients was assessed using the hazard ratio (HR) calculated by the Cox proportional hazards model. BNPs at admission and at discharge with a cut-off value of 1699 pg/ml and 434.5 pg/ml are significant prognostic factors for patients hospitalized for acutely decompensated chronic systolic heart failure with a HR 2.79 and 3.29, respectively. During the follow-up, more than half of the patients required readmission to the hospital. The most common reasons for rehospitalization were cardiovascular causes.ConclusionBNP levels at admission and at discharge are an important predictive factor of survival in patients with acutely decompensated chronic systolic heart failure.     

Utility of the neutrophil to lymphocyte ratio for predicting in-hospital mortality after levosimendan infusion in patients with acute decompensated heart failure

BackgroundThe aim of this study was to investigate the effect of a levosimendan infusion on hematological variables in patients with acute decompensated heart failure (ADHF). The predictive value of these variables for in-hospital mortality was also evaluated.MethodsA total of 553 patients (368 males; mean age, 63.4 ± 14.9 years) with acute exacerbations of advanced heart failure (ejection fraction ≤35%) and treated with either dobutamine or levosimendan were included in this retrospective analysis. The patients that received levosimendan therapy were divided into two groups according to in-hospital mortality: group 1 (21%) included patients who died during hospitalization (n = 45), while group 2 (79%) included patients with a favorable outcome (n = 174) after levosimendan infusion. Changes in several hematological variables between admission and the third day after levosimendan infusion were evaluated.ResultsThe demographic characteristics and risk factors of the two groups were similar. A comparison of changes in laboratory variables after the infusion of levosimendan revealed significant improvement only in those patients who had not died (group 2) during hospitalization. The neutrophil to lymphocyte (N/L) ratio after levosimendan infusion was an independent predictor of in-hospital mortality (odds ratio: 1.310, 95% CI: 1.158–1.483, p < 0.001). In a receiver-operating characteristic curve analysis, a value of 5.542 for the N/L ratio after levosimendan administration was identified as an effective cut-off point for predicting in-hospital mortality (area under the curve = 0.737; 95% confidence interval = 1100–1301; p < 0.001).ConclusionsLevosimendan treatment was associated with significant changes in hematological variables in patients with ADHF. A sustained higher N/L ratio after levosimendan infusion is associated with an increased risk of in-hospital mortality in patients with ADHF.     

Short-term effects of levosimendan and prostaglandin E1 on hemodynamic parameters and B-type natriuretic peptide levels in patients with decompensated chronic heart failure

BACKGROUND: Both levosimendan and prostaglandin E1 (PGE1) have beneficial effects on hemodynamic parameters and outcome compared to dobutamine in decompensated chronic heart failure (CHF). AIMS: We compared short-term effects of levosimendan versus PGE1 on hemodynamic parameters and B-type natriuretic peptide levels (BNP) in patients with decompensated CHF. METHODS AND RESULTS: 73 patients (cardiac index < 2.5 L/min/m2, pulmonary capillary wedge pressure (PCP) >15 mmHg) with decompensated CHF were randomised to treatment with either a 24 h-infusion of levosimendan (n=38) or a chronic infusion of PGE1 (n = 35). Hemodynamic parameters and BNP were measured at baseline, 24 and 48 h, BNP levels were also measured after 1 week. Baseline characteristics including concomitant medication were similar in both groups. Levosimendan and PGE1 increased cardiac output (CO) after 24 and 48 h. Levosimendan increased CO twice as much as PGE1 (24 h: Levosimendan +1.1 +/- 0.1 L/min, PGE1 +0.6 +/- 0.1 L/min, p < 0.001). Both drugs produced a comparable reduction in PCP and pulmonary artery pressure after 24 and 48 h. Levosimendan decreased BNP by 28% after 24 h and 22% after 48 h, but effects disappeared after 1 week. In contrast, PGE1 decreased BNP by 15% after 48 h (no change at 24 h), but a decrease of 20% was sustained at 1 week. CONCLUSIONS: The differential beneficial effects of levosimendan (greater increase in CO) and PGE1 (sustained decrease in BNP) may have a potential impact on clinical outcome.     

左西孟旦治疗射血分数正常充血性心力衰竭患者的短期疗效

目的：探讨左西孟旦治疗射血分数正常充血性心力衰竭（HFnEF）患者的短期疗效. 方法：入选HFnEF患者80例,随机分为常规治疗组（血管紧张素转换酶抑制剂/血管紧张素受体阻断剂＋利尿剂＋硝酸酯类扩血管药）和左西孟旦组（常规治疗的基础上加用左西孟旦）,每组各40例.所有患者于入院时和用药7d后测定N末端B型利钠肽原（NT-proBNP）血浆水平、心功能分级、静息及分级小剂量多巴酚丁胺负荷后左室收缩功能指标：左室射血分数（LVEF）、高峰射血率（PER）、高峰射血时间（TPER）,并计算其最大变化率. 结果：治疗后两组NT-proBNP血浆水平均较治疗前明显下降,左西孟旦组治疗后NT-proBNP血浆水平低于常规治疗组治疗后（P＜0.05）;左西孟旦组显效率和总有效率高于常规治疗组,无效率低于常规治疗组（P＜0.05）;左西孟旦组治疗后LVEF、PER及TPER的最大变化率均较治疗前明显增加,且左西孟旦组治疗后LVEF的最大变化率明显高于常规治疗组（P＜0.05）. 结论：左西孟旦对HFnEF患者短期疗效良好,能降低患者血浆NT-proBNP水平,改善左心室收缩功能.     

Influence of age on natriuretic peptides in patients with chronic heart failure: a comparison between ANP/NT-ANP and BNP/NT-proBNP

BACKGROUND: Natriuretic peptides are currently used in the diagnosis and follow-up of patients with Chronic Heart Failure (CHF). However, it is unknown whether there are different influences of age on atrial natriuretic peptide (ANP)/N-terminal-ANP (NT-ANP) or B-type natriuretic peptide (BNP)/N-terminal-proBNP (NT-proBNP). AIMS: To compare the influence of age and gender on plasma levels of ANP/NT-ANP and BNP/NT-proBNP in CHF patients. METHODS AND RESULTS: Natriuretic peptides were measured in 311 CHF patients (68+/-8 years, 76% males, left ventricular ejection fraction (LVEF) 0.23+/-0.08). All natriuretic peptides were significantly related to age (p<0.05) on multivariate regression analysis, with partial correlation coefficients of 0.18, 0.29, 0.28 and 0.25 for ANP, NT-ANP, BNP and NT-proBNP, respectively. The relative increase of both BNP/NT-proBNP were more pronounced than of ANP/NT-ANP (p<0.01). Furthermore, the relative increase of BNP with age was markedly larger than of NT-proBNP (p<0.01). Levels of all natriuretic peptides were also significantly related to cardiothoracic ratio, renal function and LVEF. CONCLUSION: In patients with CHF, BNP/NT-proBNP were more related to age than ANP/NT-ANP, and BNP was more related to age than NT-proBNP. However, in these CHF patients the influence of age on the levels of all natriuretic peptides was modest, and comparable to several other factors.     

Anaemia and renal dysfunction are independently associated with BNP and NT-proBNP levels in patients with heart failure

BACKGROUND: Anaemia may affect B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) levels, but this has not been well described in heart failure (HF) patients without the exclusion of patients with renal dysfunction. AIMS: To study the influence of both anaemia and renal function on BNP and NT-proBNP levels in a large group of hospitalised HF patients. METHODS AND RESULTS: We studied 541 patients hospitalised for HF (mean age 71+/-11 years, 62% male, and left ventricular ejection fraction 0.33+/-0.14). Of these patients, 30% (n=159) were anaemic (women: Hb<7.5 mmol/l, men: Hb<8.1 mmol/l). Of the 159 anaemic patients, 73% had renal dysfunction (eGFR<60 ml/min/1.73 m2) and of the non-anaemic patients, 57% had renal dysfunction. BNP and NT-proBNP levels were measured in all patients before discharge. In multivariable analyses both plasma haemoglobin and eGFR were independently related to the levels of BNP and NT-proBNP (standardised beta's of -0.16, -0.14 [BNP] and -0.19, -0.26 [NT-proBNP] respectively, P-values<0.01). CONCLUSION: Anaemia and renal dysfunction are related to increased BNP and NT-proBNP levels, independent of the severity of HF. These results indicate that both anaemia and renal dysfunction should be taken into consideration during the interpretation of BNP and NT-proBNP levels in HF patients.     

Changes in natriuretic peptide and cytokine plasma levels in patients with heart failure, after treatment with high dose of furosemide plus hypertonic saline solution (HSS) and after a saline loading

Background and Aims

Neurohormonal activation and inflammation characterizes heart failure, relates to outcome, and is a therapeutic target.The aim of this study was to evaluate the effects of high-dose furosemide plus small-volume hypertonic saline solutions (HSS) on natriuretic peptides and immuno-inflammatory marker levels and to analyze, after treatment, the response to acute saline loading.

Methods and Results

120 patients with heart failure treated with high-dose furosemide + HSS (Furosemide/HSS group) were matched with: 30 subjects with heart failure treated with high-dose furosemide (furosemide group), 30 controls with asymptomatic left-ventricular dysfunction (ALVD) (asymptomatic group) and 30 controls without heart failure or ALVD (Healthy group). We evaluated plasma levels of natriuretic peptides and cytokine levels in baseline, after treatment and after acute saline load.After treatment with high-dose furosemide + HSS compared to treatment with furosemide alone we observed a significant lowering of ANP [96 (46.5-159.5) pg/ml vs 64 (21-150) pg/ml], BNP [215.5 (80.5-487) pg/ml vs 87 (66-141.5) pg/ml], TNF-α [389.5 (265-615.5) pg/ml vs 231.5 (156-373.5) pg/ml], IL-1β [8 (7-9) pg/ml vs 4 (3-7) pg/ml], IL-6 [5 (3-7.5) pg/ml vs 3 (2-4) pg/ml], plasma values and after an acute saline load, a lower percentage change of ANP (+18.6% vs +28.03% vs +25% vs +29%), BNP (+14.5% vs +29.2% vs +30% vs +29.6%) TNF-α (+10.8% vs +15.8% vs +17.8% vs +11.3%), IL-1β (+20% vs 34.4% vs 40% vs 34.4%) compared to control groups.

Conclusions

Treatment with HSS could be responsible for a stretching relief that could influence natriuretic and immuno-inflammatory markers.     

Effects of levocarnitine on cardiac function,urinary albumin,hs-CRP,BNP, and troponin in patients with coronary heart disease and heart failure

ObjectiveTo investigate the effects of levocarnitine on cardiac function, urinary albumin (ALB), high-sensitivity C-reactive protein (hs-CRP), brain natriuretic peptide (BNP), and troponin in patients with coronary heart disease (CHD) and heart failure (HF).MethodsIn total, 246 patients with CHD-caused HF were selected and randomly divided into Group A and Group B. A fully automatic biochemical analyzer was used to measure the levels of ALB, hs-CRP, BNP, and troponin in both groups of patients, and the expression levels of LVDD and LVEF were detected by cardiac color ultrasonography. Patients in Group B were intravenously injected with 3.0 g of levocarnitine, once per day. After 14 days, changes in levels of ALB, hs-CRP, BNP, troponin, LVDD, and LVEF in Group A patients were detected.ResultsThe effective cure rates of patients in both groups were 65.8% and 81.3%, respectively, and there was a statistically significant difference between the two groups (p < 0.05). After administration of levocarnitine, all indicators showed decreasing trends, but the LVEF level increased. Among them, patients treated with levocarnitine showed the most evident decrease in LVEF. Decrease in BNP was the largest (p < 0.05). Additionally, there was no statistical difference in incidence rate between the two groups (5.8% vs. 2.5%, p = 0.222).ConclusionLevocarnitine can effectively improve ALB, hs-CRP, BNP, troponin, and LVDD levels to improve cardiac function rating and thus improve cardiac function.     

Effects of darbepoetin-alpha on plasma pro-inflammatory cytokines, anti-inflammatory cytokine interleukin-10 and soluble Fas/Fas ligand system in anemic patients with chronic heart failure

Pro-inflammatory cytokine over-expression may be implicated to the pathogenesis of anemia in chronic heart failure (CHF) through the suppression of bone marrow erythropoiesis. Erythropoietin administration has anti-inflammatory and anti-apoptotic properties in experimental CHF models and improves exercise capacity in anemic CHF patients. The present study investigates the effects of recombinant human erythropoietin analogue darbepoetin-α on circulating pro-inflammatory cytokines and soluble Fas/soluble Fas ligand system in patients with CHF and anemia. Forty-one CHF patients (NYHA class: II–III; left ventricular (LV) ejection fraction (EF) <40%; hemoglobin <12.5 g/dl; serum creatinine <2.5 mg/dl) were randomized to receive either 3-month darbepoietin-α at 1.5 μg/kg every 20 days plus iron orally (n = 21) or placebo plus iron orally (n = 20). LV systolic function, plasma B-type natriuretic peptide (BNP), inflammatory markers (TNF-α, IL-6, CRP), anti-inflammatory cytokine IL-10, endothelial adhesion molecules (soluble ICAM-1 and VCAM-1) and soluble apoptosis mediators (soluble Fas, soluble Fas ligand), and 6-min walking distance were assessed at baseline and 3 months post-treatment. In darbepoetin-α treated patients, plasma BNP (451 (62-2770) from 802 (476-4440) pg/ml, p = 0.002), IL-6 (6.5 ± 4.7 from 10.5 ± 7.8 pg/ml, p = 0.013) and soluble Fas ligand (53.2 ± 16.6 from 59.2 ± 17.9 pg/ml, p = 0.023) decreased significantly, while LVEF (32 ± 6 from 26 ± 6%, p < 0.001), hemoglobin (12.8 ± 1.4 from 10.9 ± 1.0 g/dl, p < 0.001) and 6-min walked distance (274 ± 97 from 201 ± 113 m, p < 0.01) increased significantly. No significant changes were observed in the placebo arm, except for a worsening in 6-min walked distance (p = 0.044). In conclusion, darbepoetin-α reduces circulating pro-inflammatory cytokine IL-6 and apoptotic mediator soluble Fas ligand in CHF patients with anemia, with a parallel improvement of cardiac performance and exercise capacity.     

慢性心力衰竭患者血浆脑钠肽和内皮素-1水平与血流动力学的相关性

目的:探讨慢性心力衰竭(HF)患者血浆脑钠肽(BNP)、内皮素-1(ET-1)水平与血流动力学的相关性及其临床意义。方法:2004年3月~2005年5月住院慢性HF患者75例,行Swan-Ganz导管检查53例,用干式快速免疫荧光法定量和放射免疫法分别检测血浆BNP、ET-1水平,超声心动图检查左室舒张末期内径(LVEDD)。结果:随着NYHA心功能级别增加,肺毛细血管嵌压(PCWP)、平均肺动脉压(MPAP)、右房压(RAP)和血浆BNP、ET-1水平均显著升高(P<0.01)。血浆BNP、ET-1分别与PCWP、MPAP、RAP呈显著正相关(P<0.01)。多元线性回归提示ET-1水平为影响血浆BNP浓度的独立因素(标准化偏回归系数为0.28,P<0.01)。LVEDD≥60mm组(31例)血浆BNP和ET-1浓度分别为(968.23±478.63)、(129.45±88.56)ng·L-1,显著高于LVEDD<60mm组(44例)[(286.26±156.89)、(87.45±43.65)ng·L-1],P<0.01。结论:慢性HF患者BNP、ET-1水平与PCWP、MPAP、RAP显著正相关,BNP的释放直接与心室压力负荷过度和心室容积扩张相关,BNP是反映心室受损敏感指标,ET-1可刺激HF心室BNP的分泌。     

多巴酚丁胺与环磷酸腺苷葡甲胺或咪利酮联用对实验性心力衰竭大鼠的作用

目的　对比研究实验性心力衰竭 (CHF)大鼠在用多巴酚丁胺治疗之后 ,继用咪利酮或环磷酸腺苷葡甲胺对左心室舒缩功能 ,血浆血管紧张素 (Ang )和红细胞内 Ca2 +的影响。方法　采用腹腔注射阿霉素复制大鼠 CHF模型 ,将 4 0只 CHF大鼠随机分成 (1) CHF组 (2 )多巴酚丁胺治疗组 (3)多巴酚丁胺 +环磷酸腺苷葡甲胺治疗组 (4 )多巴酚丁胺 +咪利酮治疗组 ,另设 (5 )正常对照组。给药治疗 10 d后测定血流动力学指标 ,血浆 Ang 及红细胞内Ca2 +。结果　与正常组相比 ,CHF组 ,左心室压力上升和下降最大速度 (± dp/dtmax) ,左心室收缩压 (L VSP)显著下降 ,左心室舒张末期压 (L VEDP)、等容舒张期左心室压力下降的时间常数 (T)、血浆 Ang 及红细胞内 Ca2 +显著增加 (P均 <0 .0 1)。与 CHF组相比 ,多巴酚丁胺 +环磷酸腺苷葡甲胺组 ,± dp/dtmax,L VSP升高 ,L VEDP降低 (P<0 .0 5～ 0 .0 1) ,血浆 Ang 明显降低 (P<0 .0 5 ) ,红细胞内 Ca2 + 下降。多巴酚丁胺 +咪利酮组 ,+dp/dtmax及 L VSP升高 (P<0 .0 5～ 0 .0 1) ,血浆 Ang 降低 (P<0 .0 5 )。各用药组相比 ,多巴酚丁胺 +环磷酸腺苷葡甲胺组 L VSP,- dp/dtmax,L VEDP,Ang 浓度及红细胞内 Ca2 +与多巴酚丁胺组相比差异有显著性 (P均 <0 .0 5 )。结论　多巴酚丁胺与?     

缬沙坦联合依那普利对充血性心力衰竭患者促炎细胞因子的影响

目的　观察缬沙坦与依那普利联合应用对充血性心力衰竭 (CHF)患者促炎细胞因子的影响。方法　入选CHF患者 82例 ,平均年龄 (5 2± 9)岁 ,随机分为治疗组 5 2例 ,对照组 30例。治疗组应用缬沙坦 4 0～ 80 m g/d加依那普利 10 mg/d,其余治疗同对照组 ,治疗观察共 8周。两组均于治疗前后分别测定血清肿瘤坏死因子 α(TNF- α)、白介素 6 (IL - 6 )和白介素 2 (IL - 2 )的水平。结果　两组治疗后促炎细胞因子的水平均降低 (P<0 .0 1) ,但治疗组与对照组比较降低更为明显 (P<0 .0 1)。结论　缬沙坦与依那普利联合应用可降低 CHF患者促炎细胞因子的血清水平 ,可能与其改善心功能和抑制促炎细胞因子生成有关 ,两药合用对控制 CHF的发生发展可能发挥更好的治疗作用。     

血浆BNP及CRP水平在充血性心衰与肺心病患者的动态变化

目的:探讨血浆脑钠肽(BNP)及C反应蛋白(CRP)水平在充血性心力衰竭(CHF)及肺源性心脏病(PHD)患者急性呼吸困难发作时及缓解后1周的变化并分析其临床意义。方法:入选CHF患者55例(CHF组),PHD患者47例(PHD组),分别测定各组患者急性呼吸困难发作时及缓解后1周血浆BNP及CRP水平。结果:与呼吸困难发作时比较,病情缓解后1周CHF患者血浆BNP[(1885±745)ng/L比(207±124)ng/L]、CRP[(36±11)mg/L比(8±6)mg/L]水平均明显下降,P均<0.05;PHD患者血浆BNP[(584±178)ng/L比(162±59)ng/L]、CRP水平亦均明显下降[(68±24)mg/L比(15±7)mg/L],P<0.05;呼吸困难发作时CHF组患者血浆BNP水平明显高于PHD组(P<0.05),CRP水平明显低于PHD组(P<0.05),呼吸困难缓解后1周两组间无显著差异。结论:脑钠肽及C反应蛋白水平与充血性心力衰竭及肺源性心脏病患者病情严重程度相关,在发作急性呼吸困难时检测二者水平有助于鉴别充血性心力衰竭或肺源性心脏病。