非诺贝特对慢性心力衰竭患者心肌纤维化和心功能的影响  

Effects of Fenofibrate on myocardial fibrosis and heart function induced by chronic heart failure

作　　者：赵晓燕[1] 苏金林[2] 温旭凯 王海龙[1] 吴波[1] 姜培培[1] 

机构地区：[1]解放军第五医院内科,宁夏银川750004 [2]宁夏医科大学总院心胸外科,宁夏银川750004

出　　处：《中国现代医学杂志》2013年第29期46-50,共5页China Journal of Modern Medicine

摘　　要：目的探讨过氧化物酶体增殖物激活受体α(PPARα)激动剂非诺贝特对慢性心力衰竭(CHF)患者心肌纤维化和心功能的影响。方法将70例CHF患者随机分为两组:常规治疗组(35例)给予常规抗心力衰竭药物,非诺贝特组(35例)在常规治疗的基础上加用非诺贝特,疗程均为6个月。观察治疗前后血清Ⅰ型前胶原(PCⅠ)、Ⅲ型前胶原(PCⅢ)、层黏连蛋白(LN)、透明质酸(HA)和心脏超声指标的变化。结果治疗后,非诺贝特组和常规治疗组的PCⅠ和HA均显著降低(P<0.05,P<0.01),且非诺贝特组的降低程度大于常规治疗组(P<0.05);非诺贝特组的PCⅢ和LN均较治疗前显著降低(P<0.05),但常规治疗组的PCⅢ和LN与治疗前相比无明显变化(P>0.05)。治疗后,非诺贝特组和常规治疗组的左心室重量指数(LVMI)均明显降低(P<0.01,P<0.05),且非诺贝特组较常规治疗组降低更为明显(P<0.05);非诺贝特组的左室舒张末期内径(LVEDd)和室间隔厚度(IVST)均较治疗前降低(P<0.05),心室舒张早期与晚期峰值流速之比(VE/VA)显著增加(P<0.05),但常规治疗组的IVST和VE/VA与治疗前比较无明显变化(P>0.05)。结论 PPARα激动剂非诺贝特具有逆转CHF患者心肌纤维化、改善心功能的作用。[Objective] To evaluate the effect of peroxisome proliferator-activated receptor-alpha （PPARo0 agonist Fenofibrate on myocardial fbrosis induced by chronic heart failure （CHF）. [Methods] Seventy cases of CHF patients were randomized to receive treatment with general anti-CHF （Convention Group）, or the for- mer plus Fenofibrate （Fenofibrate Group） for 6 months. To investigate the changes of the serum concentrations of procollagen type I （PCI）, procoilagen type IU （PC）, laminin （LN）, hyaluronic acid （HA） and the indexs of ultrasonic cardiogram before and after treatment. [Results] The serum concentrations of PCI and HA de- creased significantly in the both groups after treatment （P〈0.05, P〈0.O1）, and there were more significant de- creases in Fenofibrate Group than those in Convention Group （P〈O.05）. The decreases of PC III and LN were remarkable in Fenofibrate Group （P 〈0.05）, which were no obvious changes in Convention Group after treat- ment （P 〉0.05）. The mass index of left ventricle （LVMI） decreased significantly in the both groups after treat- ment （P〈O.05, P 〈0.01）, and there was more significant decrease in Fenofibrate Group than that in Convention Group （P 〈0.05）. The end-diastole diameter of left ventricle （LVEDd） and inter-ventricular septum thickness （IVST） decreased （P 〈0.05）, and the ratio of early-diastole and advanced-diastole velocity （Vr/VA） increased in Fenofibrate Group （P〈0.05）, which were no obvious changes in Convention Group after treatment （P 〉0.05）. [Conclusion] The PPARot agonist Fenofibrate can reverse myocardial fibrosis and improve heart function in- duced by CHF.

关 键 词：过氧化物酶体增殖物激活受体Α 非诺贝特 慢性心力衰竭 心肌纤维化 

分 类 号：R541.6[医药卫生—心血管疾病]