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论著:缬沙坦对慢性心衰患者神经内分泌因子的影响
Effect of Valsartan on Neuroendocrine Factors in Patientswith Chronic Heart Failure
吴同利 陈祥杰 张志华 李连海 华启洋 潘文志
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作者单位:江苏省昆山第四人民医院心内科
中文关键字:血管紧张素II受体拮抗剂;缬沙坦;神经内分泌因子;炎症因子
英文关键字:Angiotensin Ⅱ receptor blockers; Valsartan; Neuroendocrine factors; Inflammatory cytokines
中文摘要:目的:探讨血管紧张素II受体拮抗剂(ARB)药物缬沙坦胶囊对慢性心力衰竭(心衰)患者神经内分泌因子的影响。方法:将住院的慢性心衰患者,随机分为2组:对照组(43 例)及缬沙坦治疗组(44例)。患者于治疗前及治疗后2 个月后,检测血浆肿瘤坏死因子-α(TNF-α)、白介素-10(IL-10)、β-内啡肽、脑钠肽(BNP)水平。结果:β-内啡肽、BNP、 IL-10随着纽约心脏病协会心功能分级(NYHA 分级)的升高而升高;NYHA分级2级组与NYHA分级3级组TNF-α水平均低于NYHA分级4级组。TNF-α、IL-10、β-内啡肽、BNP水平均与左室射血分数(LVEF)相关,相关系数分别为-0.35、 -0.32、-0.47及-0.50(P<0.01)。缬沙坦组治疗后,LVEF明显提高、左室舒张末内经(LVDD)缩小,TNF-α、IL-10、β-内啡肽、BNP水平均降低(P<0.05);对照组LVDD变小,β-内啡肽、BNP水平也降低,而LVEF及TNF-α、IL-10无变化。缬沙坦组LVEF改善程度及LVDD缩小程度均优于对照组,各内因子水平降低程度均比对照组明显(P<0.05)。结论:缬沙坦可以改善慢性心衰患者心功能,逆转心室重构,抑制其神经内分泌及炎症因子激活。
英文摘要:Objective: To observe the effects of valsartan (Diovan) on neuroendocrine factors in patients with chronic heart failure. Methods: Eighty-seven patients with chronic heart failure were enrolled in the study. The patients were randomly divided into conventional treatment group (43 cases) and valsartan group (44 cases). The serum levels of tumor necrosis factor-alpha(TNF-α), interleukin-10(IL-10), β-endorphin(β-EP) and brain natriuretic peptides(BNP) were measured before and after treatment in 8 weeks. Results: The serum levels of β-EP, BNP and IL-10 were significantly higher with the senior grades of New York Heart Association(NYHA), while the level of TNF-α with NYHA functional class Ⅳ was higher than those with class Ⅱ-Ⅲ. The expressions of the four neuroendocrine factors were inversely correlated to the left ventricular ejection fraction (LVEF), with correlation coefficients of -0.35, -0.32, -0.47 and -0.50(P<0.01), respectively. The left ventricle end-diastole diameter were significantly decreased and LVEF were increased in the valsartan group than before treatment and the control group (P<0.05). The serum levels of TNF-α, IL-10, β-EP and BNP were significantly declined in the valsartan group, but in the control group, only the levels of BNP and β-EP were decreased, while the levels of TNF-α and IL-10 showed no change. Conclusions: Valsartan could improve cardiac function and reverse myocardial remodeling, with inhibition of neuroendocrine factor and inflammatory cytokines.
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