缬沙坦干预对慢性心力衰竭患者循环血中脑钠肽、β-内啡肽、肿瘤坏死因子-α、白介素-10水平的影响  

Effect of valsartan on the levels of brain natriuretic peptide,β-endorphin,tumor necrosis factor-αand interleukin-10 in patients with heart failure

作　　者：陈祥杰[1] 吴同利 张亚琴[1] 黄文洁[1] 

机构地区：[1]江苏省昆山市第四人民医院心内科,215331

出　　处：《疑难病杂志》2012年第5期337-340,共4页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的观察缬沙坦干预对慢性心力衰竭患者心功能改善情况及循环血中神经内分泌激素脑钠肽(BNP)、β-内啡肽(β-EP)和炎性介质肿瘤坏死因子-α(TNF-α)、白介素-10(IL-10)水平变化的影响。方法将87例慢性心力衰竭患者随机分为对照组(常规治疗组)与干预组(在常规治疗基础上加用缬沙坦),评价其治疗前和治疗后2个月心功能变化情况,并测定血清BNP、β-EP、TNF-α、IL-10水平。结果 (1)随心功能NYHA分级增高,BNF、β-EP、TNF-α、IL-10水平升高,各级间差异有统计学意义(P<0.05)。BNP、β-EP、TNF-α、IL-10水平与左室射血分数(LVEF)呈负相关(r分别为-0.50、-0.47、-0.35及-0.32,P均<0.01)。BNP水平与左室舒张末内径(LVEDD)呈正相关(r=0.32,P<0.05)。(2)与治疗前比较,治疗后干预组TNF-α、IL-10、β-EP、BNP水平显著降低(P均<0.05),对照组仅BNP、β-EP降低(p<0.05),干预组各项指标均显著低于对照组(P<0.05)。(3)与对照组比较,干预组可明显缩小LVED[),提高LVEF,改善NYHA心功能评级。结论缬沙坦可以改善慢性心力衰竭患者心功能情况,其作用机制可能与神经内分泌激素及炎性因子的抑制相关。Objective To observe the effects of valsartan on patients with chronic heart failure and its influence on the serum levels of brain natriuretic peptide （BNP） , β-endorphin （β-EP） , tumor necrosis factor-α（TNF-α） and interleukin- 10 （IL-10） , meanwhile to investigate the effects of valsartan on the neurohormonal regulation and cardiac function during heart failure treatment. Methods Eighty seven patients with chronic heart failure were randomly enrolled and allocated into conven- tional treatment group and valsartan group （routine drugs add with valsartan） , cardiac function before and after treatment were evaluated. The serum level of BNP, β--EP, TNF-α and IL-10 were recorded. Results The serum level of BNP, β-EP,TNF-α and IL-10 were significantly increased with the severity grade NYHA, there were significant difference among different grads （P 〈 0. 05） , BNP, β-EP, TNF-α and IL-10 were negatively correlated with LVEF（ r = - 0.50, r = - 0.47, r = - 0.35 and r = - 0.32, all P 〈 0. 05 ）. NBP level was positively correlated with LVEDD （ r = 0.32, P 〈 0.05 ）. （2） Compared with those before treatment, BNP, β-EP,TNF-α and IL-10 in treatment group decreased obviously （all P 〈0.05 ）, only BNP and β-EP decreased significantly in control group （ P 〈 0. 05）, all the parameters were obviously lower in treatment group than those in control group （ P 〈 0.05 ）. （3）Compared with control group, LVEDD was significantly decreased, LVEF was elevated and HY- HA grade was improved in treatment group. Conclusion Valsartan can improve the cardiac function and the potential mechanism maybe related with the inhibition of neurohormonal regulation and inflammatory cytokines.

关 键 词：心力衰竭 缬沙坦 脑钠肽 Β-内腓肽 肿瘤坏死因子-α、白介素-10 

分 类 号：R541.6[医药卫生—心血管疾病]