高血压心脏病左室射血分数正常心力衰竭患者血浆正五聚蛋白3变化及缬沙坦干预作用

目的观察正五聚蛋白3(PTX3)在高血压心脏病左室射血分数正常心力衰竭(HFNEF)患者中的水平以及缬沙坦干预前后的变化,并探讨其临床意义。方法连续选取HFNEF患者80例为观察组,以同期就诊的高血压心脏病无心力衰竭患者40例为对照组。观察组患者随机分为观察Ⅰ组(缬沙坦胶囊80 mg,每日1次)40例和观察Ⅱ组(缬沙坦胶囊160 mg,每日1次)40例。收集所有受试者一般临床资料和心脏多普勒超声指标,检测其外周血PTX3、超敏C反应蛋白(hs-CRP)和N-端脑钠前体(NT-proBNP)水平。6个月后对上述指标进行复查,并予以比较、分析。结果(1)治疗前,观察Ⅰ和Ⅱ组PTX3、hs-CRP、NT-proBNP水平和E/E’、LAVI明显高于对照组,E/A则明显低于对照组,差异有统计学意义(P<0.01)。(2)治疗6个月后,观察Ⅰ和Ⅱ组PTX3、hs-CRP、NT-proBNP水平和E/E、LAVI明显低于治疗前,E/A则明显高于治疗前,其中观察Ⅱ组较观察Ⅰ组改变更加明显,差异有统计学意义(P均<0.01)。对照组患者治疗前、后上述指标差异无统计学意义(P>0.05)。(3)Pearson直线性相关分析显示观察组患者治疗前、后PTX3差值与NT-proBNP差值、E/E’差值、LAVI差值均呈正相关(r分别为0.568、0.531、0.416,P<0.01),与E/A差值呈负相关(r=-0.452,P<0.01),而与hs-CRP、LVEF差值均无相关性(r分别为0.132、0.126,P>0.05)。结论炎性反应可能参与高血压心脏病患者左室射血分数正常的心力衰竭进程。缬沙坦可以通过抗炎作用改善患者的预后。

PTX3 changes and the role of valsartan in heart failure patients with normal LVEF and hypertensive heart disease

Objective To observe five polyprotein 3（PTX3） in normal left ventricular ejection fraction in patients with hypertensive heart failure as well as the level of change before and after valsartan,and its clinical significance.Methods Selected consecutive hypertensive heart failure and normal left ventricular ejection fraction of 80 patients in the observation group and hypertensive heart disease without heart failure patients with 40 cases of the control group.The patients were randomly divided into observation group I（valsartan capsules 80 mg,once daily） 40 cases and observation group Ⅱ（valsartan capsules 160 mg,once daily） 40 cases.Collected all the subjects＇ general clinical data,index of cardiac Doppler ultrasound and detect the peripheral blood PTX3,hypersensitive C-reactive protein（hs-CRP） and N-terminal brain natriuretic precursor（NT-proBNP） level.Six months later,review these indicators,and to compare and analyze these indices.Results（1） before treatment,the observation group Ⅰ and Ⅱ PTX3,hs-CRP,NT-proBNP levels and E/E ＇,LAVI significantly higher,E/A was significandy lower than the control group,the difference was statistically significant（/0.01）.（2） After 6 months of treatment,observation group Ⅰ and Ⅱ PTX3,hs CRP,NT-proBNP levels and E/E,LAVI significantly lower than before treatment,E/A was significantly higher than before treatment,in the observation II group than in the observation group I change more obvious difference was statistically significant（P 0.01）.Control group of patients before and after treatment showed no significant difference these indicators（P 0.05）.（3） Pearson linear correlation analysis showed that before and after treatment the difference of PTX3 were positively correlated with NT-proBNP difference,E/E difference,LAVI difference（r=0.568,0.531,0.416 respectively,P 0.01）,while was negatively correlated with E/A difference（r =-0.452,P 0.01）,but there was no correlation with hs-CRP and LVEF difference（r =0.132,0.126,P 0.05）.Conclusion Inflammatory response may be involved in the patients with hypertensive heart failure process of normal left ventricular ejection fraction.Anti-inflammatory effects of valsartan can improve patient outcomes.