Eichhorn E J, McGhie A L, Bedotto J B, Corbett J R, Malloy C R, Hatfield B A, Deitchman D, Willard J E, Grayburn P A
Cardiac Catheterization Laboratory, Dallas Veterans Administration Hospital, Texas 75216.
Am J Cardiol. 1991 Jan 1;67(1):67-73. doi: 10.1016/0002-9149(91)90102-q.
To examine the effects of beta-adrenergic blockade on neurohormonal activation in patients with congestive heart failure, 15 men had assessments of hemodynamics and supine peripheral renin and norepinephrine levels before and after 3 months of oral therapy with bucindolol, a nonselective beta antagonist. At baseline, plasma renin activity did not correlate with any hemodynamic parameter. However, norepinephrine levels had a weak correlation with left ventricular end-diastolic pressure (r = 0.74, p less than 0.01), stroke volume index (r = 0.61, p less than 0.02) and pulmonary vascular resistance (r = 0.54, p less than 0.05). Plasma renin decreased with bucindolol therapy, from 11.6 +/- 13.4 to 4.3 +/- 4.1 ng/ml/hour (mean +/- standard deviation; p less than 0.05), whereas plasma norepinephrine was unchanged, from 403 +/- 231 to 408 +/- 217 pg/ml. A wide diversity of the norepinephrine response to bucindolol was observed with reduction of levels in some patients and elevation in others. Although plasma norepinephrine did not decrease, heart rate tended to decrease (from 82 +/- 20 vs 73 +/- 11 min-1, p = 0.059) with beta-adrenergic blockade, suggesting neurohormonal antagonism at the receptor level. No changes in I-123 metaiodobenzylguanidine uptake occurred after bucindolol therapy, suggesting unchanged adrenergic uptake of norepinephrine with beta-blocker therapy. Despite reductions in plasma renin activity and the presence of beta blockade, the response of renin or norepinephrine levels to long-term bucindolol therapy did not predict which patients had improved in hemodynamic status (chi-square = 0.37 for renin, 0.82 for norepinephrine).(ABSTRACT TRUNCATED AT 250 WORDS)
为研究β-肾上腺素能阻滞剂对充血性心力衰竭患者神经激素激活的影响，15名男性在接受非选择性β拮抗剂布新洛尔口服治疗3个月前后，进行了血流动力学评估以及仰卧位外周肾素和去甲肾上腺素水平测定。基线时，血浆肾素活性与任何血流动力学参数均无相关性。然而，去甲肾上腺素水平与左心室舒张末期压力呈弱相关（r = 0.74，p < 0.01）、与每搏量指数呈弱相关（r = 0.61，p < 0.02）以及与肺血管阻力呈弱相关（r = 0.54，p < 0.05）。布新洛尔治疗后血浆肾素降低，从11.6±13.4降至4.3±4.1 ng/ml/小时（均值±标准差；p < 0.05），而血浆去甲肾上腺素未改变，从403±231升至408±217 pg/ml。观察到布新洛尔治疗后去甲肾上腺素反应差异很大，一些患者水平降低，另一些患者水平升高。尽管血浆去甲肾上腺素未降低，但β-肾上腺素能阻滞剂治疗后心率有降低趋势（从82±20降至73±11次/分钟，p = 0.059），提示在受体水平存在神经激素拮抗作用。布新洛尔治疗后I-123间碘苄胍摄取无变化，提示β受体阻滞剂治疗后去甲肾上腺素的肾上腺素能摄取未改变。尽管血浆肾素活性降低且存在β受体阻滞，但肾素或去甲肾上腺素水平对长期布新洛尔治疗的反应并不能预测哪些患者的血流动力学状态得到改善（肾素的卡方值 = 0.37，去甲肾上腺素的卡方值 = 0.82）。（摘要截短于250字）
