氯沙坦对老年慢性充血性心力衰竭患者血浆 NT-proBNP 水平的影响简

目的：探讨氯沙坦对老年慢性充血性心力衰竭（CHF）患者血浆 N 端脑钠肽前体（NT-proBNP）水平的影响。方法将60例慢性CHF患者按入院的先后顺序分为2组：观察组和对照组，每组30例。2组均采用常规治疗，包括抗心力衰竭药物、强心药和利尿剂等治疗。在此基础上，观察组研究前1周停止使用血管扩张药，采用氯沙坦治疗。使用免疫定量分析仪、采用胶体金法测定2组血浆 NT-proBNP水平。观察2组治疗前、治疗8周后的血压（SBP、DBP）、心率（HR）、心胸比、NYHA分级（NYHAⅡ级、Ⅲ级和Ⅳ级）和血浆 NT-proBNP 水平的变化情况。结果观察组治疗8周后SBP、DBP、HR、心胸比和血浆NT-proBNP水平均较对照组有所降低（均P＜0．05）， NYHAⅡ级、Ⅲ级和Ⅳ级均较治疗前、对照组明显改善（P＜0．05或P＜0．01）；对照组治疗8周后 NYHAⅡ级、Ⅲ级和Ⅳ级均较治疗前无明显改善（均P＞0．05）。结论 NT-proBNP水平可指导慢性 CHF患者药物治疗，且氯沙坦能有效地改善老年慢性CHF患者的心功能，值得临床应用。

Effects of Losartan on Plasma NT-proBNP Levels in Elderly Patients with Chronic Congestive Heart Failure

Objective To investigate the effects of losartan on plasma NT-proBNP levels in eld-erly patients with chronic congestive heart failure（CHF）.Methods Totally 60 elderly patients with chronic CHF were randomly divided into observation group and control group according to the order of admission,with 30 patients in each group.All patients received conventional therapy, including anti-heart failure drugs,cardiotonic drugs and diuretics.However,vasodilators were with-drawn and losartan potassium tablets were used in observation group 1 week before investigation. Plasma NT-proBNP levels were measured by colloidal gold immunoassay.The changes in systolic blood pressure（SBP）,diastolic blood pressure（DBP）,heart rate（HR）,cardiothoracic ratio,NY-HA classⅡ-Ⅳ and plasma NT-proBNP levels were observed before and after treatment for 8 weeks.Results Compared with control group,losartan treatment decreased the SBP,DBP,HR, cardiothoracic ratio and plasma NT-proBNP levels and improved NYHA classⅡ,Ⅲ and Ⅳ after treatment for 8 weeks（P＆lt;0.05 or P＆lt;0.01）.In addition,NYHA classⅡ,ⅢandⅣ were significantly improved after treatment for 8 weeks in observation group（P＆lt;0.05 or P＆lt;0.01）.No obvious changes in NYHA classⅡ,Ⅲ andⅣ were found after treatment in control group（P＆gt;0.05）.Con-clusion The determination of NT-proBNP levels can guide drug therapy in patients with chronic CHF.Losartan effectively improves the cardiac function and so is worthy of clinical application in elderly patients with chronic CHF.