依那普利对心力衰竭患者血压及交感活性的影响  

Effects of enalapril on blood pressure and sympathetic neural activity in patients with heart failure

作　　者：陈震[1,2] 孙欣[1,2] 徐曙东[1,2] 

机构地区：[1]江苏省泰兴市人民医院 [2]扬州大学附属泰兴医院心内科,225400

出　　处：《岭南心血管病杂志》2014年第2期209-212,共4页South China Journal of Cardiovascular Diseases

摘　　要：目的研究不同剂量依那普利治疗后,在不同血压水平对充血性心力衰竭患者交感神经活性的影响。方法选取2012年1月至2013年4月在江苏省泰兴市人民医院住院的心力衰竭患者,在未服降压药物的情况下,血压110/70 mm Hg(1 mm Hg=0.133 kPa)以上,纽约心脏协会心功能Ⅲ级或不必卧床的Ⅳ级。所有患者在入院时进行病史资料采集,并检测血浆肾上腺素、去甲肾上腺素、肾素、血管紧张素Ⅱ、醛固酮浓度。入选后予依那普利口服,起始剂量5 mg/d,根据血压情况,逐渐加量至10 mg/d。三周后按平均收缩压≥100 mm Hg和<100 mm Hg分为A组和B组。对于A组患者,从第4周开始,增加药物剂量,至平均收缩压<100 mmHg,并维持至第6周。B组患者继续原治疗方案至第6周。在第3周和第6周分别进行上述神经内分泌因子活性检测,比较不同时间段两组神经内分泌因子的活性。结果 48例患者入选,其中A组26例,B组22例。两组治疗前临床特点、交感活性及治疗后左心室射血分数比较,差异无统计学意义(P>0.05)。治疗6周后,A组血管紧张素转换酶抑制剂(ACEI)剂量较B组大,差异有统计学意义[(14.3±4.5)mg vs.(7.5±2.4)mg,P<0.05]。两组肾上腺素、去甲肾上腺素浓度比治疗前显著降低,差异有统计学意义[A组肾上腺素:(256.1±77.3)pg/mL vs.(168.7±53.3),P<0.05;A组去甲肾上腺素:(1 734±534)pg/mL vs.(844±399)pg/mL,P<0.05;B组肾上腺素:(248.7±62.3)pg/mL vs.(218.1±60.3)pg/mL,P<0.05;B组去甲肾上腺素(1 645±619)pg/mL vs.(1 084±431)pg/mL,P<0.05],且A组下降更明显。两组治疗前后血浆肾素、血管紧张素、醛固酮变化不明显,差异无统计学意义(P>0.05)。结论血管紧张素转换酶抑制剂治疗后,达到相同目标血压时,较大治疗剂量患者交感活性下降明显,而治疗剂量较小者交感活性虽有下降,但下降幅度小,提示对于后者应当采取各种措施进一步降低交感活性。Objectives To explore the influence of enalapril on blood pressure and sympathetic neural activity （SNA） at different blood pressure levels in patients with heart failure： Methods In-hospital heart failure patients whose blood pressures were more than 110/70 mm Hg （1 mm Hg=0. 133 kPa）without antihypertensive medicine with New York Heart Association （NYHA） grade Ⅲ or Ⅳ in Taixing Hospital from January 2012 to April 2013 were included. Clinic characters, NYHA grade, left ventricular ejection fraction （LVEF） were collected. Plasma concentrations of adrenaline, norepinephrine, renin, angiotensin Ⅱ and aldosterone were detected. All patients were given enalapril by 5 mg/d, then 10 mg/d if blood pressure was more than 110/70 mm Hg. All patients were divided into two groups according to the systolic pressure： group A≥ 100 mm Hg and group B〈100 mm Hg. Patients in group A were given an increased dose of enalapril until the systolic pressure was less than 100 mm Hg, and maintained until the 6th week. Patients in group B were given the initial dose for 6 weeks. Activities of their plasma adrenaline, norepinephrine, renin, angiotensin Ⅱ and aldosterone were measured and compared at 0, 3rd, and 6th week. Results A total of 48 patients were enrolled. Of these patients, 26 were in group A and 22 in group B. Neither significant difference was found in clinic characters and SNA of the two groups before treatment, nor inLVEF after treatment. A significantly higher dose of ACEI was taken in group A than in group B [ （14.3±4.5） mg vs. （7.5±2.4） mg, P〈0.05] at the 6th week. The same activities of adrenaline and norepinephrine were observed at 0 week, while significantly decreased activities were found at the 6th week [ group A： （256.1±77.3） pg/mL vs. （168.7±53.3） pg/mL in adrenaline, and （1 734±534） pg/mL vs. （844±399） pg/mL in norepinephrine; group B： （248.7±62.3） pg/mL vs. （218.1±60.3） pg/mL in adrenaline, and （1 645±619） pg/mL vs. （1 084±431 ）

关 键 词：心力衰竭 依那普利 交感神经 肾上腺素 去甲肾上腺素 

分 类 号：R541.6[医药卫生—心血管疾病]