螺内酯对老年舒张性心力衰竭患者血清Ⅰ型前胶原羧基端肽水平的影响

目的观察老年舒张性心力衰竭患者使用螺内酯治疗前后血清Ⅰ型前胶原羧基端肽(PICP)水平的变化,探讨螺内酯减轻心肌纤维化、改善心脏舒张功能的可能机制。方法选择舒张性心力衰竭患者37例,随机分为常规治疗组及螺内酯(20 mg/d)治疗组,随访6个月,测定治疗前后血清PICP水平,并通过超声心动图观察治疗前后左心房、左心室大小、左心室壁厚度、左心室射血分数及舒张早期和晚期充盈速度(E、A)及其比值(E/A)。结果两组治疗后血清PICP水平与治疗前相比均明显下降(P<0.05),且螺内酯组低于常规治疗组(P<0.05)。两组治疗后E/A比值与治疗前相比均增高(P<0.05),且螺内酯组高于常规治疗组(P<0.05)。结论螺内酯通过降低Ⅰ型胶原的合成可能可以减轻心肌纤维化,改善心脏舒张功能。

Effects of spironolactone on serum carboxy-terminal peptide of procollagen typeⅠlevel in elderly patients with diastolic heart failure

Objective To investigate the effects of spironolactone on serum carboxy-terminal peptide of procollagen typeⅠ(PICP) level in elderly patients with diastolic heart failure and to explore its possible mechanisms in improving diastolic function.Methods Thirty-seven elderly subjects with diastolic heart failure were randomly divided into two groups: spironolactone group(19 cases) received spironolactone 20 mg/day for six months along with other routine treatments and control group(18 cases) received only routine treatments like anticoagulant drugs,thrombolytic agent,nitroglycerin,angiotensin-converting enzyme inhibitor(ACEI) and beta-blocker.Serum PICP levels and echocardiographic parameters like left ventricular eject fraction(LVEF) and mitral E/A ratio were measured respectively at baseline and at the end of 6 months' treatment.Results After 6 months' treatment,serum PICP level was significantly decreased both in spironolactone group and in control group.The serum PICP level after treatment in spironolactone group was significantly lower than in control group.Mitral E/A ratio was higher after treatment in spironolactone group than in control group.Conclusions Spironolactone may alleviate myocardial fibrosis,improve cardiac diastolic function and prevent progress of heart failure in elderly patients with diastolic heart failure.