坎地沙坦对老年充血性心力衰竭患者利钾尿肽、心房钠尿肽和内皮素水平的影响  

Effects of candesartan on kaliuretic peptide,atrial natriuretic peptide and endothelin in elderly patients with congestive heart failure

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

机构地区：[1]解放军总医院第二附属医院心内科,北京100091

出　　处：《心脏杂志》2009年第6期828-831,共4页Chinese Heart Journal

摘　　要：目的:探讨血管紧张素II受体拮抗剂(ARB)坎地沙坦治疗充血性心力衰竭(CHF)时对外周血中利钾尿肽(KP)、心房钠尿肽(ANP)和内皮素(ET)水平的影响。方法:94例老年CHF患者随机分为常规治疗组(硝酸酯类药物+利尿剂+地高辛)和坎地沙坦组(常规治疗药物+坎地沙坦),随访12周,采用放射免疫分析方法测定两组治疗前后和34例健康者(正常对照组)外周血浆中KP、ANP和ET水平。同时用核素心室显像测定CHF患者左心室射血分数(LVEF)。结果:CHF患者的血浆KP、ANP和ET水平较正常对照组显著升高,随着病情的好转其水平逐渐降低,且不同的心功能分级之间有显著差异(P<0.05)。治疗后,坎地沙坦组外周血中KP、ANP和ET水平较常规治疗组下降更显著。结论:坎地沙坦有抑制CHF患者神经内分泌的过度激活和肾素-血管紧张素-醛固酮(RAAS)系统亢进的作用。AIM： To investigate the levels of the kaliuretic peptide （KP）, atrial natriuretic peptide （ANP） and endothelin （ET） in elderly patients with congestive heart failure （CHF） and to evaluate the beneficial effects of angiotensin receptor blockers on the above variables. METHODS： Ninety-four elderly patients with CHF were randomly divided into two groups： routine group was treated with routine drugs （nitrate-like drugs, diuretics and digoxins） （n=47） and candesartan group treated with angiotensin receptor blocker candesartan （n=47）. Plasma levels of KP, ANP and ET were detected by radioimmunoassay before and after treatment in all patients and in the control group of 34 healthy subjects. Left ventricular ejection fraction （LVEF） was also measured by nuclear ventricular imaging. RESULTS： Compared with those in the control group, plasma levels of KP, ANP and ET in elderly patients with CHF were much higher at each time point during the study. There was a significant negative correlation between KP and ANP and LVEF 12 weeks after treatment, and there were significant differences in KP levels within NYHA II, III and IV in elderly CHF patients. KP and ANP levels decreased more significantly in the candesartan group than in the routine group （P〈0.05）. CONCLUSION： KP and ANP may play an important role in the pathogenesis of CHF. Candesartan suppresses the overactivation of the neurohumoral system and renin-angiotensin-aldosterone system in elderly patients with CHF.

关 键 词：坎地沙坦 心力衰竭 充血性 利钾尿肽 钠尿肽 心房 内皮素 

分 类 号：R541.6[医药卫生—心血管疾病]