螺内酯对慢性心力衰竭患者醛固酮水平及心功能的影响  

Effects of Spironolactone on the Aldosterone Level and Heart Function in Patients With Heart Failure

作　　者：郭志琴[1] 刘坤申[2] 彭应心[1] 王进华[3] 齐晓勇[1] 姚冬梅[1] 卢雅敏[4] 

机构地区：[1]河北省人民医院心脏中心,河北省石家庄市050071 [2]河北医科大学第一医院心内科 [3]河北省人民医院功能科,河北省石家庄市050071 [4]河北省人民医院同位素科,河北省石家庄市050071

出　　处：《中国循环杂志》2002年第4期269-271,共3页Chinese Circulation Journal

摘　　要：目的 :观察慢性心力衰竭 (心衰 )患者应用血管紧张素转化酶抑制剂 (ACEI)治疗中加用醛固酮受体拮抗剂螺内酯对血浆醛固酮和心功能的影响。方法 :选择心衰患者 6 9例 ,心功能 (NYHA)分级为Ⅱ～Ⅳ级 ,左心室射血分数 (LVEF)≤ 0 45 ,均接受利尿剂、洋地黄、ACEI类药物治疗。随机分为 :治疗组 ( 34例 )每日给予螺内酯 40mg ,并行上述治疗 ;对照组 ( 35例 )除不给予螺内酯外 ,余处理与治疗组相同。所有患者于治疗前 (基线 )、治疗后 1、3、6个月化验血清钾、血浆醛固酮浓度 ,同时测定LVEF值和心功能分级。结果 :①血浆醛固酮水平的变化 :1个月时治疗组和对照组血浆醛固酮水平均有所降低 ,两组血浆醛固酮水平与基线比较有显著性差异 (P <0 0 5 ) ,但两组间无统计学差异。 3个月时治疗组和对照组血浆醛固酮水平均有所回升 ,两组比较有显著性差异 (P <0 .0 5～ 0 0 1)。 6个月时血浆醛固酮水平回升至基线水平 ,对照组较治疗组组间无明显差异 (P>0 0 5 )。②观察 6个月时心功能明显改善 ,较基线时及治疗组与对照组组间比较均有显著性差异 (P <0 0 5 )。③血清钾水平治疗组呈上升趋势 ,6个月时已明显高于对照组 ,有显著性差异 (P <0 0 5 )。结论 :①慢性心衰患者在应用ACEI治疗中 。Objective:The aim of this study was to investigate the effects of extra spironolactone on the aldosterone (Aldo) level and heart function in patients with heart failure treated with angiotensin-converting enzyme inhibitor (ACEI). Methods:Sixty-nine heart failure patients,aged 32-71 years,defined as New York Heart Association (NYHA) functional classes Ⅱ-Ⅳ,with left ventricular ejection fraction (LVEF)≤0.45,and without severe hepatic and renal dysfunction,received medication of ACEI,diurectic and digitals.The patients were randomly divided into treatment group (extra spironolactone 40 mg daily) and the control group.The data were obtained at baseline,and 1,3 and 6 months after admission,including those of the plasma Aldo level,serous potassium level,LVEF and NYHA classes. Results: The plasma Aldo level decreased 1 month after medication.And picked up again 3 months later in both groups,especially in the treatment group.There was no difference in Aldo level between treatment and control groups at 6 months.The heart function was improved 6 months after medication,more significanty in the treatment group. Conclusion:The Adlo escape phenomenon was observed 3 months after ACEI treatment in patients with heart failure.The spironolactone,an antagonist for Adlo,significantly improved the heart function and increased the plasma Adlo level.

关 键 词：螺内酯 慢性心力衰竭 醛固酮 心功能 

分 类 号：R541.6[医药卫生—心血管疾病] R972.1[医药卫生—内科学]