| Objective: Heart failure is the final stage of various kinds of heart diseases, according to overseas statistics,the morbidity rate of heart failure is 1.5%2.0% in adult,and it becomes 6%10% in people over 65 years;during the last 40 years,the amount of people dead from heart failure increases 6 times.At present, following the aging of people,improvement of living standard and increase of morbility of hypertension and coronary heart disease, the morbidity rate of chronic heart failure is increasing. Thus, the therapy of heart failure is a focus which we all pay close attention to.Angiotensin-converting enzyme inhibitor(ACEI) is the conor stone of therapy in heart failure at present.One of its mechanisms is to affect kininaseⅡ,restrain the degradation of bradykinin(BK),then increase BK level to product more PGI2.Patients with heart failure are prone to form thrombus,they often need antiplatelet therapy.But whether antiplatelet drug- aspirin could be used in patients with heart failure has different findings.There is research manifests that aspirin restrains Cycloxygenase(COX) of platelet and synthesis of prostaglandin (PG),then causes decrease of PGI2 level,which counteracts the effect of ACEI and then decreases its therapeutic effect. There is also research manifests that above-mentioned reasult is due to the dose of aspirin is too large,low-dose apirin and ACEI have synergistic effect.Thus,whether the combination of low- dose aspirin with ACEI obviously affect the production of PGI2 needs more researches.Following deeper study of statin,we gradually find many effects.There is research find that statin is beneficial for heart failure,one of its reasons might be to increase PGI2,decrease TXA2 then increase PGI2/TXA2,and then educe endothelium protection. ACEI,aspirin and statin all can affect the metabo- lism of PGI2 and TXA2,but how about combining the three drugs is not reported.Thus,this study is to explore whether combining low-dose aspirin with perindopril obviously affect the production of PGI2 compared to perindopril alone in patients with heart failure; on the basis of perindopril and low-dose aspirin,combining atorva- statin how to affect PGI2,TXA2 and PGI2/TXA2 in patients with heart failure.Methods: 104 patients with heart failure were Chosen in department of cardiology, the second hospital of Hebei University of Medical Sciences from December 2006 to October 2007.All patients did not have ACEI,aspirin and statin at least 2 weeks before study.Also excluding serious liver and kidney disease,malignant tumour, connective tissue disease,disease of respiratory system and serious infectious diseases. The selected perindopril(groupP) ,that is perindopril 4 mg once a day and other anti-heart failure drugs (including diuretica, nitrate, digitalis,β-receptor blocker and so on);Group 2 is group perindopril plus aspirin(groupPA), that is added aspirin 100 mg once a day on the basis of group1; Group 3 is group perindopril plus aspirin plus atorvastatin(groupPAA),that is added atorvastatin 10 mg once on night on the basis of group2.Patients of the three groups were collected venous blood before and 2 weeks after study,then were detected 6-keto-PGF1αand TXB2 level in blood plasma using radio-immunity method.Data statistical analysis uses SPSS package(edition13.0), data denotation uses(±s). Comparison inside group uses paired t-test, comparison between groups uses analysis of variance, comparison of constituent ratio uses chi-squared test. P<0.05 is deemed to have statistical significance.Results:1 Level of 6-keto-PGF1αbefore treatment in patients with heart function gradeⅡ,gradeⅢand gradeⅣare (64.38±23.09 pg/ml)(,41.21±18.44 pg/ml)and (37.59±19.84 pg/ml); Level of TXB2 are (210.16±40.85 pg/ml),(244.45±46.48 pg/ml) and (275.47±41.90 pg/ml). 6-keto-PGF1αin patients with cardiac function gradeⅢand gradeⅣare lower then patients with cardiac function gradeⅡ(P<0.05), patients with cardiac function gradeⅢand gradeⅣhave no significant difference(P>0.05). TXB2 in patients with cardiac function gradeⅣis higher then patients with cardiac function gradeⅡ and gradeⅢ(P<0.01,P<0.05), patients with cardiac function gradeⅡand gradeⅢhave no significant difference(P>0.05).2 Level of 6-keto-PGF1αbefore treatment in groupP, groupPA and groupPAA are (43.44±20.39 pg/ml),(44.40±20.38 pg/ml) and (42.31±26.23 pg/ml ); level of TXB2 are (254.71±50.05 pg/ml),(248.35±47.42 pg/ml) and (241.75±52.47 pg/ml); 6-keto-PGF1α/TXB2 are(18.44±9.14)%, (17.46±8.37)% and (17.57±9.46)%,differences of them have no statistical significance(P>0.05).Level of 6-keto-PGF1αafter treatment in groupP, groupPA and groupPAA are (73.19±24.32 pg/ml),(71.60±20.55 pg/ml) and (96.02±19.68 pg/ml),groupP and groupPA have no statistical significance(P>0.05),groupPAA is higher then groupPA(P<0.01); level of TXB2 after treatment in groupP,groupPA and groupPAA are (190.10±45.99 pg/ml) ,(170.76±38.63 pg/ml) and (139.00±34.01 pg/ml) ,groupP and groupPA have no statistical significance(P>0.05), groupPAA is lower then groupPA(P<0.05); 6-keto-PGF1α/TXB2 after treatment in groupP, groupPA and groupPAA are (18.44±9.14)%,(17.46±8.37)% and (17.57±9.46)%,groupP and groupPA have no statistical significance (P>0.05),groupPAA is higher then groupPA(P<0.05).3 Inside group comparison of groupP, groupPA and groupPAA , 6-keto-PGF1αand 6-keto-PGF1α/TXB2 after treat- ment are higher then before treatment, TXB2 after treatment is lower then before treatment, their differences have statistical significance(P<0.01). 4 Comparing the difference between before and after treatment,we find thatΔ6-keto-PGF1α,ΔTXB2 andΔ6-keto- PGF1α/TXB2 of groupPAA is the most significant.Δ6-keto- PGF1αandΔ6- keto-PGF1α/TXB2 is higher andΔTXB2 is lower compared groupPA to groupP,but the difference has no significance(P>0.05).Δ6-keto-PGF1α,ΔTXB2 andΔ6-keto- PGF1α/TXB2 are all higher compared groupPAA to group PA(P<0.05).Conclusion: 1 PGI2 is decreased and TXA2 is increased,which is related to cardiac function.2 Combining low-dose aspirin with perindopril has no obvious effect on production of PGI2 compared to perindopril alone in patients with heart failure.3 On the basis of perindopril and low-dose aspirin, combining atorvastatin can increase PGI2 and PGI2/TXA2, decrease TXA2 further in patients with heart failure. |
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