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目的探讨慢性心力衰竭(chronic heart failure,CHF)患者应用培哚普利和(或)坎地沙坦治疗对血浆内皮素-1(ET-1)、白介素-6(IL-6)、基质金属蛋白酶-9(MMP-9)干预以及改善心室重构作用。方法 90例CHF患者在常规治疗基础上采取双盲随机分为3组,每组30例。A组:培哚普利组4 mg/d;B组:坎地沙坦4~8 mg/d;C组:培哚普利4 mg+坎地沙坦4~8 mg/d。疗程均为8周。26例健康体检者为正常对照组。分别测定治疗前、后患者血清ET-1、IL-6、MMP-9的浓度。采用心脏彩色多普勒测定左心室射血分数(LVEF)、左心室舒张末内径(LVEDd)。结果 CHF患者ET-1、IL-6、MMP-9显著高于正常对照组(P<0.01);CHF患者ET-1、IL-6、MMP-9与LVEDd呈正相关(r=0.436,P<0.01),与LVEF呈负相关(r=-0.481,P<0.01)。经过8周治疗后,3组血清ET-1、IL-6、MMP-9及LVEDd均较治疗前明显减小,LVEF均较治疗前升高(P<0.05)。C组经治疗后血清ET-1、IL-6、MMP-9水平及LVEDd与A、B组比较明显减小,LVEF明显增高(P<0.05);而A、B组差异无统计学意义(P>0.05)。结论 CHF患者血清ET-1、IL-6、MMP-9、LVEDd水平显著升高,LVEF显著降低,且与心衰严重程度相关。培哚普利与坎地沙坦均能降低ET-1、IL-6、MMP-9水平,且疗效两者联合治疗明显优于单用培哚普利或坎地沙坦治疗。
Objective To investigate the effects of perindopril and candesartan on plasma endothelin-1 (ET-1), interleukin-6 (IL-6), matrix metalloproteinases (MMPs) in patients with chronic heart failure -9 (MMP-9) intervention and improve ventricular remodeling. Methods Ninety patients with CHF were randomly divided into three groups (n = 30 in each group) on a regular basis. Group A: Perindopril 4 mg / d; Group B: Candesartan 4-8 mg / d; Group C: Perindopril 4 mg + Candesartan 4-8 mg / d. The course of treatment is 8 weeks. Twenty-six healthy subjects were normal control group. The concentrations of serum ET-1, IL-6 and MMP-9 in patients before and after treatment were measured respectively. Left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDd) were measured by color Doppler. Results The levels of ET-1, IL-6 and MMP-9 in CHF patients were significantly higher than those in normal controls (P <0.01). The levels of ET-1, IL-6 and MMP-9 in CHF patients were positively correlated with LVEDd (r = 0.01), and negatively correlated with LVEF (r = -0.481, P <0.01). After 8 weeks of treatment, the serum levels of ET-1, IL-6, MMP-9 and LVEDd in three groups were significantly decreased compared with those before treatment, and LVEF was higher than before treatment (P <0.05). The serum levels of ET-1, IL-6 and MMP-9 and LVEDd in group C were significantly decreased compared with those in group A and B, and LVEF was significantly increased (P <0.05), while there was no significant difference between groups A and B P> 0.05). Conclusions The levels of ET-1, IL-6, MMP-9 and LVEDd in CHF patients were significantly increased, while LVEF was significantly lower in patients with CHF, which was related to the severity of heart failure. Both perindopril and candesartan can reduce the levels of ET-1, IL-6 and MMP-9, and the curative effect is better than the combined treatment of perindopril or candesartan alone.