老年慢性心力衰竭患者心功能与神经内分泌系统变化的特点

目的　探讨老年慢性心力衰竭患者心功能状态及神经内分泌系统变化的特点。方法　将入院诊断为慢性心力衰竭急性发作的患者 16 4例分为老年组 (10 0例 )和非老年组 (6 4例 )。根据症状对患者进行心功能分级 (NYHA) ;根据血流动力学指标对患者进行Forrester分级。用放射免疫法测定血浆去甲肾上腺素 (NE)、肾素活性 (PRA)、血管紧张素Ⅱ (AngⅡ )、醛固酮 (ALD)及心房肽 (ANP)和脑钠素 (BNP)浓度。结果　 (1)老年组由缺血性心脏病所致心力衰竭的比例显著高于非老年组 (P <0 .0 5 ) ;(2 )老年组NYHAⅣ级以及ForresterⅣ级的比例较非老年组多 (P <0 .0 1,P <0 .0 5 ) ;(3)老年组心脏指数及左心室射血分数均较非老年组显著降低 (P <0 .0 1,P <0 .0 1) ;(4 )两组患者的神经内分泌因子较正常对照组显著增加 ,老年组除PRA外 ,NE、AngⅡ、ALD、ANP和BNP血浆浓度的增加较非老年组显著为低 (分别为 P <0 .0 5 ,P<0 .0 1,P <0 .0 5 ,P<0 .0 1,P<0 .0 5 )。结论　老年慢性心力衰竭由缺血性心脏病引起者较多 ,急性发作时其临床症状较重 ,心功能低下较为显著 ,但神经内分泌系统的反应性不明显

Characteristics of changes in cardiac function and neuroendocrine system in the senile patients with chronic heart failure

Objective To investigate the characteristics of changes in cardiac function and neuroendocrine system in the senile patients with chronic heart failure (CHF). Methods One hundred senile patients and sixty-four non-senile patients with acute attack of chronic heart failure were recruited in the study. According to the clinical symptoms and the hemodynamic parameters (CI and PCWP), the patients were classified with NYHA and Forrester's classification immediately after admission. The plasma concentrations of norepinephrine (NE), renin activity (PRA), angiotensin Ⅱ (AngⅡ), aldosterone(ALD), atrial natriuretic peptide(ANP) and brain natriuretic peptide (BNP) were measured by IRMA in stable conditions after routine treatment without ACEI, ARB and β-blockers. Results 1.The heart failure caused by ischemic heart disease in senile group was much more frequent than in non-senile group. 2.In senile group, patients classified in NYHA Ⅳ and Forrester Ⅳ in the acute phase of CHF were also much more than in non-senile group(P<0.01, P< 0.05). 3.Cardiac index(CI) and left ventricular ejection fraction (LVEF) were significantly lower in senile group ( P<0.01,P<0.01). 4.The plasma levels of neuroendocrine parameters in both senile and non-senile groups were higher markedly than in the control. However, except PRA, the plasma levels of NE, AngII, ALD, ANP and BNP in senile group did not increase so high as in non-senile group.Conclusions In senile patients, chronic heart failure was caused mostly by ischemic heart disease. In spite of severe symptoms and LV dysfunction, the responses of neuroendocrine system were lower in senile group than in non-senile group.