螺内酯对慢性心力衰竭患者心功能及血清脑利钠肽水平的影响  

Effects of spironolactone on cardiac function and serum brain natriuretic peptide levels in patients with chronic heart failure

作　　者：陈协兴[1] 洪华山[1] 陈良龙[1] 王一波[1] 叶明芳[1] 江琼[1] 

机构地区：[1]福建医科大学附属协和医院心内科,福建省冠心病研究所,福州,350001,福建

出　　处：《中国临床药理学与治疗学》2004年第4期447-450,共4页Chinese Journal of Clinical Pharmacology and Therapeutics

摘　　要：目的 :观察螺内酯对慢性心力衰竭患者心功能及血清脑利钠肽 (BNP)水平的影响。方法 :心衰患者 4 2例 ,心功能 (NYHA)分级为Ⅱ～Ⅳ级 ,均接受利尿剂、洋地黄、血管转换酶抑制剂类药物治疗 ,随机分为 2组 :螺内酯组 2 1例 ,在上述治疗基础上每日给予螺内酯 2 0mg ;对照组 2 1例 ,除不给予螺内酯外 ,余处理与治疗组相同。动态观察心衰患者治疗前和治疗后 1个月NYHA分级变化和采用酶联免疫吸附法测定心衰患者治疗前和治疗后 3个月血清BNP 32浓度。同时使用超声心动图测定左心室射血分数和左心室舒张末期内径。结果 :螺内酯组和对照组治疗 1个月后临床综合疗效总有效率分别为85 .7%和 76 .2 % (P <0 .0 5 ) ,显效率分别为 6 1.9%和 4 2 .9% (P <0 .0 5 )。两组患者治疗 1个月后 ,NY HA分级均有所改善 ,但螺内酯组治疗后改善显著(P <0 .0 5 )。治疗后螺内酯组患者左心室射血分数显著升高 (P <0 .0 5 ) ,左心室舒张末期内径显著降低 (P <0 .0 5 )。治疗后 2组血清BNP水平均显著下降 (P <0 .0 5 ) ,但螺内酯组对照组下降更显著 (P <0 .0 1)。螺内酯组治疗前后血清BNP水平降低值与左心室射血分数增加呈负相关 (r =- 0 .4 2 ,P <0 .0 5 ) ,而与左心室舒张末期内径缩小呈正相关 (r =0 .6 0 ,P <0 .0 5 )。结论 :螺?AIM : To investigate the effects of spironolactone on cardiac function and serum brain natriuretic peptide (BNP) level in patients with chronic heart failure (CHF). METHODS : 42 patients with CHF, defined as New York Heart Association (NYHA) functional classes Ⅱ-Ⅳ, received medication of diuretic, digitalis and angiotensin-converting enzyme inhibitor. The patients were randomly divided into the treatment group (extra spironolactone 20 mg daily, n =21) and the control group ( n =21). The changes of NYHA functional class were evaluated before and after the treatment for 1 mon. The levels of BNP-32 in serum were measured by immunoradiometric assay immediately after administration. Left ventricular ejection fraction (LVEF) and left ventricular internal dimension at end-diastole (LVED) were measured by M-mode Echocardiography. BNP, LVEF and LVED were re-checked 3 mon later. RESULTS : The total effective rates were 85.7% in the spironolactone group and 76.2% in the control group ( P < 0.05), and the evident effective rates were 61.9% in the spironolactone group and 42.9% in the control group ( P < 0.05). Spironolactone significantly decreased NYHA functional class ( P < 0.05) after 1 mon therapy in patients of the treatment group, which had no difference from the control group. Spironolactone significantly increased LVEF ( P < 0.05), and decreased LVED ( P < 0.05) after 3 mon therapy in patients of the treatment group, but had no difference in those of the control group. There were significantly attenuated BNP levels in patients with CHF between two groups ( P < 0.05), but were more decreased in the spironolactone group ( P < 0.01). Changes in BNP levels were significant negative correlation with CHF patients in the spironolactone group after medication in LVEF ( r=- 0.42, P < 0.05), and significant positive correlation with those in LVED ( r= 0.60, P < 0.05). CONCLUSION : Spironolactone can not only improve left ventricular remodeling and cardiac function but also lower BNP levels in CHF pat

关 键 词：螺内酯 心力衰竭 左心室射血分数 脑利钠肽 疗效评价 

分 类 号：R9694[医药卫生—药理学] R972[医药卫生—药学]