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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≤15ng·ml~(-1)·h~(-1)组及PRA>15ng·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>15ng·ml~(-1)·h~(-1)组LVEF明显低于PRA≤15ng·ml~(-1)·h~(-1)组(P<0.05);NYHA分级、LVEDD、BNP明显高于PRA≤15ng·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>15ng·ml~(-1)·h~(-1)组临床终点事件发生率(22.86%)明显高于PRA≤15ng·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。
PURPOSE: To investigate whether baseline plasma renin activity (PRA) levels can be used as an important indicator in the assessment of chronic heart failure (CHD). Methods: Seventy patients with chronic CHD who had NYHA class Ⅱ ~ Ⅳ and whose left ventricular ejection fraction (LVEF) <40% were evaluated by echocardiography were enrolled. NYHA classification, LVEF, LVEDD, BNP and PRA were recorded before treatment (baseline), and all the patients were divided into PRA≤15ng · ml ~ (-1) · h ~ (-1) group and PRA> 15ng · ml ~ (-1) h ~ (-1) group. The patients in both groups were given standard anti-heart failure (HF) drug therapy, NYHA classification, LVEF, LVEDD, BNP and PRA levels were recorded again in the early treatment (4 weeks) and late treatment (16-48 weeks) End event. Results: LVEF in PRA> 15ng · ml -1 h -1 group was significantly lower than that in PRA ≤15ng · ml -1 h -1 group (P <0.05) , LVEDD and BNP were significantly higher than PRA≤15ng · ml ~ (-1) · h ~ (-1) group (all P <0.05). After 2 groups of standardized anti-heart failure treatment were improved, regardless of the baseline PRA level, standardized anti-heart failure treatment programs are valid. The results of comparison of the clinical endpoint rates between the two groups showed that the incidence rate of clinical end point (22.86%) in PRA> 15ng · ml -1 · h -1 group was significantly higher than that in PRA ≤15ng · ml ~ (- 1) · h ~ (-1) group (2.86%) (P <0.05). Conclusion: The baseline PRA level can reflect the severity of CHD more accurately, and can be used as an important reference to evaluate the prognosis.