Dietz R
Medizinische Klinik des Klinikums, Universität Heidelberg.
Klin Wochenschr. 1991;69 Suppl 24:24-7; discussion 27-9.
In the treatment of heart failure ACE inhibitors gained a unique position because of their beneficial effect on prognosis. The most likely explanation is their influence on factors that determine progression of the disease. These are: progressive deterioration of central hemodynamics, impairment of coronary perfusion, further activation of vasopressor systems, imbalance of sodium and water homeostasis and occurrence of malignant arrhythmias. ACE inhibitors have been shown to modulate these factors in a positive manner. In addition, they may also act by modulating factors, which may exert harmful effects on cardiac function in long term. These are: prevention and regression of the hypertrophy of the left ventricle as well as the media of resistance vessels, prevention of restenosis following PTCA, prevention of cyclosporin-induced premature coronary artery sclerosis, and correction of an impaired glucose metabolism. Whereas the positive effects of ACE inhibitors in the treatment of heart failure are well documented, their value for preventing heart failure has not been established, yet.
在心力衰竭的治疗中，由于其对预后的有益作用，血管紧张素转换酶（ACE）抑制剂占据了独特的地位。最可能的解释是它们对决定疾病进展的因素产生影响。这些因素包括：中心血流动力学的进行性恶化、冠状动脉灌注受损、血管加压系统的进一步激活、钠和水平衡失调以及恶性心律失常的发生。已证明ACE抑制剂能以积极的方式调节这些因素。此外，它们还可能通过调节一些长期可能对心脏功能产生有害影响的因素发挥作用。这些因素包括：预防和逆转左心室以及阻力血管中层的肥厚，预防经皮腔内冠状动脉成形术（PTCA）后的再狭窄，预防环孢素诱导的冠状动脉过早硬化，以及纠正受损的糖代谢。虽然ACE抑制剂在心力衰竭治疗中的积极作用已有充分记录，但它们在预防心力衰竭方面的价值尚未确立。
