螺内酯对慢性心力衰竭患者血浆脑钠肽水平及心功能的影响

目的:探讨螺内酯对慢性心力衰竭(CHF)患者血浆脑钠肽(BNP)水平和心功能的影响。方法:64例CHF患者被随机分为常规对照组(32例)和螺内酯组(32例),两组均给予常规治疗,螺内酯组另加螺内酯20mg,2次/d,观察期3个月,测定治疗前、后左心室舒张末内径(LVEDd)、左心室射血分数(LVEF)、血浆BNP浓度的变化。结果:治疗3个月后,螺内酯组总有效率(90.6%)明显高于常规治疗组(81.3%,P0.05);两组治疗后BNP、LVEDd较治疗前有显著下降,LVEF较治疗前显著升高(P均0.01),螺内酯组血浆BNP浓度由(839±67)ng/L降至(359±51)ng/L(P0.01),LVEDd由(66.01±3.7)mm降至(59.1±2.4)mm(P0.05),LVEF由(36±1.2)%升至(49±5.9)%(P0.01),且明显优于常规对照组(P0.05)。结论:在常规心衰治疗的基础上加用螺内酯能明显改善心功能,显著降低血浆脑钠肽水平。

Effects of spironolactone on cardiac function and plasma level of brain natriuretic peptide in patients with chronic heart failure

Objective：To investigate the changes of cardiac function and plasma brain natriuretic peptide（BNP） level in patients with chronic heart failure（CHF） after spironolactone treatment.Methods：A total of 64 CHF patients were randomly divided into two groups,spironolactone group（n=32） and normal control group（n=32）.Patients in spironolactone group were given spironolactone 20mg,2 times/d for three months beside conventional therapy.Plasma BNP level,left ventricular end-diastolic dimension（LVEDd） and left ventricular ejection fraction（LVEF） were evaluated before and after treatment.Results：After 3-month treatment,the overall effective rate of spironolactone group was significantly higher than that of normal control group（90.6% vs.81.3%,P〈0.05）.Plasma BNP level,LVEDd and LVEF of the two groups were significantly improved compared with those of before treatment（P〈0.01all）.In spironolactone group,plasma BNP concentration decreased from（839±67）ng/L to（359±51）ng/L（P〈0.01）,LVEF increased from（36±1.2）% to（49±5.9）%（P〈0.01） and LVEDd decreased from（66.01±3.7）mm to（59.1±2.4）mm（P〈0.05）,all these were significantly better than those of normal control group（P〈0.05）.Conclusion：Based on conventional therapy,spironolactone can significantly improve cardiac function and decrease plasma brain natriuretic peptide in patients with chronic heart failure.