血管紧张素转换酶抑制剂对慢性心力衰竭患者脑钠肽和去甲肾上腺素的作用

目的探讨不同剂量血管紧张素转换酶抑制剂(ACEI)对慢性心力衰竭患者脑钠肽和去甲肾上腺素(NE)的作用,以及较大剂量ACEI治疗的可行性与安全性。方法将66例慢性心力衰竭患者随机分为培哚普利较小剂量组(33例,2～4mg/d)和较大剂量组(33例,8～10mg/d)治疗12周,治疗前后测定各项指标NE、脑钠肽浓度,左室舒张末内径(LVED),左室射血分数(LVEF)等]。并且选择30名年龄相仿的健康对照者,分别测定基础NE、脑钠肽浓度。结果慢性心力衰竭患者血浆中脑钠肽浓度随着纽约心脏病协会心功能分级增加而升高,与LVEF呈显著负相关(r=-0.327,P=0.012);脑钠肽与LVED和NE呈显著正相关(r=0.42,P=0.015;r=0.402,P=0.002)。治疗12周后7例患者因出现不能耐受的咳嗽反应而退出(其中较小剂量组3例,较大剂量组4例),其余59例完成研究。较小剂量组治疗后脑钠肽浓度为8μg/L±4μg/L,NE浓度为387ng/L±211ng/L,较大剂量组治疗后脑钠肽浓度为6μg/L±4μg/L,NE浓度为250ng/L±63ng/L,较大剂量组治疗后的脑钠肽、NE浓度明显低于较小剂量组治疗后(均P<0.05)。结论心力衰竭时血浆脑钠肽浓度与心力衰竭严重程度密切相关,且与NE浓度呈正相关。在慢性心力衰竭患者中采用小剂量逐渐递增剂量方式给予培哚普利可明显降低脑钠肽、NE,且耐受性良好。

Effects of angiotensin converting enzyme inhibitor with different doses on plasma brain natriuretic peptide and norepinephrine in patients with chronic heart failure

OBJECTIVE: To investigate the effects of angiotensin converting enzyme inhibitor (ACEI) with different doses on the plasma brain natriuretic peptide and norepinephrine (NE) of patients with chronic heart failure and the feasibility and safety of high dose ACEI treatment. METHODS: Sixty-six patients with chronic heart failure were randomly divided into 2 groups: low-dose group, treated by perindopril with the dosage of 2 mg/d initially and gradually increased up to 2-4 mg/d, and high-dose group, treated by perindopril with the dosage of 2 mg/d initially and gradually increased up to 8 approximately 10 mg/d. Treatment lasted for 12 weeks. Before and after the treatment peripheral blood was collected to test the plasma NE and brain natriuretic peptide levels, and the left ventricular ejection fraction (LVEF), left ventricular end diameter (LVED), blood pressure, and heart rate were examined. The differences of these indexes between the two groups and within the same group before and after the 12-week treatment were analyzed. Thirty healthy subjects were used as control group. RESULTS: The levels of plasma brain natriuretic peptide and NE of the chronic heart failure patients were significantly higher than those of the normal controls, and the higher the NYHA class of heart failure the higher the plasma levels of NE and brain natriuretic peptide. The plasma brain natriuretic peptide level was negatively correlated with LVEF (r = -0.327, P = 0.012) and positively correlated with plasma NE level (r = 0.402, P = 0.002) and LVED (r = 0.42, P = 0.015). The plasma brain natriuretic peptide and NE levels in the high-dose group were 6 microg/L +/- 4 microg/L and 250 ng/L +/- 63 ng/L respectively, both significantly lower than those of the low-dose group (8 microg/L +/- 4 microg/L and 387 ng/L +/- 211 ng/L respectively, both P < 0.05). Most of the patients in these 2 groups tolerated well. CONCLUSION: Plasma brain natriuretic peptide level is negatively correlated with the severity of heart failure and positively correlated with plasma NE. Treatment of CHF by perindopril with gradually increasing dose obviously decreases the plasma brain natriuretic peptide and NE levels and is tolerable for the patients.