Khoury A M, Davila D F, Bellabarba G, Donis J H, Torres A, Lemorvan C, Hernandez L, Bishop W
Centro Cardiovascular, Universidad de Los Andes. Merida, Venezuela.
Int J Cardiol. 1996 Nov 15;57(1):21-9. doi: 10.1016/s0167-5273(96)02776-3.
Chagasic patients with congestive heart failure are usually treated with digitalis and converting enzyme inhibitors. According to the neurogenic and dysautonomic theories, chagasic patients would not benefit from these drugs. To clarify this controversial issue, we have studied patients with congestive heart failure and suspected Chagas' heart disease. All patients received intravenous methyl-digoxin for 24 h and oral enalapril for 96 h. Blood samples for plasma norepinephrine, aldosterone and renin were taken at baseline, after acute digitalization and following enalapril. Based on the serology for Chagas' disease, the patients were divided into non-chagasic and chagasic patients. In the chagasic group three patients were in functional class III and 3 were in functional class IV. In the non-chagasic group five patients were in functional class III and 2 were in functional class IV. Both groups had a marked and quantitatively similar degree of neurohormonal activation. All patients improved at least one functional class and lost more than 5 kg of body weight with treatment. The chagasic patients had a statistically significant reduction in plasma norepinephrine (2262 +/- 1407 to 865 +/- 390, P < 0.008, pg/ml, M +/- S.D.), plasma aldosterone (330 +/- 168 to 155 +/- 75, P < 0.01, pg/ml, M +/- S.D.) and plasma renin activity (14 +/- 13 to 2 +/- 1.6 ng/ml per h, M +/- S.D., P < 0.05), with digitalis. Following enalapril, norepinephrine and aldosterone there was a further but non-significant reduction, when compared to postdigitalis values. These results indicated that chagasic patients do benefit from digitalis and enalapril. Furthermore, the prominent and significant reduction in all three neurohormones suggest that the parasympathetic and sympathetic systems of these chagasic and non-chagasic patients, are responding to the neuromodulatory effects of digitalis and enalapril.
患有充血性心力衰竭的恰加斯病患者通常接受洋地黄和转换酶抑制剂治疗。根据神经源性和自主神经功能异常理论，恰加斯病患者不会从这些药物中获益。为了阐明这一有争议的问题，我们对患有充血性心力衰竭且疑似患有恰加斯心脏病的患者进行了研究。所有患者静脉注射甲基地高辛24小时，口服依那普利96小时。在基线、急性洋地黄化后以及服用依那普利后，采集血样检测血浆去甲肾上腺素、醛固酮和肾素。根据恰加斯病的血清学检查结果，将患者分为非恰加斯病患者和恰加斯病患者。恰加斯病组中，3例患者为心功能Ⅲ级，3例为心功能Ⅳ级。非恰加斯病组中，5例患者为心功能Ⅲ级，2例为心功能Ⅳ级。两组患者神经激素激活程度均显著且在数量上相似。所有患者经治疗后心功能至少改善一级，体重减轻超过5千克。恰加斯病患者血浆去甲肾上腺素（从2262±1407降至865±390，P<0.008，pg/ml，均值±标准差）、血浆醛固酮（从330±168降至155±75，P<0.01，pg/ml，均值±标准差）和血浆肾素活性（从14±13降至2±1.6 ng/ml per h，均值±标准差，P<0.05）在使用洋地黄后有统计学显著降低。服用依那普利后，与洋地黄化后的值相比，去甲肾上腺素和醛固酮进一步降低，但无统计学意义。这些结果表明，恰加斯病患者确实从洋地黄和依那普利中获益。此外，所有三种神经激素的显著降低表明，这些恰加斯病和非恰加斯病患者的副交感神经和交感神经系统对洋地黄和依那普利的神经调节作用有反应。
