老年心力衰竭中NT-proBNP的意义及不同剂量血管紧张素Ⅱ受体拮抗剂的干预作用  

Clinical Significance of NT-proBNP in Elderly Patients with Chronic Heart Failure and Intervention of Angiotensin Ⅱ Receptor Blockade at Different Doses

作　　者：李必强[1] 姚恩辉[1] 

机构地区：[1]福建医科大学附属协和医院干部病房,福州350001

出　　处：《福建医科大学学报》2010年第4期280-283,共4页Journal of Fujian Medical University

摘　　要：目的研究老年慢性心力衰竭（CHF）患者血浆N端B型利钠肽原（NT-proBNP）浓度与心力衰竭严重程度、血浆内皮素（ET-1）浓度的相关关系,探讨不同剂量血管紧张素Ⅱ受体拮抗剂（ARB）对CHF患者NT-proBNP和ET-1的影响。方法将70例临床症状稳定的老年CHF患者在接受常规治疗基础上随机分为小剂量组（缬沙坦40~80 mg/d）和较大剂量组（120~160 mg/d）,治疗12周,治疗前后测定两组患者各项指标[血浆ET-1、NT-proBNP浓度、左室舒张末内径（LVEDd）、左室射血分数（LVEF）、心率、血压],观察治疗前后各项指标的变化及组间差异。同时选择30例年龄相仿的健康对照者,分别测定基础血浆ET-1、NT-proBNP浓度。结果老年CHF患者血浆NT-proBNP浓度随着纽约心脏病协会心功能分级（NYHA）增加而升高,与LVEF呈显著负相关（r=-0.328,P=0.013）;NT-proBNP与LVEDd和血浆ET-1呈显著正相关（r=0.431,P=0.016;r=0.412,P=0.005）;较大剂量组比小剂量组能更明显降低血浆NT-proBNP、ET-1浓度;较大剂量组患者采用小剂量逐渐递增剂量的方式给药,安全且耐受性良好。结论 CHF时血浆NT-proBNP浓度与心衰严重程度密切相关,而且NT-proBNP与血浆ET-1浓度呈正相关。血浆NT-proBNP浓度是心力衰竭诊断、治疗和预后评估的很好的指标。在老年CHF患者中采用小剂量逐渐递增剂量的方式给予缬沙坦是安全可行的,耐受性良好。Objective To study in patients with chronic heart failure（CHF） the relationship between plasma NT-proBNP level and severity of heart failure and plasma endothelin-1（ET-1） level,and to investigate the effect of angiotensinⅡreceptor blockade（ARB） on plasma NT-proBNP and ET-1 at varied dosage.Methods Seventy patients with stable CHF who were receiving conventional therapy for heart failure were randomly assigned to the low-dose group（valsartan 40～80 mg/d） and the high-dose group（valsartan started at a low dose and gradually increased up to 120～160 mg/d）.All indices（including plasma ET-1 and NT-proBNP levels,LVEF,LVEDd,BP,HR） were measured before and after a 12 w treatment and were compared between the two groups.Thirty healthy subjects were selected as the control group and measured for plasma levels of ET-1 and NT-proBNP.Results The plasma NT-proBNP level was correlated closely with NYHA classes of heart failure,LVEF（r=-0.328,P=0.013）,plasma ET-1 level（r=0.412,P=0.005） and LVEDd（r=0.431,P=0.016） in patients with CHF.Both plasma NT-proBNP and ET-1levels in the high-dose group（valsartan at 120～160 mg/d） were significantly decreased compared with those in the low-dose group.Patients in the high-dose group responded safely to and tolerated the gradual increase of valsartan dosage well.Conclusion Plasma NT-proBNP level in patients with CHF is correlated closely with the severity of CHF.Plasma ET-1 and plasma NT-proBNP levels are reliable indices for the diagnosis,treatment,and prognosis of heart failure.Patients with chronic heart failure respond safely to and tolerate the gradual increase of the valsartan dose well.

关 键 词：心力衰竭 受体 血管紧张素 2型 缬氨酸 四唑类 利钠肽 脑 

分 类 号：R541.610.53[医药卫生—心血管疾病] R977.4[医药卫生—内科学]