奥美沙坦对慢性心力衰竭患者胱抑素C水平的影响

目的 观察慢性心力衰竭（CHF）患者血清胱抑素C（Cys C）的浓度变化,探讨奥美沙坦对CHF胱抑素C水平的影响.方法 血清Cys C浓度采用颗粒增强免疫比浊法测定.选取124例CHF患者,分为奥美沙坦组和依那普利组,奥美沙坦组64例,依那普利组60例.慢性心力衰竭依NYHA心功能分级标准,分为Ⅰ～Ⅳ级各亚组,测定各亚组在治疗前后血清Cys C浓度及血肌酐（Scr）浓度,并进行统计学分析.结果 两组患者Cys C浓度随NYHA分级增高而升高；Ⅱ～Ⅳ级分别与Ⅰ级相比,差别有统计学意义（P＜0.05）.Scr浓度从Ⅰ～Ⅳ级逐渐升高；NYHA Ⅰ～Ⅱ级Scr浓度升高不明显,两者差异无统计学意义（P＞0.05）；Ⅲ～Ⅳ级分别与Ⅰ级相比,血Scr浓度差异有统计学意义（P＜0.05）.NYHAⅠ～Ⅱ级亚组、Ⅱ～Ⅲ级亚组及Ⅲ～Ⅳ级亚组之间血清Cys C浓度差异有统计学意义（P＜0.01）.CHF患者血清Cys C的改变较Scr的改变出现迅速.治疗后,奥美沙坦组及依那普利组Cys C浓度均呈下降趋势（P＜0.01）,但奥美沙坦降低血清Cys C的作用更明显（P＜0.05）.结论 奥美沙坦能使CHF患者Cys C明显下降,可对肾功能起有效保护作用.

The influence of olmesartan on the levels of serum cystatin C in patients with chronic heart failure

Objective To observe changes of serum concentration of cystatin C （Cys C） in patients with chronic heart failure（CHF）, and explore the influence of olmesartan on the levels of serum Cys C in CHF. Methods Particle enhanced immunoturbidimetry was used to detect serum Cys C concentration. We recruited 124 CHF pa- tients, which were further divided into olmesartan group（64 cases） and enalapril group（60 cases）. According to NY- HA cardiac function classification criteria,CHF was divided into class I , l], m and IV. Serum Cys C concentration and serum creatine （Scr） concentration of each class were measured and analyzed before and after treatment. Results The Cys C concentration of two groups increased with NYHA cardiac function classification.Comparing with NYHA class I （1.31~0.16 mg/L）,the Cys C level was significantly increased（P〈0.05）in NYHA class II （1.52~ 0.11 rag/L）, 11[ （1.75 ~0.15 rag/L） and 1V （1.90~0.13 rag/L）. Scr concentration of two groups were also increased with NYHA cardiac function classification,but it had no significant change in NYHA class I and II （93.92~13.41 vs 96.32~8.99, P〉0.05）.In comparision with that of NYHA class I （93.92~13.41 p, mol/L）, the Scr level was signifi- cantly increased（P〈0.05 ）in NYHA class Ill （107.98~10.02 ~mol/L） and IV（111.74~12.41 p, mol/L）. Serum Cys C concentration had significant change in NYHA class I and H （P〈0.01）, NYHA class ]I and Iil （P〈0.01）and NY- HA class Ill and IV （P〈0.01）. Changes of serum concentration of Cys C were more rapid than that of Scr in pa- tients with CHF. Although the levels of Cys C had decreased in two groups after treatment （P〈0.01）, olmesartangroup should be more obvious （P〈0.05）. Conclusion Olmesartan descendes serum Cys C concentration obvi- ouslyand would provide with more protection on renal function in patients with CHF.