螺内酯治疗心力衰竭的价值  

Value of spironolactone in treating congestive heart failure

作　　者：鲁燕[1] 冯燕光[1] 王卉茜[2] 张素华[3] 李倩[4] 

机构地区：[1]石家庄市第一医院心内科,河北石家庄0500113 [2]石家庄市中心医院急诊科,河北石家庄050011 [3]河北医科大学附属第三医院高干病房,河北石家庄050051 [4]石家庄市第一医院干部病房,河北石家庄0500113

出　　处：《临床荟萃》2006年第13期930-932,共3页Clinical Focus

摘　　要：目的观察心力衰竭常规血管紧张素转换酶抑制剂(ACEI)治疗后血浆血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)水平变化,探讨加用螺内酯治疗对心力衰竭预后的影响。方法93例慢性心力衰竭患者随机分为两组。ACEI加螺内酯(螺内酯组)和不加螺内酯(对照组),采用放射免疫方法测定ACEI治疗前、治疗6个月时血浆肾素(PRA)、AngⅡ、ALD的水平,观察治疗前后PRA、AngⅡ、ALD的变化。以6分钟步行距离为客观指标,比较两组步行距离的改变,借以评价心功能改善的程度。结果①观察组治疗6个月后血浆ALD水平较治疗前明显升高[(205±30)pmol/L vs(148±60)pmol/L](P<0.01);对照组治疗6个月后血浆ALD水平较治疗前升高(170±68)pmol/L vs 144±63)pmol/L。但差异无统计学意义。②观察组治疗6个月时6分钟步行距离与治疗前比较明显增加[(420±163)m vs(338±118)m](P<0.01),对照组治疗6个月时步行距离有所增加[(380±112)m vs(346±106)m],但与治疗前比较,差异无统计学意义(P>0.05),两组治疗6个月后6分钟步行距离差异无统计学意义。结论①心力衰竭患者ACEI治疗后,不管是否加用螺内酯均可观察到醛固酮逃逸现象。加用螺内酯逃逸现象似乎更明显。这可能与螺内酯阻断醛固酮受体使血浆ALD游离浓度升高有关。②观察组6个月后6分钟步行距离明显增加。提示螺内酯改善心功能其机制可能与阻断ALD致Ⅰ、Ⅲ型胶原基因表达,使胶原合成增加促使心肌纤维化有关。Objective To observe the changes of plasma angiotensin（Ang） and aldosterone（ALD） activity and the extend of aldosterone escape in patients with congestive heart failure after treatment of angiotensin converting enzyme inhibitor（ACEI） and to explore the effective role after adding spironolactone treatment. Methods Ninety-three consecutive patients with congestive heart failure were divided into two groups randomly： group one（observational group）, standard treatment with ACEI, together with spironolactone treatment,group two（control group）, standard treatment with ACEI without spironolactone. The activities of plasma rennin, angiotensin and aldosterone were measured in the two groups before and 6 months after ACEI treatment by the method of radioimmunoassay test. The activities of Ang and Ald and the degree of aldosterone escape were compared between the two groups. For identification of improvement of heart function, the distance after 6 minutes walk test was compared between the two groups before and after treatment. Results ①After 6 months treatment in spironelatone group the level of ALD was significantly different compared with before the treatment （205 ± 30） pmol/L vs （148± 60） pmol/L. After 6 months treatment in control group the level of ALD was increased significantly compared with before the treatment（170± 68） pmol/L vs （144±63） pmol/L.② The distance of 6 minuets walk test bacame much longer in spironelatone group after 6 months treatment before [（420±163） m vs （338± 118） m]. There was significant improvement in walk efficiency in control group after 6 months treatment comparing with that before treatment [（380±120） mvs （346±106） m]. Conclusion ①The aldosterone escape appears in congestive heart failure patients with ACEI treatment irrespective of spironolactone use. In terms of aldosterone escape, the effect of spironolactone treatment group seems more apparent comparing with the control group. The spironolactone, analdosterone receptor

关 键 词：心力衰竭 心肌梗塞 螺内酯 心肌纤维化症 

分 类 号：R542.43[医药卫生—心血管疾病]