【摘要】 目的　观察氯沙坦对慢性心力衰竭 (chronicheartfailure ,CHF)患者肿瘤坏死因子α(TNF α)与血管内皮依赖性舒张功能 (endothelialdependentdiastolicfunction ,EDD)的影响。 方法测定 4 9例CHF患者 (CHF组 )和 38例无慢性心力衰竭患者 (无CHF组 )TNF α水平。 4 9例CHF患者随机分为氯沙坦组和常规治疗组。治疗前和治疗 4周后测定TNF α水平及用彩色多普勒血流仪测定肱动脉内径和反应性充血后的内径。结果　CHF组TNF α水平明显高于无CHF组 [( 10 7 4±4 7 2 )比 ( 76 2± 35 4 )ng/L ,P <0 0 1]。治疗 4周后 ,氯沙坦组TNF α水平比治疗前明显降低[( 10 8 5± 12 1)比 ( 91 3± 11 4 )ng/L ,P <0 0 5 ];而反应性充血后血管内径及其变化百分比明显升高 [( 4 9± 8 4 )比 ( 5 5± 7 7)mm ,P <0 0 5 ;( 2 9 2± 4 2 )比 ( 38 9± 5 9) % ,P <0 0 5 ];氯沙坦组的TNF α水平与反应性充血后血管内径及其变化百分比呈负相关 (r =- 0 5 2 ,P <0 0 5 ;r =- 0 6 4 ,P <0 0 5 )。结论　慢性心力衰竭患者的血管内皮功能受损 ,TNF α是引起这一损害的主要因素 ,氯沙坦治疗不仅可以控制心力衰竭症状 ,而且可以有效地改善血管内皮功能更多还原

【Abstract】 Objective To observe the effect of short term treatment with losartan on tumor necrosis factor alpha (TNF α) and endothelial dependent diastolic function (EDD) in patients with chronic heart failure (CHF). Methods The levels of serum TNF α were measure in 49 patients with CHF in 39 patients without CHF. The CHF patients were randomized into losartan group ( n =25) and control group ( n =24). TNF α level and the baseline of brachial angiobore and its changes at response to reactive hyperemia were measure before and after treatment. Results The serum TNF α level in CHF patients was significantly higher than that in patients without CHF[(107 4±47 2) vs (76 2±35 4) ng/L, P <0 05]. Serum TNF α level was decreased after 4 weeks of treatment in losartan group [(91 3±11 4) vs (108 5±12 1) ng/L, P <0 05]. And the measurements of brachinal angiobore after reactive hyperemia were increased[(5 5±7 7) vs (4 9±8 4)mm, P <0 05; (38 9±5 9)vs (29 2±4 2)%, P <0 05], while these changes were significantly negatively correlated with TNF α level ( r =-0 52, P <0 05; r =-0 64, P <0 05). Conclusions The EDD in patients with CHF was damaged probably by TNF α. Losartan had obvious effect on the EDD of them, which was proved by the improved brachial EDD measurements and the symptoms of heart failure.更多还原