Belenkov Yu N, Privalova E V, Danilogorodskaya Yu A, Zheleznykh E A, Shchendrygina A A, Tishman M I, Chekneva I S
Sechenovs First Moscow State Medical University, Moscow, Russia.
Kardiologiia. 2015 Dec;55(12):5-10. doi: 10.18565/cardio.2015.12.5-10.
Experimental and clinical data confirm that endothelial dysfunction (ED) of microvessels is one of mechanisms of progression of chronic heart failure (CHF).
To assess the impact of 12-month treatment with perindopril A (5-10 mg/day) on structural and functional state of microcirculatory vascular bed in patients with CHF.
We included into this study 30 patients aged 45-70 years with NYHA class II-III CHF. All patients received perindopril A 5-10 mg/day for 12 months. For assessment of endothelial function we used test with reactive hyperemia. During this test we evaluated flow dependent vasodilation by photoplethysmography, and registered the state of skin capillary network by computer videocapillaroscopy. We also measured level of proinflammatory cytokines - von Willebrand factor, and -tumor necrosis factor (-TNF).
After treatment with perindopril A 5 we observed improvement of microvascular endothelial function (occlusion index rose from 1.5 [1.2; 2.9] to 2.0 [1.7; 2.4], p=0.03), and of functional state of the finger skin capillary network (percentage of perfused capillaries rose from 88 [77; 95] to 95 [87; 97], p=0.05, percentage of recovered capillaries rose from 8 [4.5; 12.1] to 14.2 [9.3; 17.1], p=0.04). These effects were associated with significant lowering of (-TNF) level (from 6.58 [3.72, 10.3] to 3.35 [0.15; 6.33] g/L, p<0.01).
实验和临床数据证实，微血管内皮功能障碍（ED）是慢性心力衰竭（CHF）进展的机制之一。
评估培哚普利A（5 - 10毫克/天）治疗12个月对CHF患者微循环血管床结构和功能状态的影响。
本研究纳入30例年龄在45 - 70岁、纽约心脏协会（NYHA）心功能分级为II - III级的CHF患者。所有患者接受培哚普利A 5 - 10毫克/天治疗12个月。为评估内皮功能，我们采用反应性充血试验。在此试验中，我们通过光电容积描记法评估血流依赖性血管舒张，并通过计算机视频毛细血管镜记录皮肤毛细血管网络状态。我们还测量了促炎细胞因子 - 血管性血友病因子和 - 肿瘤坏死因子（-TNF）的水平。
使用培哚普利A 5治疗后，我们观察到微血管内皮功能得到改善（闭塞指数从1.5 [1.2; 2.9]升至2.0 [1.7; 2.4]，p = 0.03），手指皮肤毛细血管网络的功能状态也得到改善（灌注毛细血管百分比从88 [77; 95]升至95 [87; 97]，p = 0.05，恢复毛细血管百分比从8 [4.5; 12.1]升至14.2 [9.3; 17.1]，p = 0.04）。这些效应与（-TNF）水平显著降低相关（从6.58 [3.72, 10.3]降至3.35 [0.15; 6.33]微克/升，p < 0.01）。
