摘要
目的探讨Apelin在中老年慢性心力衰竭(CHF)患者中的表达及RAS阻滞剂的调控作用。方法选取处于不同心功能阶段且未经系统治疗的中老年CHF患者186例,根据NYHA心功能分级分为早期组(NYHA分级Ⅰ-Ⅱ级,86例)和晚期组(NYHA分级Ⅲ-Ⅳ级,100例);每组随机平均分为两个亚组,分别用贝那普利(ACEI类)和缬沙坦(ARB类)治疗;另选30位健康体检人员作为对照组。CHF患者在治疗前及治疗后三个月而对照组在体检时测定血清Apelin 12和Apelin 13水平。CHF患者治疗前测定血脂、血浆N末端脑钠肽前体(NTpro BNP)、左室舒张末期内径(LVID)及左室射血分数(EF)。结果 Apelin12、Apelin13在早期组的表达均高于对照组(P均<0.05),而在晚期组则均低于对照组(P均<0.05)。Apelin12、Apelin 13的表达与EF呈正相关(r=0.252,P<0.05),与LVID d、NT-pro BNP呈负相关(r=-0.194,P<0.05)。晚期组经ARB类药物治疗后三个月Apelin的表达与治疗前比较有明显提高(P均<0.05),而ACEI类药物治疗后无明显改变(P均>0.05);经ARB/ACEI治疗后,早期组Apelin表达水平与治疗前均无明显变化(P均>0.05)。结论 Apelin 12、Apelin 13在中老年CHF患者心衰早期表达升高而晚期下降,而ARB类药物对晚期CHF患者Apelin表达有正性调控作用。
Objective To investigate the expression of Apelins with regulation effect of RAS blockers in elderly and middle-aged patients with chronic heart failure （CHF）. Methods A total of 186 elderly and middle-aged non-system therapeutically CHF patients were included in the study. They were divided into early stage group （NYHA classification Ⅰ-Ⅱ, 86 cases） and late stage group （NYHA classification Ⅲ-Ⅳ, 100 cases） according to the NYHA classification of cardiac function. Each group was further randomly and equally subdivided into patients treated with Benazepril （ACEI subgroup） and patients treated with Valsartan （ARB subgroup）; 30 healthy persons were selected as control （healthy control）. Expressions of Apelin 12 and Apelin 13 in all the CHF patients were detected on admission and 3 months after the treatment, while that inhealthy control were tested in their physical examination. The levels of serum lipid, N-terminal pro-brain nitric peptide （NT-pro BNP）, left ventricular internal diameter （LVID） and left ventricular ejection fraction （EF） were measured before treatment in all the patients with CHF. Results The levels of Apelinl2 and Apelinl3 in early stage group were higher while that in late stage group were significantly lower as compared with the control healthy （all P 〈 0.01）. Multiple regression analysis revealed that the expressions of Apelinl2 and Apelinl3 were positively correlated with EF （r = 0.252, P 〈 0.05）, but negatively correlated with LVID and NT-pro BNP （r = -0.194, P 〈 0.05）. Three months after the ARB treatment, the Apelins levels in the late stage group were obviously higher than those before treatment （all P 〈 0.05）, but no statistical differences were noted between before and after the ACEI treatment （all P 〉 0.05）. There were no significant changes in the Apelins levels in the early stage group between before and after the ACEI / ARB treatment （all P 〉 0.05）. Conclusions The expressions of Apelinl2 and Apelinl3 increased in early stage but reduced in late stage of heart failure. ARB has positive regulation effect on the expressions of Apelins only in the late stage in the elderly and middle-aged patients with CHF.
出处
《中华危重症医学杂志（电子版）》
CAS
2014年第1期35-40,共6页
Chinese Journal of Critical Care Medicine:Electronic Edition
基金
浙江省嘉兴市科技局项目(2010AY1024)
