摘要
目的探讨慢性心力衰竭（chronic heart failure,CHF）患者应用培哚普利和（或）坎地沙坦治疗对血浆内皮素-1（ET-1）、白介素-6（IL-6）、基质金属蛋白酶-9（MMP-9）干预以及改善心室重构作用。方法 90例CHF患者在常规治疗基础上采取双盲随机分为3组,每组30例。A组：培哚普利组4 mg/d;B组：坎地沙坦4~8 mg/d;C组：培哚普利4 mg＋坎地沙坦4~8 mg/d。疗程均为8周。26例健康体检者为正常对照组。分别测定治疗前、后患者血清ET-1、IL-6、MMP-9的浓度。采用心脏彩色多普勒测定左心室射血分数（LVEF）、左心室舒张末内径（LVEDd）。结果 CHF患者ET-1、IL-6、MMP-9显著高于正常对照组（P〈0.01）;CHF患者ET-1、IL-6、MMP-9与LVEDd呈正相关（r=0.436,P〈0.01）,与LVEF呈负相关（r=-0.481,P〈0.01）。经过8周治疗后,3组血清ET-1、IL-6、MMP-9及LVEDd均较治疗前明显减小,LVEF均较治疗前升高（P〈0.05）。C组经治疗后血清ET-1、IL-6、MMP-9水平及LVEDd与A、B组比较明显减小,LVEF明显增高（P〈0.05）;而A、B组差异无统计学意义（P〉0.05）。结论 CHF患者血清ET-1、IL-6、MMP-9、LVEDd水平显著升高,LVEF显著降低,且与心衰严重程度相关。培哚普利与坎地沙坦均能降低ET-1、IL-6、MMP-9水平,且疗效两者联合治疗明显优于单用培哚普利或坎地沙坦治疗。
Objective To evaluate the effects of perindopril and/or candesartan on the levels of endothelin-1（ET-1）,interleukin-6（IL-6） and matrix metal proteinase-9（MMP-9） in serum and the left ventricular remodeling in patients with chronic heart failure（CHF）.Methods Serum concentrations of ET-1,IL-6 and MMP-9 in normal controls（n=26） and patients with CHF（n=90）,who were randomized into perindopril group（4 mg/d of perindopril）,candesartan group（4 to 8 mg/d of candesartan） and combined group（4 mg/d of perindopril and 4 to 8 mg/d of candesartan） were measured before and after 8-week treatment.Left ventricular end-diastolic dimension（LVEDd） and left ventricular ejection fraction（LVEF） were measured by color Doppler echocardiography before and after the treatment.Results Before treatment,serum ET-1,IL-6 and MMP-9 levels in patients were significantly higher than those in normal subjects（110.31±18.83 vs 48.16±8.21,P0.01;116.39±16.52 vs 62.47±10.78,P0.01;248.31±65.42 vs 74.63±9.87,P0.01;respectively）.Serum ET-1,IL-6 and MMP-9 levels were positively correlated with LVEDd（r=0.436,P0.01）,and negatively correlated with LVEF（r=-0.481,P0.01）.After treatment,serum ET-1,IL-6 and MMP-9 levels and LVEDd in the combined group were significantly lower than those in the perindopril group and the candesartan group（63.52±17.17 ng/ml vs 79.24±12.81 ng/ml vs 75.47±16.23 ng/ml,P0.05;82.58±9.47 ng/L vs 94.16±11.43 ng/L vs 91.46±10.27 ng/L,P0.05;183.52±30.66 pg/ml vs 208.16±36.62 pg/ml vs 205.91±32.28 pg/ml,P0.05;50.51±6.38 vs 55.73±7.85 vs 55.16±8.19,P0.05;respectively）.On the contrary,LVEF in the combined group was significantly higher than that in the perindopril group and the candesartan group（49.21±8.59 vs 44.87±4.73 vs 46.17±6.36,P0.05）.However,no such difference was noted between the perindopril group and the candesartan group（P0.05）.Conclusion Perindopril combined with candesartan is remarkably superior to perindopril or candesartan alone in treating patients with CHF.The combined therapy can effectively decrease serum ET-1,IL-6 and MMP-9 levels and LVEDd while increasing LVEF.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2011年第6期633-636,共4页
Journal of Third Military Medical University
