Schaufelberger M, Andersson G, Eriksson B O, Grimby G, Held P, Swedberg K
Department of Medicine, Ostra University Hospital, Göteborg, Sweden.
Eur Heart J. 1996 Nov;17(11):1678-85. doi: 10.1093/oxfordjournals.eurheartj.a014751.
To evaluate if enalapril treatment can influence skeletal muscle metabolism and histology we investigated 26 patients with congestive heart failure and 20 normal subjects. The patients were treated with enalapril for 3 months in addition to diuretics and digitalis. Biopsies from the lateral vastus muscle were taken before and after treatment. Citrate synthetase, 3-hydroxyacyl-CoA dehydrogenase and phosphorylase activities were significantly decreased in the patients compared with controls. The number of capillaries per fibre and the number of capillaries surrounding each fibre were significantly decreased among patients. After 3 months of enalapril treatment functional class improved significantly. The lactate dehydrogenase activity increased whereas the oxidative enzymes did not change significantly. The type I, II and II A fibre areas increased significantly after enalapril treatment. We conclude that patients with chronic heart failure have decreased activity of oxidative enzymes and of phosphorylase in skeletal muscle. They also have decreased capillarization in skeletal muscle. These changes were not influenced by enalapril treatment. The increase in muscle fibre area seen after enalapril treatment could be due to increased physical activity. The cause of increased muscle lactate dehydrogenase activity after enalapril treatment needs further investigation.
为评估依那普利治疗是否会影响骨骼肌代谢和组织学，我们研究了26例充血性心力衰竭患者和20名正常受试者。除利尿剂和洋地黄外，患者接受依那普利治疗3个月。在治疗前后取股外侧肌活检样本。与对照组相比，患者的柠檬酸合酶、3-羟酰基辅酶A脱氢酶和磷酸化酶活性显著降低。患者每根肌纤维的毛细血管数量以及围绕每根肌纤维的毛细血管数量均显著减少。依那普利治疗3个月后，心功能分级显著改善。乳酸脱氢酶活性增加，而氧化酶无显著变化。依那普利治疗后，I型、II型和II A型肌纤维面积显著增加。我们得出结论，慢性心力衰竭患者骨骼肌中的氧化酶和磷酸化酶活性降低。他们的骨骼肌毛细血管化也减少。这些变化不受依那普利治疗的影响。依那普利治疗后观察到的肌纤维面积增加可能是由于体力活动增加。依那普利治疗后肌肉乳酸脱氢酶活性增加的原因需要进一步研究。
