己酮可可碱治疗缺血性心肌病

     背景 炎性免疫激活常见于心力衰竭，并使这种综合征难以治愈。作者探索免疫调节剂己酮可可碱（pantoxifylline）是否增加缺血性心肌病患者左心室功能，同时研究治疗对脑钠肽（NT-pro BNP）、C-反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）和调亡标示物,即调亡抑制因子(Fas/Apo-1)水平的影响。

    方法与结果 在一项单中心、前瞻性随机双盲对照研究中，38例缺血性心肌病患者，在接受标准治疗的前提下，使用己酮可可碱400mg，一日3次，或安慰剂治疗。在基线和6周后进行临床评估、放射性核素心室图、心电图和血液分析。两组病例基本临床特征无明显差异。死亡5例（对照组4例）。己酮可可碱与对照组比较，心功能分级和左心室放射性核素射血分数，显著改善（P＜0.05)。治疗组患者血浆C-反应蛋白、脑钠肽、肿瘤坏死因子-α和调亡抑制因子，较对照组低。

    结论 在缺血性左心室功能紊乱的心力衰竭患者中，将己酮可可碱加入标准治疗，可改善临床病情和放射性核素射血分数，并伴血浆炎症、预后和调亡标示物的降低。

Therapy of Ischemic Cardiomyopathy With the Immunomodulating Agent Pentoxifylline. Results of a Randomized Study

Sliwa K, Woodiwiss A, Kone V N，Geoffrey C, Badenhorst D，Norton G,et al. Circulation. 2004;109(6):750-755.

Background— Inflammatory immune activation commonly occurs in heart failure and may perpetuate this syndrome. We sought to determine whether the immunomodulating agent pentoxifylline enhances left ventricular function in patients with ischemic cardiomyopathy. We also investigated the effect of therapy on levels of brain natriuretic peptide (NT-pro BNP), C-reactive protein (CRP), tumor necrosis factor- (TNF-α), and the marker of apoptosis, Fas/Apo-1.

Methods and Results— In a single-center, prospective, randomized, double-blind, placebo-controlled study, 38 patients with ischemic cardiomyopathy received pentoxifylline 400 mg TID or placebo in addition to standard therapy. Clinical assessment, radionuclide ventriculography, echocardiography, and blood analyses were performed at baseline and after 6 months. There were no differences in baseline characteristics between the groups. Five patients died (4 in the placebo group). Pentoxifylline treatment resulted in an improvement in functional class (P<0.005) and an increase in systolic blood pressure (P<0.05) and left ventricular radionuclide ejection fraction (P<0.05) compared with the placebo-treated group. There were reductions in plasma concentrations of CRP, NT-pro BNP, TNF-α, and Fas/Apo-1 in the pentoxifylline compared with the placebo-treated group.

Conclusions— In patients with heart failure due to ischemic left ventricular dysfunction, the addition of pentoxifylline to standard therapy results in improvements in clinical status and radionuclide ejection fraction, which are accompanied by reductions in plasma markers of inflammation, prognosis, and apoptosis.