螺内酯对扩张型心肌病患者心脏交感神经活动及左心室重构的影响。
Effect of spironolactone on cardiac sympathetic nerve activity and left ventricular remodeling in patients with dilated cardiomyopathy.
作者信息
Kasama Shu, Toyama Takuji, Kumakura Hisao, Takayama Yoshiaki, Ichikawa Shuichi, Suzuki Tadashi, Kurabayashi Masahiko
机构信息
Second Department of Internal Medicine, Gunma University School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma 371-0034, Japan.
出版信息
J Am Coll Cardiol. 2003 Feb 19;41(4):574-81. doi: 10.1016/s0735-1097(02)02855-3.
OBJECTIVES
We sought to evaluate the effects of spironolactone on cardiac sympathetic nerve activity and left ventricular (LV) remodeling in patients with dilated cardiomyopathy (DCM).
BACKGROUND
Aldosterone prevents the uptake of norepinephrine and promotes structural remodeling of the heart. Spironolactone, an aldosterone receptor blocker, improves LV remodeling in patients with DCM, but its influence on cardiac sympathetic nerve activity has not been determined.
METHODS
We selected 30 patients with DCM who were treated with an angiotensin-converting enzyme inhibitor and a loop diuretic. Fifteen patients were assigned to receive spironolactone additionally, whereas the remaining 15 patients continued their current regimen. The delayed heart/mediastinum (H/M) count ratio, delayed total defect score (TDS), and washout rate (WR) were determined from iodine-123 ((123)I)-meta-iodobenzylguanidine (MIBG) images before and six months after treatment. The left ventricular end-diastolic volume (LVEDV) and left ventricular ejection fraction (LVEF) were determined by echocardiography, and New York Heart Association (NYHA) functional class was estimated.
RESULTS
In the spironolactone group, the TDS decreased from 36 +/- 9 to 24 +/- 13 (p < 0.0001), the H/M ratio increased from 1.64 +/- 0.20 to 1.86 +/- 0.27 (p < 0.0001), and WR decreased from 55 +/- 12% to 41 +/- 15% (p < 0.0005). In addition, the LVEDV decreased from 187 +/- 26 to 154 +/- 41 ml (p < 0.005), and LVEF increased from 33 +/- 6% to 39 +/- 6% (p < 0.005). However, there were no significant changes in these parameters in the control group. There was a significant correlation between changes in the (123)I-MIBG findings and changes in LVEDV with spironolactone treatment (TDS: r = 0.684, p = 0.0038; H/M ratio: r = -0.878, p < 0.0001; and WR: r = 0.737, p = 0.0011). The NYHA functional class improved in both groups but showed a greater improvement in the spironolactone group than in the control group (p < 0.01).
CONCLUSIONS
Spironolactone improves cardiac sympathetic nerve activity and LV remodeling in patients with DCM.
目的
我们旨在评估螺内酯对扩张型心肌病（DCM）患者心脏交感神经活动及左心室（LV）重构的影响。
背景
醛固酮可阻止去甲肾上腺素的摄取并促进心脏结构重构。螺内酯作为一种醛固酮受体阻滞剂，可改善DCM患者的LV重构，但其对心脏交感神经活动的影响尚未明确。
方法
我们选取了30例接受血管紧张素转换酶抑制剂和襻利尿剂治疗的DCM患者。15例患者额外给予螺内酯治疗，其余15例患者继续当前治疗方案。在治疗前及治疗6个月后，通过碘-123（¹²³I）-间碘苄胍（MIBG）显像测定延迟心脏/纵隔（H/M）计数比值、延迟总缺损评分（TDS）及洗脱率（WR）。通过超声心动图测定左心室舒张末期容积（LVEDV）和左心室射血分数（LVEF），并评估纽约心脏协会（NYHA）心功能分级。
结果
在螺内酯组，TDS从36±9降至24±13（p<0.0001），H/M比值从1.64±0.20升至1.86±0.27（p<0.0001），WR从55±12%降至41±15%（p<0.0005）。此外，LVEDV从187±26降至154±41ml（p<0.005），LVEF从33±6%升至39±6%（p<0.005）。然而，对照组这些参数无显著变化。螺内酯治疗后，¹²³I-MIBG检查结果的变化与LVEDV的变化之间存在显著相关性（TDS：r = 0.684，p = 0.0038；H/M比值：r = -0.878，p<0.0001；WR：r = 0.737，p = 0.0011）。两组NYHA心功能分级均有改善，但螺内酯组改善程度大于对照组（p<0.01）。
结论
螺内酯可改善DCM患者的心脏交感神经活动及LV重构。
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