慢性充血性心力衰竭抗醛固酮治疗对神经内分泌和性激素的影响  

Effect of antialdosterone on neuroendocrine hormone and sex hormone in treatment of chronic congestive heart failure

作　　者：王继征 王凤 阚国庆 张国清 李广军 

机构地区：[1]山东枣庄矿业集团枣庄医院心内科,山东枣庄277100

出　　处：《心脏杂志》2007年第2期205-208,共4页Chinese Heart Journal

摘　　要：目的探讨慢性充血性心力衰竭（CHF）抗醛固酮治疗对神经内分泌激素和性激素的影响。方法心功能（NYHA分级）Ⅱ～Ⅳ级的CHF患者136例随机分为两组，对照组给予强心、利尿剂、血管紧张素转换酶抑制剂（ACEI）、β-受体阻滞剂等常规治疗；治疗组在常规治疗的基础上加用螺内酯40mg／d，连用3个月。分别于入院后及3个月时，根据临床症状评价心功能；测定血浆血管紧张素Ⅱ（AngⅡ）、醛固酮（ALD）、雌二醇（E2）、睾酮（T）、肌酐、尿素氮、血钾、钠；心脏超声测定左室射血分数（LVEF）。结果两组患者治疗3个月后血浆AngII、ALD均有降低，治疗组尤为显著（P〈0．01）；与治疗前相比，治疗组E2升高，T降低，差异达显著性；治疗后两组心功能均有改善，治疗组更加明显；治疗组血钾明显升高；两组肾功能无明显改变。结论螺内酯治疗可改善CHF患者神经内分泌激素和性激素水平，进一步改善临床预后。AIM To investigate the effect of antialdosterone on neuroendocrine hormone and sex hormone in the treatment of chronic congestive heart failure （CHF）. METHODS One hundred and thirty-six CHF patients with cardiac functions of Ⅱ - 1V grade were randomized to either the control group or treatment group. The patients in control group received the routine treatment including digitalis, diuretics, ACEI and B-blocking agents. The treatment group was given conventional treatment plus spironolaction 40 mg/d for three months. Assessments of cardiac function （ NYHA class ） were made according to clinical symptoms. Before and three months after the treatment, angiotensin （Ang Ⅱ ）, aldosterone （ALD）, estradiol （E2）, testosterone （T）, creatinine, blood urea nitrogen, serum Kalium and serum Natrium were measured. Left ventricular ejection fraction was measured by echocardiography. RESULTS Ang Ⅱ and ALD were lower in the treatment group than those in the control group after three months （P 〈 0.01 ）. Higher E2 and lower T in the treatment group were significant after treatment. The cardiac function improved in both groups after three months and the improvement was more significant in the treatment group. Serum Kalium was higher in the treatment group and no significant changes in renal function were found in both groups. CONCLUSION Spironolaction therapy can improve neuroendocrine hormone and sex hormone in CHF patients and thus alleviate clinical symptom .

关 键 词：心力衰竭 充血性 神经内分泌 性激素 螺内酯 

分 类 号：R541.6[医药卫生—心血管疾病]