心力衰竭患者外周血内皮祖细胞水平变化及氯沙坦对其干预作用研究  

Levels of Circulating Endothelial Progenitor Cells in Heart Failure and Changes in Them in Response to Losartan Treatment

作　　者：陈菊明[1] 左琦[2] 宋艳玲[1] 麦华德 纪新博[1] 王雅纯[1] 林芸芸[1] 顾申红[1] CHEN Ju-ming;ZUO Qi;SONG Yan-ling;MAI Hua-de;JI Xin-bo;WANG Ya-chun;LIN Yun-yun;GU Shen-hong(Department of General Medicine,the First Affiliated Hospital of Hainan Medical University,Haikou 570102,China;Department of Cardiology,the First Affiliated Hospital of Hainan Medical University,Haikou 570102,China)

机构地区：[1]海南医学院第一附属医院全科医学科,海南省海口市570102 [2]海南医学院第一附属医院心内科,海南省海口市570102

出　　处：《中国全科医学》2018年第3期274-277,共4页Chinese General Practice

基　　金：国家自然科学基金资助项目(81560054);海南省自然科学基金资助项目(814355)

摘　　要：目的观察内皮祖细胞(EPCs)水平在心力衰竭患者外周血中的变化及氯沙坦对其的影响。方法选取2015年3月—2016年3月海南医学院第一附属医院心内科收治的慢性心力衰竭患者68例为心力衰竭组。根据纽约心脏病协会(NYHA)心功能分级,将心力衰竭组患者分为NYHAⅠ级亚组10例、NYHAⅡ级亚组20例、NYHAⅢ级亚组26例、NYHAⅣ级亚组12例;采用随机数字表法将心力衰竭组患者分为常规亚组和氯沙坦亚组,各34例。常规亚组予以常规抗心力衰竭治疗,氯沙坦亚组在常规亚组治疗基础上加用氯沙坦50 mg/d,连续治疗2周。选取同期本院体检健康的志愿者30例作为健康对照组。测定心力衰竭患者治疗前及治疗2周后、健康志愿者体检时的左心室射血分数(LVEF)、脑钠肽(BNP)水平、外周血EPCs水平。结果 NYHAⅠ级亚组、NYHAⅡ级亚组外周血EPCs水平高于健康对照组,NYHAⅢ级亚组、NYHAⅣ级亚组外周血EPCs水平低于健康对照组(P<0.05)。常规亚组与氯沙坦亚组治疗后LVEF、外周血EPCs水平高于本组治疗前(P<0.05),BNP水平低于本组治疗前;氯沙坦亚组治疗后LVEF、外周血EPCs水平高于常规亚组,BNP水平低于常规亚组(P<0.05)。结论外周血EPCs水平在心力衰竭早期明显升高,而在心力衰竭晚期明显降低;氯沙坦能够提高心力衰竭患者外周血EPCs水平。Objective To investigate the levels of circulating endothelial progenitor cells(EPCs)in heart failure and the changes in them in response to losartan treatment.Methods A total of 68 patients with heart failure treated in Department of Cardiology of the First Affiliated Hospital of Hainan Medical University from March 2015 to March 2016 were selected as heart failure group,including 10 cases of NYHA classⅠ(NYHA classⅠsubgroup),20 cases of NYHA classⅡ(NYHA classⅡsubgroup),26 cases of NYHA classⅢ(NYHA classⅢsubgroup)and 12 cases of classⅣ(NYHA classⅣsubgroup).By random number table,they were equally and randomly divided into the conventional subgroup(n=34)receiving the conventional antiheart failure treatment,and losartan subgroup(n=34)receiving the conventional anti-heart failure treatment plus losartan 50 mg/d.The course of treatment was 2 weeks.Other 30 healthy volunteers underwent physical examination in the hospital during the same period were selected as healthy control group.The left ventricular ejection fraction(LVEF),brain natriuretic peptide(BNP)level and circulating EPCs level were measured in heart failure patients before and after 2 weeks of treatment and in healthy volunteers during physical examination.Results Compared with the healthy control group,the levels of circulating EPCs in the NYHA classⅠandⅡsubgroups were higher,while those in the NYHA classⅢandⅣsubgroups were lower(P<0.05).In the losartan subgroup and the conventional subgroup,the LVEF and levels of circulating EPCs were higher but BNP levels were lower compared with the before treatment(P<0.05).After treatment,the LVEF and levels of circulating EPCs were higher but BNP levels were lower in the losartan subgroup compared with the conventional subgroup(P<0.05).Conclusion The circulating EPCs level is increased significantly in the early stage of heart failure,but it is decreased substantially in the late stage of this disease.Losartan can increase the level of circulating EPCs in such patients.

关 键 词：心力衰竭 干细胞 氯沙坦 

分 类 号：R541.6[医药卫生—心血管疾病]