The Effect Of Aldosterone Receptor Antagonist On Insulin Resist-ance And Cytokine In Patients With Chronic Heart Failure

Objective To observe the insulin resistance phenomenon and inflammatory cytokine level in patients with chronic heart failure(CHF), and try to explore the effect of aldosterone receptor antagonist(ARA) on insulin resistance and inflammatory cytokine in patients with CHF, and observe the cardiac function improved by ARA in patients with CHF.Methods The patients chosen by adoption standards are divided into 3 groups:control group(38 cases), chronic heart failure without high insulin group(48 cases), chronic heart failure with high insulin group(52 cases). The patients were selected for not less than 60 years.We do comparability studies with statistical methods among 3 groups for age, sex, body mass index and other factors.The indexes were detected as follows:Fasting plasma glucose(FPG),fasting insulin level(FIS), insulin sensitivity index (IAI), tumor necrosis factor -a(TNF-a), interleukin -6 (IL-6), interleukin -1β(IL-1β)。At the same time we get left ventricular ejection fraction (LVEF) by cardiac ultrasonography. The three above indexes were statistically analyzed to determine whether there are difference on insulin resistance and cytokine changing in chronic heart failure patients.Depend on etiology 100 CHF patients were divided into groups:coronary artery disease group,hypertensive heart disease group,degenerative valvular heart disease group,dilated cardiomyopathy group,all the indexes were analyzed to find the differences. Then 100 chronic heart failure patients (including high-insulin group and non-high-insulin group) were divided randomly into two groups, one group were given the conventional treatment:aβ-blocker, ACE-I or ARB, diuretics, Nitrates, and digitalis and other conventional drug treatment; another group accept the same treatment and additional aldosterone receptor antagonist treatment (spironolactone tablets 20mg, qd). The treatment maintains 6 months and all indexes were detected again to explore the effect of aldosterone receptor antagonist on insulin resistance and cytokine in chronic heart failure (CHF) patients, and observe the cardiac function improved by aldosterone receptor antagonist in patients with CHF.Results1.①Age, gender, body mass index among the three groups were not significant different (P> 0.05), comparable.②According to different causes of chronic heart failure patients, by statistical analysis, FIS,IAI,IL-1β,IL-6,TNF-a in each group were not significantly different (P> 0.05).2. Compared with the control group, FIS,TNF-a,IL-1β,IL-6 were significantly higher and IAI was lower in chronic heart failure with high insulin group and without high insulin group (P<0.05).3. Compared with CHF without high insulin group,FIS,TNF-a ware higher and IAI was lower in CHF with high insulin group(P<0.05).4. Compared with NYHAⅢgroup,FIS,TNF-a,IL-1β,IL-6 were higher and IAI was lower in NYHAIV group(p<0.05).5. After 6 months of treatment, both groups get better in cardiac function, and compared with treatment before in every group,the indexes (FIS, TNF-a, IL-1β, IL-6) decreased LVEF,IAI improved, Statistical significance(P<0.05).6.Compared with the conventional treatment group after treatment, degree of FIS,TNF-a,IL-1β,IL-6 levels decreasing and LVEF,IAI increasing was more obvious in aldosterone receptor antagonist group, statistical significance (P<0.05).7.Compared with the conventional treatment group in clinical effect(57.57), it was better in aldosterone receptor antagonist group(64.58),P<0.05.Conclusion1.Insulin resistance phenomenon and inflammatory cytokine changing ware observed in patients with CHF, and insulin resistance may have already existed before the onset of hyperinsulinemia in patients with CHF.2. Insulin resistance and inflammatory cytokine may have no correlation to its primary cause of CHF, and may be a common pathophysiological state in patients with CHF.3. Insulin resistance and inflammatory cytokine may be positively related to NYHA-FC. The poorer heart function was,the more obvious insulin resistance was and the higher cytokine level was.4. Insulin resistance decreased and the release of inflammatory cytokine also reduced with the improvement of heart function..5.The heart function and clinical effect ware further improved by additional ARA administration on standard treatment in patients with CHF, and this may be related to the improvement of insulin resistance and inflammatory cytokine level declining, and it may be one of the mechanisms of the ARA in treatment of CHF.