Song Hao-ming, Zhang Jia, Deng Bing, Luo Ming
Department of Cardiology, Tongji Hospital, Tongji University, Shanghai 200065, China.
Zhonghua Yi Xue Za Zhi. 2005 Jul 6;85(25):1737-40.
To investigate the effects of angiotensin converting enzyme inhibitor (ACEI) with different doses on the plasma brain natriuretic peptide and norepinephrine (NE) of patients with chronic heart failure and the feasibility and safety of high dose ACEI treatment.
Sixty-six patients with chronic heart failure were randomly divided into 2 groups: low-dose group, treated by perindopril with the dosage of 2 mg/d initially and gradually increased up to 2-4 mg/d, and high-dose group, treated by perindopril with the dosage of 2 mg/d initially and gradually increased up to 8 approximately 10 mg/d. Treatment lasted for 12 weeks. Before and after the treatment peripheral blood was collected to test the plasma NE and brain natriuretic peptide levels, and the left ventricular ejection fraction (LVEF), left ventricular end diameter (LVED), blood pressure, and heart rate were examined. The differences of these indexes between the two groups and within the same group before and after the 12-week treatment were analyzed. Thirty healthy subjects were used as control group.
The levels of plasma brain natriuretic peptide and NE of the chronic heart failure patients were significantly higher than those of the normal controls, and the higher the NYHA class of heart failure the higher the plasma levels of NE and brain natriuretic peptide. The plasma brain natriuretic peptide level was negatively correlated with LVEF (r = -0.327, P = 0.012) and positively correlated with plasma NE level (r = 0.402, P = 0.002) and LVED (r = 0.42, P = 0.015). The plasma brain natriuretic peptide and NE levels in the high-dose group were 6 microg/L +/- 4 microg/L and 250 ng/L +/- 63 ng/L respectively, both significantly lower than those of the low-dose group (8 microg/L +/- 4 microg/L and 387 ng/L +/- 211 ng/L respectively, both P < 0.05). Most of the patients in these 2 groups tolerated well.
Plasma brain natriuretic peptide level is negatively correlated with the severity of heart failure and positively correlated with plasma NE. Treatment of CHF by perindopril with gradually increasing dose obviously decreases the plasma brain natriuretic peptide and NE levels and is tolerable for the patients.
探讨不同剂量血管紧张素转换酶抑制剂（ACEI）对慢性心力衰竭患者血浆脑钠肽及去甲肾上腺素（NE）的影响，以及大剂量ACEI治疗的可行性与安全性。
66例慢性心力衰竭患者随机分为2组：小剂量组，初始使用培哚普利剂量为2mg/d，逐渐增至2～4mg/d；大剂量组，初始使用培哚普利剂量为2mg/d，逐渐增至8～10mg/d。治疗持续12周。治疗前后采集外周血检测血浆NE及脑钠肽水平，并检测左心室射血分数（LVEF）、左心室内径（LVED）、血压及心率。分析两组间及同一组治疗12周前后这些指标的差异。30例健康受试者作为对照组。
慢性心力衰竭患者血浆脑钠肽及NE水平显著高于正常对照组，心力衰竭NYHA分级越高，血浆NE及脑钠肽水平越高。血浆脑钠肽水平与LVEF呈负相关（r = -0.327，P = 0.012），与血浆NE水平呈正相关（r = 0.402，P = 0.002），与LVED呈正相关（r = 0.42，P = 0.015）。大剂量组血浆脑钠肽及NE水平分别为6μg/L±4μg/L和250ng/L±63ng/L，均显著低于小剂量组（分别为8μg/L±4μg/L和387ng/L±211ng/L，P均<0.05）。两组大部分患者耐受性良好。
血浆脑钠肽水平与心力衰竭严重程度呈负相关，与血浆NE呈正相关。培哚普利逐渐增加剂量治疗慢性心力衰竭明显降低血浆脑钠肽及NE水平，且患者耐受性良好。
