安体舒通对充血性心力衰竭心肌纤维化和左室重塑的影响  

Effects of spironolactone on myocardial fibrosis and left ventricular remodeling in patients with congestive heart failure

作　　者：刘圣文[1] 欧细平[1] 蒋腊梅[1] 刘遂心[1] 

机构地区：[1]福建医科大学附属厦门市第一医院心内科,福建厦门361003

出　　处：《中国现代医学杂志》2004年第13期124-126,130,共4页China Journal of Modern Medicine

摘　　要：目的探讨安体舒通对充血性心力衰竭患者心肌纤维化和左室重塑的影响。方法选择充血性心力衰竭患者观察组42例和健康对照组20例,采用放射免疫法测定血清Ш型前胶原、血浆醛固酮的浓度;将观察组随机分为常规治疗组(21例)和安体舒通组(21例),观察前及3个月时测定上述指标变化和应用心脏彩色超声测定左室结构和功能变化。结果观察组Ш型前胶原和醛固酮均高于健康对照组;安体舒通组与常规治疗组比较Ш型前胶原下降;与基线比较左室舒张末期容积指数下降和醛固酮升高,但与常规治疗组之间无统计学差异;观察组基线Ⅲ型前胶原与左室重量指数正相关。结论安体舒通能够抑制充血性心力衰竭患者心肌纤维化和改善心室重塑。Ⅲ型前胶原可作为充血性心力衰竭心肌纤维化血清学指标。Objective: To evaluate the effects of spironolactone on the myocardial fibrosis and left ventricular remodeling in patients with congestive heart failure. Methods: The subjects were divided into investigation group with congestive heart failure (n=42) and health control group (n=20). Serum levels of procollagen type Ⅲ (PCⅢ) and plasma levels of aldosterone (ALD) were measured through radioimmunoassay. The investigation group was furtherly subdivided into either conventional or conventional plus spironolactone groups. After 3 months, procollagen type Ⅲ and aldosterone were re-checked and the data of ventricular function were measured by echocardiography at baseline, 3 months after admission. Results: The serum levels of procollagen type Ⅲ and plasm levels of aldosterone of investigation group were higher than that of healthy control group (P<0.01). There were significant decrease on serum procollagen type Ⅲ, left ventricular mass index (LVMI) between spironolactone group and the conventional group (P<0.05). Compared with baseline, the spironolactone group have decreased left ventricular end-diastolic volume index (LVEDVI) and increased plama aldosterone at 3-month (P<0.05, P<0.01, respectively),but there were no significant difference compared with the conventional group. There was significant positive correlation between serum PCⅢ and LVMI (r =0.42, P<0.05). Conclusions: The finding indicates that the spironolactone therapy can suppress myocardial fibrosis and improve left ventricular remodeling in patients with congestive heart failure. Aldosterone plays an important role in the development of heart failure. PCⅢ may be the serum marker of mycardial fibrosis in congestive heart failure.

关 键 词：心力衰竭 充血性 安体舒通 心肌纤维化 心室重塑 

分 类 号：R541.61[医药卫生—心血管疾病]