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摘要: 目的:研究基线血浆肾素活性(PRA)水平是否可以作为评价慢性心力衰竭(CHD)的重要指标。方法:纳入70例心功能分级(NYHA分级)为Ⅱ~Ⅳ级,且经心脏超声评价其左室射血分数(LVEF)＜40%的慢性CHD患者。记录治疗前(基线)NYHA分级、LVEF、左室舒张末内径(LVEDD)、B型脑钠肽(BNP)及PRA水平,并按基线PRA中位数将所有入选患者分为PRA≤15 ng·ml-1·h-1组及PRA＞15 ng·ml-1·h-1组。2组均给予标准抗心力衰竭(心衰)药物治疗后,再次记录治疗早期(4周)、治疗晚期(16~48周)时,NYHA分级、LVEF、LVEDD、BNP及PRA水平,并记录临床终点事件。结果:PRA＞15 ng·ml-1·h-1组LVEF明显低于PRA≤15 ng·ml-1·h-1组(P＜0.05);NYHA分级、LVEDD、BNP明显高于PRA≤15 ng·ml-1·h-1组(均P＜0.05)。2组经标准化抗心衰治疗后病情均好转,无论基线PRA高低,标准化抗心衰治疗方案均有效。2组间临床终点事件发生率比较结果显示,PRA＞15 ng·ml-1·h-1组临床终点事件发生率(22.86%)明显高于PRA≤15 ng·ml-1·h-1组(2.86%)(P＜0.05)。结论:基线PRA水平能够较准确地反映CHD的严重程度,并可作为评估其预后的重要参考指标。Abstract: Objective:This study is to evaluate whether the baseline plasma renin activity (PRA) could be used as an important index to assess the severity of chronic heart failure.Method:Seventy consecutive patients with chronic systolic left ventricular dysfunction [ejection fraction ＜40%, mean age (61.36±11.48) years] were recruited. The heart functions were graded intoⅡ-Ⅳ levels according to the standard of New York Heart Disease Academy ( NYHA). The NYHA classification, left ventricular ejection fraction (LVEF), left ventricular diastolic end diastolic diameter (LVEDD), brain natriuretic peptide (BNP) and PRA level of each patient were recorded in detail before treatment (baseline). According to the median baseline PRA, all subjects were divided into two groups:PRA＞15 ng·ml-1·h-1 group and PRA≤15 ng·ml-1·h-1 group. Standard treatment for chronic heart failure was given to both groups, and then the NYHA classification, LVEF, LVEDD, BNP and PRA level were recorded again in the early (4 weeks) and late treatment (16-48 weeks) respectively. The clinical endpoint events were also recorded.Result:The LVEF was lower in PRA ＞15 ng·ml-1·h-1 group than in PRA≤15 ng·ml-1·h-1group(P＜0.05) .The NYHA classification, LVEDD and BNP were higher in the 15 ng·ml-1·h-1 group than in the PRA≤15 ng·ml-1·h-1 group(all P＜0.05). After the standard treatment for chronic heart failure, the clinical conditions of both groups were improved. Regardless of the baseline PRA level, the standard strategy of anti heart failure treatment was shown to be effective. Lastly, the incidence of clinical endpoint events was significantly higher in the PRA＞15 ng·ml-1·h-1 group than in the PRA≤15 ng·ml-1·h-1 group ( 22.86 % vs 2.86 %, P＜0.05).Conclusion:Baseline PRA level was consistent with the NYHA classification, LVEF, LVEDD and BNP level. PRA may be used as an important index to assess the prognosis of chronic heart failure accurately.
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