摘要
目的比较缬沙坦与培哚普利对扩张型心肌病(dilated cardiomyopathy,DCM)慢性心力衰竭(CHF)患者血清细胞因子及心肌纤维化的影响。方法扩心病CHF患者30例分为缬沙坦组(n=15)和培哚普利组(n=15)。30例健康体检者为正常对照组。测定对照组及治疗组治疗前、后血清TNF-α、IL-6、TGF-β1及心肌纤维化指标:血清Ⅲ型前胶原(PCⅢ)、层黏连蛋白(LN)、透明质酸(HA)的浓度。采用彩色多普勒超声测定治疗前后左心室射血分数(LVEF)。结果入选扩心病心衰病例血清炎性细胞因子水平及心肌纤维化指标显著高于正常对照组(P<0.01),抗炎细胞因子TGF-β1显著低于正常对照组(P<0.01)。血清细胞因子TNF-α、IL-6及心肌纤维化指标水平随心衰严重程度而升高(P<0.05),TGF-β1水平随心衰严重程度而降低(P<0.05)。TNF-α、IL-6水平及心肌纤维化指标与LVEF呈负相关(r=-0.44,P<0.05,r=-0.38,P<0.05,r=-0.51,P<0.05),TGF-β1与LVEF呈正相关(r=0.79,P<0.01)。缬沙坦组、培哚普利组分别治疗3个月后,TNF-α、IL-6显著下降(P<0.01),TGF-β1显著升高(P<0.01),心肌纤维化指标均下降(P<0.01),缬沙坦的上述作用更为显著(P<0.05)。心功能改善明显者其血浆PCⅢ、LN、HA下降程度显著(P<0.05)。结论DCM心衰患者血清炎性细胞因子水平及心肌纤维化指标显著升高,抗炎细胞因子显著降低,且均与心衰严重程度及LVEF相关。缬沙坦及培哚普利均具有降低血清炎性细胞因子水平、升高抗炎细胞因子水平、改善心肌纤维化及提高LVEF的作用,以缬沙坦的作用更具显著性,且耐受性较好。
Objective To investigate the effects of valsartan and perindopril on serum cytokine levels and myocardial fibrosis in patients with chronic heart failure of dilated cardiomyopathy （DCM）. Methods Serum concentrations of TNF-α, IL-6, TGF-β1 and serum procollagen m peptide （Pcm）, laminin（LN）, hyaluronic acid（HA） in normal controls （n= 30） and patients with CHF resulting from DCM （n = 30）, who were randomized into valsartan group （n = 15 ） and perindopril group （n = 15 ）, were measured before and 3 months af- ter treatment respectively, Left ventricular ejective fractions （LVEF） were also estimated in those subjects. Results There was a significant increase in serum levels of TNF-α, IL-6 and Pcm, LN, HA in patients with CHF compared with normal controls（P 〈0. 01 ） while the serum levels of TGF-β1 decreased （P 〈0. 01 ）. The serum levels of TNF-α, IL-6 and Pcm, LN, HA were negative related to LVEF but TGF-β1 was positive related to LVEF. There was a significant decrease in serum levels of TNF-α, IL-6 and Pcm, LN, HA and increase in TGF-β1 and LVEF in both valsartan group and perindopril group, but the changes in the valsartan group was more visible. The increasing of cardiac function and the decreasing of myocardial fibrosis have some relationship. Conclusion There is a disequilibrium in the levels of serum concentrations including TNF-α, IL-6 and TGF-β1 and a significant increase in serum levels of Pcm, LN, HA in patients with CHF of DCM, and the serum levels of cytokine and myocardial fibrosis are related to LVEF. Valsartan or perindopril adjusts the balance of the serum levels of cytokine and ameliorated myocardial fibrosis and LVEF but the effect of valsartan is more visible.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2008年第12期1189-1192,共4页
Journal of Third Military Medical University
关键词
扩张型心肌病
心衰
缬沙坦
培哚普利
细胞因子
心肌纤维化
心功能
dilated cardiomyopathy
chronic heart failure
valsartan
perindopril
cytokine
myocardial fibrosis
left ventricular ejective fractions
