培哚普利对心力衰竭患者神经激素激活及血管内皮功能的临床作用  

Effect of perindopril on neurohormonal activation and vascular endothelial dysfunction in patients with congestive heart failure and its clinical efficacy

作　　者：邓南伟[1] 戚秀卿[1] 罗明[1] 邓兵[1] 邹颂海[1] 马文林 黄卫斌 徐文渊[1] 蒋金法[1] 徐文俊[1] 于德华[1] 方美菊[1] 顾惠琴 

机构地区：[1]上海铁道大学附属甘泉医院心内科,上海200072

出　　处：《临床心血管病杂志》1999年第5期209-213,共5页Journal of Clinical Cardiology

摘　　要：目的 :观察培哚普利 (Pe)治疗心力衰竭患者的疗效及其对神经激素、血管内皮功能和心率变异性 (HRV)的作用。方法 :分别对 35例和 10例心力衰竭患者口服 Pe4 mg/ d6个月和 2 4 h期间疗效进行观察 ,并与 32例临床特征相匹配的患者对照。结果 :治疗组乙酰胆碱酯酶、血管紧张素 、心房利钠多肽、内皮素、肿瘤坏死因子 α和血浆肾素活性分别显著性降低或升高 (P <0 .0 1) ,总体标准差、均数标准差、差值均方平方根和低频、高频、总功率均有显著升高 (P <0 .0 1) ,运动耐量时间显著增加 (P <0 .0 1)。口服单剂 Pe 4 mg后平均肺动脉压、肺动脉压、肺毛细血管楔压和心脏指数分别呈显著性降低和升高 ,无 1例发生症状性低血压。结论 :Pe长期治疗可抑制慢性心力衰竭患者过度激活的肾素 -血管紧张素系统 ,逆转血管内皮功能不全和恢复自主神经性平衡和调节功能 ,增加患者的运动耐量。对急性血流动力学有有益的效应且耐受性良好 。Objective:To assess the effects of perindopril on neurohormonal activation,vascular endothelial dysfunction,heart rate variability and its clinical efficacy in patients with CHF.Method:35 patients with CHF treated with oral perindopril (4 mg daily) for 6 months and 10 patients treated with the same single dosage observed over 24 hours were included in the control group,32 patients with matched clinical characteristics were included in the contrast group.Result:The results showed that the plasma levels of ACE activity,ATⅡ,ANP,ET,TNF α and PRA significantly decreased or increased (P< 0.01 ) respectively,SDNN,SDANN,rMSSD and LF,HF,TP also increased significantly (P< 0.01 ).In the perindopril group,excercise test duration increased significantly.After taking the single dosage of perindopril (4 mg),MPAP and PCWP were decreased and CI was increased significantly (P< 0.01 ) respectively.Conclusion:These results showed that perindopril in the long term treatment of patients with CHF not only suppresses the over activated RAS,but also reverses the dysfunction of vascular endothelium and restores the functions of autonomic balance and of autonomic control,which is combined with increasing excercise tolerance and having acute beneficial haemodynamic effect and good tolerability.

关 键 词：充血性心力衰竭 培哚普利 神经激素 血管内皮 

分 类 号：R541.61[医药卫生—心血管疾病]