联合应用ACEI和ARB治疗慢性心功能不全的临床研究

目的观察血管紧张素转换酶抑制剂（ACEⅠ）及其合用血管紧张素受体抑制剂（ARB）治疗半年对慢性心功能不全患者血浆血管紧张Ⅱ（AngⅡ）、醛固酮（ALD）、脑钠钛（BNP）及心功能的影响，探讨苯那普利合用缬沙坦在慢性心功能不全治疗中的临床价值，同时观察两者联合应用的安全性影响。方法95例慢性心功能不全患者随机分为苯那普利、缬沙坦治疗组及两者合用组，用同位素放射免疫测定法和酶联免疫吸附法分别测定两组患者治疗前、治疗半年后血浆AngⅡ、ALD及BNP的水平，用心脏彩色多普勒超声诊断仪测量两组患者治疗前、治疗半年后左室射血分数（LVEF）。结果苯那普利及缬沙坦治疗后血浆BNP水平明显降低，LVEF明显增高（P〈0．01），而血浆AngⅡ、ALD水平改变不大；苯那普利加缬沙坦治疗后血浆ALD、BNP水平明显降低（P〈0．01），LVEF明显增高。而血浆AngⅡ水平改变不大：组间对比发现，苯那普利合用缬沙坦并不能进一步降低血中AngⅡ、BNP水平，以及提高左室射血分数（P〉0.05）。改善心功能，且不良反应进一步增加。结论苯那普利或缬沙坦治疗均明显降低血浆BNP水平，对AngⅡ和ALD水平影响不大；单药治疗或联舍治疗方法都能提高充血性心力衰竭（CHF）患者的LVEF，改善心功能；联合用药组在降低BNP、AngⅡ水平并不优于单用苯那普利或缬沙坦组，而能显著降低血浆ALD水平（P〈0.05），减轻醛固酮逃逸现象的发生。

Effects of ACEI and ARB on heart function and neuroendocrinologic hormone in patients with chronic congestive heart failure

Objective To study the effects of ACEI and ARB on heart function and neuroendocrinologic hormone in patients with chronic congestive heart failures. Methods Ninty - five patients with chronic congestive heart failure （CHF） were enrolled in this study. The patients were randomly assigned to benazepril group （31 patients）, valsartan group （32 patients） and combination treatment group （32 patients） in addition to standard therapy for a total six months. Plasma levels of Angiotensin Ⅱ （ AngⅡ ） , Aldosterone （ALD） and brain natriuretic peptide （BNP） were measured, doppler echocardiography was performed to measure the parameters of left ventricular function before and 6 months after treatment. Restilts Six months after treatment with benazepril or valsartan in addition to standard therapy, the plasma BNP was significantly decreased and LVEF was significantly increased （ P 〈 0.01 ）, but the plasma levels of Ang Ⅱ and ALD were not changed significantly. After six months treatment with benazeprll in combination with valsartan in addition to standard therapy, the plasma ALD and BNP were significantly decreased and LVEF was significantly increased （ P 〈0.01 ）, but the plasma levels of Ang Ⅱ was not changed obviously. Conclusion Benazepril in combination with valsartan may relieve aldosterone escape in patients with CHF, but may not reduce the plasma levels of AngⅡ and BNP more effectively.