比索洛尔治疗慢性充血性心力衰竭对外周血中利钾尿肽、肾素活性和心房钠尿肽水平的影响  

Effects of bisoprolol on kaliuretic peptide,plasma renin activity and atrial natriuretic peptide in patients with chronic congestive heart failure

作　　者：唐发宽[1] 华宁[1] 钮炜西[1] 肖军[1] 陆宏[1] 唐雪正[1] 齐帜[1] 曾强[2] 

机构地区：[1]解放军总医院附属第二医院心内科,北京100091 [2]解放军总医院南楼心血管二科,北京100853

出　　处：《第四军医大学学报》2009年第2期162-165,共4页Journal of the Fourth Military Medical University

基　　金：全军医学科研"十五"面上项目(01MA216)

摘　　要：目的:探讨β受体阻滞剂比索洛尔治疗充血性心力衰竭(CHF)时对外周血中利钾尿肽(KP)、肾素活性(PRA)和心房钠尿肽(ANP)水平的影响.方法:120例充血性心力衰竭患者随机分为常规治疗组(血管紧张素转换酶抑制剂+利尿剂+地高辛)和比索洛尔组(常规治疗药物+比索洛尔),随访12wk,采用放射免疫分析方法测定两组治疗前后和60例健康体检者(正常对照组)外周血浆中KP,PRA和ANP水平.同时使用核素心室显像测定心衰患者左心室射血分数(LVEF).结果:CHF患者的血浆KP,PRA和ANP水平较正常对照组显著升高,其中,KP和ANP水平在比索洛尔治疗前与LVEF显著负相关,但PRA水平与LVEF无关,随着病情的好转其水平逐渐降低,且不同的心功能分级组之间有显著差异(P<0.05).在比索洛尔治疗后,比索洛尔组外周血浆中KP,PRA和ANP水平较常规治疗组明显下降.结论:血浆KP与ANP含量的改变水平在CHF病理生理中起着一定的作用,且在β受体阻滞剂治疗后仍可用于指导CHF患者的治疗.β受体阻滞剂能抑制CHF患者神经内分泌的过度激活.AIM： To investigate the levels of kaliuretic peptide （KP）, plasma renin activity（PRA） and atrial natriuretic peptide （ANP） in patients with chronic congestive heart failure （CHF） and to evaluate the beneficial effects of beta-blockers on the varia- bles mentioned above. METHODS： One hundred and twenty patients with CHF were divided into two subgroups randomly. Routine group was treated with routine drugs （ACE inhibitors, diuretics and digoxin, n = 60）, while bisoprolol group was given beta-blocker（bisoprolol, n = 60） additionally. The levels of plasma KP, PRA and ANP were detected by radioimmunoassay and the left ventricular ejeetive fraction （LVEF） was measured by nuclide ventricular imagery in patients with CHF, as well as subjects in control group （ healthy people, n = 60）. RESULTS ： The levels of KP, PRA and ANP in patients with CHF were much higher than those in the control group at each time point during the course. Significantly negative correlations were found between KP, ANP and LVEF 12 weeks after treatment （rKp = -0. 34, rANp = -0.31, P 〈0.05） and great differences were observed in KP level between NYHA Ⅱ ,Ⅲ and Ⅳ patients with CHF. The levels of KP, PRA and ANP in bisoprolol group were significantly lower than those in routine group （ P 〈 O. 05 ）. CONCLUSION： KP and ANP might play an important role in the pathogenesis of CHF and their levels can serve as guide for the treatment of CHF even after beta-blockers therapy. Betalockers suppress the overactivation of neurohumoral system in patients with CHF.

关 键 词：心力衰竭 充血性 利钾尿肽 心钠系 肾素 

分 类 号：R541.6[医药卫生—心血管疾病]