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目的:比较缬沙坦及贝那普利对慢性充血性心力衰竭(CHF)患者细胞凋亡相关因子的干预作用。方法:随机将CHF组69例患者分为2个亚组:在强心利尿、扩血管、应用β受体阻滞剂等常规治疗基础上加用贝那普利者为血管紧张素转化酶抑制剂(ACEI)亚组(35例),加用缬沙坦者为血管紧张素受体拮抗剂(ARB)治疗亚组(34例);两亚组均连续治疗12周。检测并对比69例CHF患者治疗前后与20例健康者(正常对照组)的肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-1β、IL-6、高敏C反应蛋白(hs-CRP)、可溶性凋亡因子(sFas)及sFas配体(sFasL)浓度;并检测CHF组治疗前后左室舒张末内径、射血分数、6min步行试验(6MWT)距离等各指标的变化;对比以上各指标在2个亚组之间的差异。结果:①CHF组血浆TNF-α、IL-1β、IL-6、hs-CRP、sFas、sFasL水平明显高于正常对照组(P<0.01),治疗后均有明显下降(P<0.01),ARB亚组治疗后较ACEI亚组治疗后IL-6、sFas下降更显著(P<0.05);②CHF组治疗后心功能分级、6MWT距离等有显著改善(P<0.05),ARB亚组6MWT距离的增加比ACEI亚组治疗后更显著(P<0.05)。结论:缬沙坦和贝那普利可降低CHF患者细胞凋亡相关因子的水平,改善心脏功能。与贝那普利相比,缬沙坦降低sFas、IL-6水平及增加6MWT距离的作用更明显。
Objective: To compare the effects of valsartan and benazepril on the apoptosis-related factors in patients with chronic congestive heart failure (CHF). Methods: 69 CHF patients were randomly divided into 2 subgroups: angiotensin converting enzyme inhibition was given to benazepril on the basis of conventional therapy such as cardiac diuresis, vasodilatation and application of β-blockers (ACEI) subgroup (35 cases), plus valsartan as angiotensin receptor antagonist (ARB) subgroup (34 cases); two subgroups were treated for 12 weeks. The levels of tumor necrosis factor-α (TNF-α), interleukin (IL) -1β, IL-6 and high sensitivity C-reactive protein -CRP, sFas and sFasL were measured before and after treatment. The changes of end-diastolic diameter, ejection fraction, 6MWT distance and other parameters before and after treatment in CHF group were also measured. The above indicators in the two subgroup differences. Results: ① The levels of TNF-α, IL-1β, IL-6, hs-CRP, sFas and sFasL in CHF group were significantly higher than those in normal control group (P <0.01) After treatment, the levels of IL-6 and sFas in ACEI subgroup decreased more significantly than those in ACEI subgroup (P <0.05); ② The heart function grading, 6MWT distance and so on in CHF group were significantly improved (P <0.05) Increased more significantly than ACEI subgroup after treatment (P <0.05). Conclusion: Valsartan and benazepril can reduce the levels of apoptosis-related factors in CHF patients and improve cardiac function. Compared with benazepril, valsartan decreased sFas, IL-6 levels and increased the role of 6MWT distance more pronounced.