氯沙坦和培哚普利对心衰患者心功能及心室重构的影响

血管紧张素转换酶抑制剂 (ａｎｇｉｏｔｅｎｓｉｎ ｃｏｎｖｅｒｔｉｎｇｅｎｚｙｍｅｉｎｈｉｂｉｔｏｒ,ＡＣＥＩ)能改善心功能和心室重构 ,在我国 ,血管紧张素Ⅱ (ａｎｇｉｏｔｅｎｓｉｏｎⅡ ,ＡｎｇⅡ )受体拮抗剂多用于治疗高血压 ,对心衰患者心功能和心室重构的影响研究不多 ,本研究将ＡｎｇⅡ受体拮抗剂氯沙坦 (ｌｏｓａｒｔａｎ)和ＡＣＥＩ培哚普利(ｐｅｒｉｄｏｐｒｉｌ)进行对比研究 ,报告如下。1　资料与方法1.1　临床资料　 1999年 10月至 2 0 0 1年 9月诊断为扩张型心肌病 (ｄｉｌａｔｅｄｃａｒｄｉｏｍｙｏｐａｔｈｙ ,ＤＣ…     

福辛普利联合氯沙坦对慢性心力衰竭患者心室重构及NT—proBNP水平的影响

目的：观察联合应用福辛普利与氯沙坦对于老年慢性心力衰竭患者心室重构及NT—proBNP水平的影响。方法：将患者随机分为实验组及对照组。在治疗前后测定LVESd、LVEDd、LVEF及NT—proBNP浓度。结果：实验组LVESd、LVEDd下降显著，LVEF明显增加，与对照组比较差异有显著性（P〈0．05）。结论；联合应用福辛普利与氯沙坦能更好地改善左室重构、降低血浆BNP水平。     

赖诺普利与安体舒通联合治疗高血压性心力衰竭

目的观察血管紧张素转换酶抑制剂赖诺普利与醛固酮拮抗剂安体舒通联合治疗高血压性心力衰竭的安全性和有效性。方法40例高血压性心力衰竭患者同时服用赖诺普利10mg,每日1次,安体舒通20~80mg,每日1~3次,经8周治疗后观察血压及心功能改善情况。结果全部患者的收缩压和舒张压均降低(P<0.01),降压总有效率为90.0%,心功能改善有效率为95.0%,其中显效70.0%,有效25.0%,且血钾无严重增高。结论赖诺普利与安体舒通联合治疗高血压性心力衰竭安全、有效。     

赖诺普利对原发性高血压患者早期肾功能的影响

目的:研究赖诺普利对原发性高血压患者早期肾功能的影响。方法:原发性高血压46例,随机分成两组,各23例(男16例、女7例)。另设正常对照组23例,性别和年龄与上述两组相仿。三组人员,尿常规(包括尿蛋白)、血尿素氮、肌酐均正常,无肾病史。46例患者停服降压药,改服安慰剂10~14 d后,两组分别服用赖诺普利10 mg,每天1次;硝苯地平10 mg,每天3次;均服药4~6周。服药期间每周至少测卧位血压3次。服安慰剂及服降压药期间最后1 d分别测动态血压1次,取均值为服药前后的血压。并分别在服药前及服药后4~6周测定尿NAG,β2-MG。尿NAG采用吸光度比色法,β2-MG采用放射疫法测定。统计学处理各参数用均值±标准差(x±s)表示,组间比较采用t检验。结果:各组尿NAG,β2-MG浓度及血压变化比较服降压药前,两组的尿NAG,β2-MG与正常对照组比较明显升高(P<0.01)。服药前后比较,两组均有不同程度下降,但赖诺普利组下降明显(P<0.01),而硝苯地平组差异无显著(P>0.05)。两组治疗后收缩压或舒张压均明显下降(P<0.05)。结论:赖诺普利可以改善原发性高血压患者肾小管功能。     

沙库巴曲缬沙坦与培哚普利对改善慢性心力衰竭患者心室重构的对比研究

目的 探讨沙库巴曲缬沙坦与培哚普利对改善慢性心力衰竭患者心室重构的效果.方法 将115例心力衰竭患者分为A组(n=84)和B组(n=71),患者心力衰竭类型为射血分数降低性心力衰竭(HFrEF)、中间范围射血分数心力衰竭(HFmrEF)、射血分数保留性心力衰竭(HFpEF).在常规用药基础上,A组加用沙库巴曲缬沙坦,B...     

赖诺普利联合螺内酯治疗心力衰竭的临床价值分析

目的分析赖诺普利联合螺内酯治疗心力衰竭的临床应用价值。方法选取我院2008-07—2010-07期间收治的心力衰竭患者100例,随机平均分为对照组与治疗组两组。给予对照组患者常规治疗,给予治疗组患者赖诺普利联合螺内酯治疗,对比两组患者临床治疗效果。结果对照组患者治疗有效率为60.0%,治疗组患者治疗有效率为92.0%,两组患者治疗效果对比,后者治疗效果更为优越,差异具有统计学意义（P〈0.05）。治疗组患者1年生存率、2年生存率、3年生存率均明显高于对照组,两组对比差异具有统计学意义（P〈0.05）。对两组患者治疗期间不良反应进行观察可知,所有患者均未出现明显的脑、肝、肾等不良反应,差异无统计学意义（P〉0.05）。结论赖诺普利联合螺内酯治疗心力衰竭效果显著,安全实效,值得临床推广与应用。     

氯沙坦和培哚普利对急性心肌梗死后左心室重构的影响

目的探讨氯沙坦和培哚普利对急性心肌梗死(AMI)患者左心室重构的治疗效应。方法急性心肌梗死患者96例,随机分为3组:氯沙坦组(33例),培哚普利组(33例),对照组(30例),采用超声心动图测量入院后第1天、2周、6个月左心室收缩末期容积指数(LVESVI)、左心室舒张末期容积指数(LVEDVI)、左心室舒张早期和晚期充盈速度比值(E/A)及左心室射血分数(LVEF)的变化,并进行观察分析。结果对照组与入院基础值比较,6个月内LVESVI、LVEDVI增加,具有统计学意义(P<0·05)。氯沙坦组与培哚普利组,对照组比较,LVES-VI、LVEDVI减少,具有统计学意义(P<0·05)。氯沙坦组与培哚普利组比较,LVESVI、LVEDVI值在2周、6个月时减少,有统计学意义(P<0·05)。结论氯沙坦对AMI患者抗左心室重构效应优于培哚普利,且耐受性好。     

赖诺普利对慢性心力衰竭患者心室重塑和心功能的影响

目的　观察血管紧张素转换酶抑制剂赖诺普利对慢性心力衰竭患者心室重塑和心功能的影响。方法　选择慢性心力衰竭患者 80例 ,随机分为对照组 (38例 )和治疗组 (42例 )。对照组采用综合疗法 ,治疗组在上述基础上加用赖诺普利 (5～ 10mg/d)。在治疗前和观察期满 6个月时分别测定心功能 (NYHA分级 ) ,心脏彩色超声测定左室结构及功能指标变化 ,测试 6min步行距离。结果　治疗组NYHA分级与治疗前相比明显改善 (P <0 0 0 1) ,治疗组与对照组比较左室射血分数上升[(5 1 1± 2 8) % ]vs[(34 2± 2 6 ) % ,P <0 0 0 1]、左室收缩末容积下降 [(118± 4 1 9)mLvs (15 3± 4 2 6 )mL ,P <0 0 0 1];左室舒张末容积与治疗前比较下降 [(16 2 5± 4 4 )mLvs (181 2± 4 5 0 ) ,P <0 0 5 ];患者 6min步行距离提高 [(372± 76 )mvs (341± 82 1)m ,P <0 0 5 ]。结论　赖诺普利可显著改善慢性心力衰竭患者心室重塑和心功能。     

强心合剂对充血性心力衰竭患者血浆脑钠素水平的影响

目的:观察中药强心合剂对充血性心力衰竭(CHF)的临床疗效及其对血浆脑钠素(BNP)水平的影响,探讨其对心室重构的作用机制。方法:54例CHF患者随机分为对照组24例和治疗组30例。对照组给予标准抗心力衰竭基础治疗,治疗组在标准治疗基础上加服中药强心合剂,两组均8周为1个疗程。观察两组治疗前后患者的临床心功能分级情况、临床症状、左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)和左室射血分数(LVEF)的改善情况及血浆BNP水平的变化。结果:治疗8周后,治疗组总有效率明显高于对照组(P<0.05),LVESD、LVEDD、LVEF及血浆BNP水平均较对照组明显降低(P均<0.05)。结论:强心合剂能明显改善患者左心室的舒缩功能,延缓心室重构并且降低血浆BNP水平,是一种治疗CHF安全有效的中药制剂。     

充血性心力衰竭患者血浆脂联素和脑钠肽的相关性研究

目的 探讨充血性心力衰竭(CHF)患者血浆脂联素(APN)、脑钠肤(BNP)水平的变化及临床意义.方法 应用酶联免疫吸附法(ELISA)分别测定70例扩张型心肌病CHF患者治疗前、治疗后及20例正常人血浆APN和BNP水平,并进行统计学分析比较.结果 ①CHF组APN、BNP水平分别为(11.66±4.59)mg/L、(1079.78±550.76)ng/L明显高于正常对照组(1.38±0.47)mg/L、(59.63±22.43)ng/L(均P＜0.01);②心功能Ⅱ、Ⅲ、Ⅳ级组APN分别为(5.59±1.85)mg/L、(11.27±3.00)mg/L及(15.19±3.81)mg/L,BNP水平分别为(463.78±169.50)ng/L、(917.05±290.19)ng/L及(1 595.72±481.76)ng/L,随着心功能恶化二者水平显著升高(均P＜0.01).③CHF组治疗后APN(5.88±2.55)mg/L、BNP(547.25±234.88)ng/L明显低于治疗前水平,(11.66±4.59)mg/L、(1 079.78±550.76)ng/L(均P＜0.01);④CHF组血浆APN水平与BNP呈正相关(r=0.680,P＜0.01).结论 CHF患者血浆APN和BNP水平明显高于正常对照组且随着心功能恶化而显著升高.CHF患者经治疗后随心功能好转血浆APN和BNP水平可降低.CHF患者血浆APN和BNP呈正相关.     

生长激素、脑利钠肽和肾上腺髓质素在心力衰竭中的变化及其临床意义

目的通过观察不同病因所致充血性心力衰竭(CHF)患者血清生长激素(GH)、脑利钠肽(BNP)和血浆肾上腺髓质素(ADM)的水平变化,比较三者在CHF中的诊断价值及其灵敏度和特异度。方法将受试对象分为非心力衰竭组30例和心力衰竭组72例。心力衰竭组中冠心病31例,高血压病12例,风湿性心脏病16例,扩张型心肌病13例。其中NYHA心功能分级Ⅱ级组22例,Ⅲ级组20例,Ⅳ级组30例。分别用放射免疫法和酶联免疫法测定血浆ADM、血清BNP和GH的浓度,同时行心脏彩色多普勒超声测定左室舒张末内径(LVED)和左室射血分数(LVEF)。结果心力衰竭组GH和BNP的水平较非心力衰竭组升高,分别是(0.83±1.06)μg/L vs(0.15±0.42)μg/L和(115.31±191.16)ng/L vs(33.51±49.85)ng/L(均P<0.01);ADM两组间比较,差异无统计学意义(P>0.05)。不同病因组间BNP和GH比较,差异无统计学意义(P>0.05)。不同心功能级别间BNP和GH比较,差异有统计学意义(P<0.05)。GH和BNP均与心功能级别呈正相关(P<0.001)。对GH和BNP的ROC曲线下面积做是否为0.5的假设检验,差异无统计学意义(均P<0.001)。BNP诊断心力衰竭的敏感度为89.3%,特异度为63.0%;GH诊断心力衰竭的灵敏度为85.7%,特异度为59.3%。BNP和GH联合使用,诊断心力衰竭的灵敏度为75.0%,特异度为74.0%。结论GH和BNP有助于CHF的诊断,ADM对CHF的诊断价值不大;BNP诊断CHF的敏感度和特异度均优于GH;BNP与GH联合应用诊断心力衰竭好于二者单用。     

Atrial natriuretic peptide during acute treatment of congestive heart failure

Summary. Atrial natriuretic peptide (ANP) induces potent diuretic/natriuretic, vasorelaxing and aldosterone inhibitory effects. Increased plasma levels in congestive heart failure (CHF) have been reported. The aim of this study was to investigate plasma immunoreactive ANP (ir-ANP) levels during acute treatment of CHF. Seven patients with CHF underwent cardiac catheterization. Ir-ANP plasma levels were followed up to two h after administration of an orally given phosphodiesterase inhibitor (Milrinone); a substance with positive inotropic and peripheral vasodilating properties. In all patients cardiac output increased and cardiac filling pressures decreased markedly. Initially high ir-ANP plasma levels decreased. Our patients did not have an increased blood volume. It is concluded that plasma ir-ANP levels in the pulmonary artery rapidly decrease when atrial pressure is reduced. These data suggest that atrial pressure is the major determinant for release of ir-ANP in man and that the ability to respond quickly to changes in cardiac filling pressures is maintained in patients with severe CHF. Plasma ir-ANP levels may also become useful as an index of the degree of heart failure and serve as a tool in monitoring response to drug therapy.     

N-terminal proBNP: a novel biomarker for the diagnosis,risk stratification and management of congestive heart failure

Congestive heart failure is a leading cause of morbidity and mortality throughout the world and is now the leading cause of hospitalizations in adults over 65 years of age with an estimated annual expenditure in excess of US$20 billion . In addition, it is the only cardiovascular disorder that continues to increase in both incidence and prevalence , and as the population continues to age, it is expected that the prevalence of this disease will continue to rise. Ironically, the armamentarium of medications that decrease mortality due to congestive heart failure also continues to grow [3–5]; however, the relative number of eligible patients with congestive heart failure (or at risk for congestive heart failure) that receive these important therapies remains low. Thus, better tools to aid the early diagnosis and management of this disease are needed. Testing for natriuretic peptide markers, such as B-type natriuretic peptide or its amino-terminal fragment, has emerged as an important tool to assist in the optimal diagnosis and risk stratification of patients with congestive heart failure and may also play a valuable role in guiding therapy.     

重组人脑钠肽对房间隔缺损封堵术后的心脏重塑和心功能的影响

目的 研究重组人脑钠肽(recombinant human brain natriuretic peptide,rhBNP)对房间隔缺损(atrial septal defect,ASD)合并肺动脉高压(PAH)封堵术后的心脏重塑和心功能的影响.方法 ASD合并中重度PAH患者封堵成功患者60例,将其随机分为rhBNP组(28例)和对照组(32例),rhBNP组在动脉导管封堵术后即刻静脉应用rhBNP48小时,比较两组术前、术后48小时及术后6个月左心室舒张末内径、左心室舒张末容积、右心室内径及射血分数的变化.结果 治疗前rhBNP组和对照组左心室舒张末容积和内径、左心室射血分数和右心室内径之间差异无统计学意义(P＞0.05),随着治疗时间的延长,两组的左心室舒张末内径和容积、左心室射血分数均有上升趋势,两组右心室内径有下降趋势,组间、不同时点以及组间·不同时点的差异均有统计学意义(P＜0.05),两组间的左心室舒张末内径和客积和左心室射血分数上升和右心室内径下降趋势有所不同,rhBNP组较对照组上升(下降)差异有统计学意义(P＜0.05),术后6个月差异更明显.结论 静脉滴注rhBNP可在ASD封堵术后进一步缓解心室重塑,改善心功能.     

血浆脑钠肽对围生期心力衰竭的预后评估价值

目的探讨血浆脑钠肽对围生期充血性心力衰竭患者的预后评估价值。方法选择本院2009年1月至2011年1月收治的36例剖宫产终止妊娠后并发急性充血性心力衰竭患者为观察组,同时选择28例剖宫产终止妊娠后无急性充血性心力衰竭患者为对照组,分别于终止妊娠后进行血浆脑钠肽浓度、血液常规、心电图、心脏射血分数检查。结果观察组血浆脑钠肽浓度高于对照组,且观察组的心脏射血分数低于对照组。血浆脑钠肽水平和心脏射血分数呈负相关。在住院期间内,观察组的全因死亡率高于对照组,差异有统计学意义(P<0.05)。结论对围生期合并充血性心力衰竭患者进行血浆脑钠肽浓度检测,是判断患者心功能的重要指标之一,有助于对其预后进行评估,具有临床应用价值。     

Neurohumoral activation and ventricular arrhythmias in patients with decompensated congestive heart failure: role of endothelin

Patients with congestive heart failure (CHF) have a high incidence of ventricular arrhythmias and sudden arrhythmic death. CHF entails profound and complex abnormalities in humoral responses that are thought to promote arrhythmic events. However, it is unknown which of the many endogenous mediators that accumulate as part of neurohormonal activation is important in arrhythmogenesis in the setting of CHF. The study included 83 patients admitted to the hospital for treatment of decompensated CHF. Neurohormonal and cytokine activation was assessed by measuring plasma renin activity, aldosterone, norepinephrine, endothelin-1, tumor necrosis factor-alpha, and interleukin-6 levels. Atrial and ventricular arrhythmic events were assessed by 24-hour Holter monitoring. In a univariate analysis, a highly significant, positive relationship was found between plasma endothelin-1 levels and the average hourly total premature ventricular beats (P = 0.003), the frequency of ventricular pairs (P = 0.0003), and the frequency of ventricular tachycardia episodes (P = 0.001). After inclusion of clinical variables, drug therapies, neurohormones, and cytokine levels in a multivariate analysis, the positive relationship between plasma endothelin-1 level and the average hourly total premature ventricular beats (P = 0.008), the frequency of ventricular pairs (P = 0.007), and ventricular tachycardia episodes (P = 0.009) remained independent. No association between other neurohormones or cytokines and arrhythmic events was demonstrated. The results of the present study suggest that increased endothelin-1 concentrations may be involved in promoting the occurrence of ventricular ectopy in patients with decompensated CHF. Proarrhythmic effects may account, in part, for the poor outcome associated with increased endothelin-1 levels in patients with decompensated CHF.     

加味参附汤治疗心阳亏虚型慢性心力衰竭的效果及对患者心室重构、BNP水平的影响

目的 探讨加味参附汤治疗心阳亏虚型慢性心力衰竭(CHF)的临床效果.方法 采用随机抽签法将2019年1月至2020年1月住院治疗的110例CHF患者分为对照组和观察组,各55例.对照组采用常规西药治疗,观察组在常规西药治疗基础上加用加味参附汤治疗.比较两组的临床疗效及治疗前、治疗12周的凝血功能指标、B型脑钠肽(BNP...