AT_1受体拮抗剂及血管紧张素转换酶抑制剂对充血性心力衰竭纤溶活性影响的意义  

Effects of acute angiotensin Ⅱ type 1 receptor antagonism and angiotensin converting enzyme inhibition on plasma fibrinolytic parameters in patients with heart failure

作　　者：罗助荣[1] 郑冰[2] 

机构地区：[1]南京军区福州总医院心内科,福州350025 [2]福建中医学院附属第二人民医院检验科

出　　处：《临床心血管病杂志》2001年第4期166-167,共2页Journal of Clinical Cardiology

摘　　要：目的 :研究服用血管紧张素转换酶抑制剂 (ACEI)培哚普利及 AT1 受体拮抗剂氯沙坦对充血性心力衰竭 (CHF)纤溶活性影响的意义及可能机制。方法 :采用随机单盲交叉方法 ,选择 30例 CHF患者不同日两次给予培哚普利 4m g及氯沙坦 5 0 m g治疗 ,并检测服药前基础状态及服药后 6 h血浆纤溶酶原激活物 (t- PA)活性、纤溶酶原激活物抑制物 (PAI- 1)活性、内皮素 - 1(ET- 1)及血管紧张素 (Ang )的含量。结果 :与治疗前比较 ,治疗后 t- PA浓度增加 ,PAI- 1、ET- 1、Ang 均降低。服用氯沙坦治疗前后结果比较差异有显著性意义 (P<0 .0 5 ) ;而服用培哚普利治疗前后比较差异无显著性意义 (P >0 .0 5 )。结论 :与 ACEI相比 ,服用 AT1 受体拮抗剂改善 CHF纤溶活性更明显 ,这种改变可能是通过改善内皮细胞功能 ,从而抑制 Ang 生成实现的。Objective:To observe the effects of acute angiotensin Ⅱ type 1 (AT 1) receptor antagonism and angiotensin converting enzyme inhibition (ACEI) on plasma fibrinolytic parameters in patients with heart failure.Method:Thirty patients with heart failure received peidolapril 10 mg and losartan 50 mg on 2 separate days in a single blind randomind crossover design.Plasma tissue plasmingon activator (t PA), plasmingon activator inhibitor (PAI 1), endothelin 1 (ET 1) and angiotensin Ⅱ (AngⅡ) were measured at baseline and 6 hours after treatment.Result:Acute administration of losartan and peidolapril increased plasma t PA, and reduced PAI 1,ET 1 and AngⅡ.These changes were more marked during losartan treatment (P< 0.05 ) than during peidolapril treatment (P> 0.05 ).Conclusion:Acute AT 1 antagonism in patients with heart failure is associated with a significant improvement in plasma fibrinolytic parameters that is greater than during ACEI treatment.These benefical effects of AT 1 and ACEI would therefore appear to be mediated principally through suppression of angiotensin Ⅱ.

关 键 词：充血性心力衰竭 血管紧张素转换酶抑制剂 纤溶活性 内皮素 AT1受体拮抗剂 

分 类 号：R541.61[医药卫生—心血管疾病] R972[医药卫生—内科学]