缬沙坦对老年心力衰竭患者N端脑钠肽前体及和肽素的影响

目的观察老年慢性心力衰竭（简称“心衰”）患者缬沙坦治疗前后血浆N端脑钠肽前体（NT-proBNP）及和肽素的变化，探讨缬沙坦抑制心室重构的作用机制。方法纳入2011年6月至2012年9月在湖南株洲凯德心血管病医院心内科就诊的老年慢性心衰患者99例，随机分为治疗组（常规治疗＋缬沙坦，n＝50）和对照组（仅常规治疗，n＝49），分别检测两组治疗前、治疗1个月、治疗6个月，血浆NT-proBNP、和肽素水平及心室结构功能的变化。结果两组患者治疗1个月与治疗前、治疗6个月与1个月比较，血浆NT-proBNP及和肽素水平均下降，差异均有统计学意义（P＜0.05或P＜0.01）；治疗组患者治疗1个月、6个月的血浆NT-proBNP、和肽素水平与同时间段对照组相比均下降，差异均有统计学意义（P＜0.05或P＜0.01）。治疗1个月，两组患者左室射血分数（LVEF）、左心室收缩末期内径（LVESD）及左心室舒张末期内径（LVEDD）与治疗前比较，以及两组间比较，差异均无统计学意义（P＞0.05）；治疗6个月，治疗组LVEF较对照组明显升高（P＜0.01），LVESD及LVEDD较对照组明显减小（均P＜0.01）。结论血管紧张素Ⅱ受体拮抗剂缬沙坦能够抑制老年慢性心衰患者血浆NT-proBNP、和肽素的分泌，抑制神经内分泌因子，抑制心室重构，改善心功能。

Effect of valsartan on NT-proBNP and copeptin in elderly patients with chronic heart failure

Objective To determine the effects of valsartan on the plasma levels of N-terminal pro-B-type natriuretic peptide （NT-proBNP） and copeptin in the elderly patients with chronic heart failure （CHF）, and to investigate the possible mechanism of valsartan to prevent ventricular remodeling. Methods A total of 99 CHF elderly patients aged from 60~81（68±12）years who were hospitalized in our department from June 2011 to September 2012 were recruited in this study. They were randomly divided into 2 groups：valsartan and conventional treatment group （valsartan group, n=50）, and conventional treatment （control group, n=49）. The plasma levels of NT-proBNP and copeptin, and the structural function of left ventricle were measured at the baseline, 1 and 6 months after valsartan treatment. Results The levels of NT-proBNP and copeptin were decreased in both groups at 1 month after treatment, and more significantly at 6 months （P〈0.05 or 0.01）. Their levels were significantly lower in the valsartan treatment group than in the control group at 1 and 6 months after treatment respectively （P〈0.05 or 0.01）. No significant difference was found in the left ventricular ejection fraction （LVEF）, left ventricular end systolic diameter （LVESD） and left ventricular end diastolic diameter （LVEDD） in the 2 groups at 1 month after treatment, and between the 2 groups before and at 1 month after treatment （P〉0.05）. But at 6 months after treatment, the LVEF was significantly higher （P〈0.01）, while the LVESD and LVEDD were significantly lower in the valsartan treatment group than in the control group （P〈0.01）. Conclusion Angiotensin Ⅱ receptor antagonist valsartan could inhibit the secretion of NT-proBNP and copeptin in the plasma of elderly patients with CHF, and then suppresses neuroendocrine factors, prevents ventricular remodeling, and therefore improves the heart function.