| PrefaceHeart failure is the severe or terminal stage of most primary cardiovascular disease. It seriously effects the patients 'living quality and threatens their life. The mechanism of heart failure is various. In recent years, many studies show that during the development of heart failure the cytokines always express abnormally and promot the patients'heart failure with the continuous activating of neu-ro - endosecretion. Nowadays, the cytokines especially the tumor necrosis factor- α (TNF - α) is considered to be closely related to heart failure . The TNF -αcan promote ventricular remodeling and the myocardial damage, and made the heart function getting worse. There are theories informed that the activity of the renal - angiotensin system ( RAS) increased in patients with congestive heart failure , so that the production of TNF - α was significantly high. With the recognize of heart failure, people now using the angiotensin converting enzyme inhibitors (ACEI) and the angiotensin II receptor inhibitor in the treatment and have got better results. But until now, the study and report of this area is relatively short. This research aims at clarifying the abnormal changes of serum TNF-odevel in patients with heart failure ,and probing the effects of angiotensin -converting enzyme inhibitor ( ACEI) such as fosinopril on the serum TNF - α level and the cardiac function of patients with heart failure.ObjectiveThe research observe the change of serum level of TNF - αand the left ven-tricular ejection fraction (LVEF) in patients with heart failure and the effect of fosinopril on them. Analyze the correlation between LVEF and serum TNF -otlevel, and clarify the influence of fosinopril on serum TNF - otlevel and cardiac function.MethodThere are 60cases of patient with heart failure were elected according to the standard of ①Ⅱ - Ⅳ degree of heart function of NYHA , ②the left ventricular ejection fraction ≤ 40% , ③ the end diastolic diameter of left ventricular ≥ 60mm, male 34, female 26, the average age was 59. 22 ±5.97 years old, and they were divided into the fosinopril group and the valsartan group randomly, each group include 30cases,the baseline of the two group such as age,sex, blood press have no significant difference. The fosinopril group were treated with fosinopril 10mg/d for 4 weeks and the valsartan group were treated with valsartan 80mg/d for 4 weeks. The serum level of TNF - αand LVEF of each group were measured before and after the therapy. There are 30 healthy people included in the normal control group, only measure one time of the serum level of TNF -aand the LVEF.ResultCompared with the normal controls, the serum level of TNF - alevel and the LVEF of the fosinopril group and the valsartan group were significantly high ( p < 0.01) before the therapy. After 4 weeks treatment , the serum level of TNF -α of fosinopril group and valsartan group were all significantly decreased (p< 0.01) , and the LVEF were all elevated obviously ( p < 0.01). The post - therapeutic serum level of TNF - α of fosinopril group decreased obviously and the LVEF of fosinopril group significantly increased compared with the valsartan group (p <0. 01). There is negative correlation between LVEF and the serum level of TNF-α (r= -0.773).
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