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Objective To investigate the effect of spirolactone on cardiac function and serum brain natriuretic peptide in patients with chronic heart failure( CHF). Methods Eighty-four patients with CHF were randomly divided into control group( n=42 )and observation group( n=42 ). The patients in the control group were given conventional therapy,while in the observation group were given spirolactone( 20 mg/times,2 times/day)based on treatment of the control group for six months. The clinical effects and left ventricular end diastolic diameter( LVEDd ),left ventricular ejection fraction( LVEF ) and serum brain natriuretic peptide( BNP ) of pretherapy and post-treatment between the two groups were recorded and compared. Results The total effective rate of observation group was 95. 2%(40/42),obviously higher than that of control group(80. 9%(34/42),χ2=6. 468,P=0. 028). The levels of LVEDd and BNP in two groups after treatment were(57. 8 ± 6. 2)mm and (62. 4 ± 7. 8)mm,(364. 4 ± 32. 8)ng/L and(457. 4 ± 43. 2)ng/L,significantly lower than those at before treatment((64. 6 ± 7. 4)mm and(64. 8 ± 7. 6)mm,(867. 8 ± 78. 5)ng/L and(864. 4 ± 74. 8)ng/L),while LVEF in two groups after treatment were( 49. 8 ± 5. 4 )% and( 42. 6 ± 4. 6 )%,significantly higher than those before treatment((35. 2 ± 3. 9)% and(35. 4 ± 3. 5)%),and the differences were significant(t = -3. 264, 4. 626,-5. 373,-3. 932,5. 438,-6. 548;P﹤0. 05). Moreover the changes in observation group were obvious than those in control group in terms of LVEDd,BNP and LVEF( t = -3. 425,3. 644,-2. 846;P ﹤0. 05 ) . Conclusion Spironolactone can effectively decrease the serum brain natriuretic peptide levels,improve the cardiac function in patients with chronic heart failure,and it is worthy of popularization and application.
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Objective To explore the protective effect and its possible mechanism of spirolactone against kidney injury in rats after amputation. Methods Forty-two male Wistar rats were randomly divided into 6 groups: normal control, 6 hours, 24 hours, 48 hours, 72 hours after the operation and spirolactone intervention groups (n=7, each). Plasma angiotensin Ⅱ (Ang Ⅱ), aldosterone (ALD), myeloperoxidase (MPO), malondialdehyde (MDA), interleukin-6 (IL-6), nitric oxide (NO), urea nitrogen (Ur), creatinine (Cr) concentration and renal tissue ALD, MPO, MDA and calcineurin (CaN) mRNA levels were determined. Renal pathological changes were observed by light microscopy. Results At 6h after amputation, traumatic changes in rat kidney tissue were seen, and the levels of Cr, AngⅡ, MDA, MPO, IL-6 and CaN-mRNA were significantly elevated, while NO concentration was significantly lowered. Spirolactone intervention reduced the damage of kidney tissue, and the levels of MPO, IL-6, Ang Ⅱ in plasman, contents of MPO and ALD and expression level of CaN mRNA in kidney tissue were significantly lowered, but the levels of Cr, Ur, MDA and ALD in plasma and content of MDA in kidney tissue showed no significant change. Conclusion Spirolactone can provide protective effect against renal damage in rats after amputation, and it may be related to the mechanism that spirolactone inhibits secretion of ALD and lowers the expression and activation of CaN mRNA, thus reducing the release of pro-inflammatory factors.
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Objective To examine whether aldosterone contribute to obesity related glomerular disease. Methods C57BL/6J mice were randomly divided into three groups: a control group (low?fat?diet, n=10), a model group (high?fat?diet, n=10) and a intervention group (high?fat?diet, n=12). After 8 weeks intervention group were treated with a mineralocorticoid receptor antagonist, spirolactone (SPL).The physicochemical indexes and the renal pathology of the three groups were all detected. The mRNA and protein expressions of podocyte marker protein were determined by real?time PCR and Western blotting, respectively. Results Compared with the control group, body weight, kidney weight, Lee ’s index, fat index, blood cholesterol, blood triglyceride, creatinine clearance rate, urinary protein excretion, glomerular average diameter, glomerular foot process average width were significantly up ? regulated (P<0.05); The mRNA and protein expression of nephrin, podocin, podoplanin and podocalyxin were significantly down?regulated in model group (P<0.05). Meanwhile, these changes were attenuated by SPL. Conclusion Aldosterone can participate in the process of obesity? related renal injury, and these can be attenuated by mineralocorticoid receptor antagonist, spirolactone. This gives us preliminary clues to treat ORG.
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FUNDAMENTO: A incidência de hiperpotassemia relacionada à espironolactona é baixa na insuficiência cardíaca estável, entretanto não foi estudada durante a descompensação. OBJETIVO: Avaliar a influência da espironolactona na insuficiência cardíaca descompensada sobre o potássio sérico. MÉTODOS: Em um estudo de coorte, selecionamos pacientes hospitalizados por descompensação da insuficiência cardíaca, FEVE < 0,45 e potássio sérico entre 3,5 e 5,5 mEq/l. Os pacientes foram divididos segundo o uso da espironolactona (grupo E) ou não (grupo C). O desfecho foi aumento do potássio (> 6,0 mEq/l) e uso de poliestireno de cálcio. Realizou-se a análise multivariada pela regressão logística, e p < 0,05 foi considerado significante. RESULTADOS: Foram estudados 186 pacientes (grupo E: 56; grupo C: 130), FEVE 0,25, idade 55,5 anos e 65,2 por cento de homens. A incidência de hiperpotassemia foi de 10,7 por cento no grupo E e de 5,4 por cento no grupo C (p = 0,862). A análise multivariada mostrou que a uréia sérica > 60,5 mg/dl, durante a internação, apresenta risco relativo de 9,6 (IC 95 por cento 8,03 - 11,20; p = 0,005) para a ocorrência de hiperpotassemia. CONCLUSÃO: A incidência de hiperpotassemia foi duas vezes maior com espironolactona, mas não estatisticamente significante. Elevação da uréia foi associada à hiperpotassemia. Estudos randomizados são necessários para esclarecer o assunto.
BACKGROUND: The incidence of hyperkalemia related to spironolactone use is low in stable heart failure; however, it has not been studied during decompensation. OBJECTIVE: To evaluate the influence of spironolactone on serum potassium in decompensated heart failure (HF). METHODS: In a cohort study, patients that had been hospitalized due to decompensated HF, with left ventricular ejection fraction (LVEF) < 0.45 and serum potassium between 3.5 and 5.5 mEq/l were selected. The patients were divided according to spironolactone use (Group S) or no use (Group C). The outcome was potassium increase (> 6.0 mEq/l) and the use of calcium polystyrene. A multivariate analysis through logistic regression was carried out and values of p < 0.05 were considered significant. RESULTS: A total of 186 patients (group S: 56; group C: 130) were studied; LVEF of 0.25, aged 55.5 years and 65.2 percent of them males. The incidence of hyperkalemia was 10.7 percent in group S and 5.4 percent in group C (p = 0.862). The multivariate analysis showed that serum urea > 60.5 mg/dl during the hospitalization presents a relative risk of 9.6 (95 percentCI 8.03 - 11.20; p = 0.005) for the occurrence of hyperkalemia. CONCLUSION: The incidence of hyperkalemia was two-fold higher with spironolactone use, but it was not statistically significant. The increase in urea levels was associated to the hyperkalemia. Randomized studies are necessary to clarify this issue.
Subject(s)
Female , Humans , Male , Middle Aged , Mineralocorticoid Receptor Antagonists/adverse effects , Heart Failure/drug therapy , Hyperkalemia/chemically induced , Spironolactone/adverse effects , Mineralocorticoid Receptor Antagonists/therapeutic use , Brazil/epidemiology , Epidemiologic Methods , Hyperkalemia/blood , Hyperkalemia/epidemiology , Potassium/blood , Spironolactone/therapeutic use , Urea/bloodABSTRACT
Objective To study the chemical constituents in plants of Hypericum hookerianum and their activities by pharmacological experiment. Methods Cytotoxicity screening of the extracts from H. hookerianum were carried to isolate and purify the chemical constituents. The chemical structures were (identified) by physicochemical properties and spectral data analysis. Results Seven compounds were isola-(ted) and (established) as quercetin (Ⅰ), luteolin (Ⅱ), apigenin (Ⅲ), hyperin (Ⅳ), astragalin (Ⅴ), hyper-(olactone) A (Ⅵ), and hyperolactone C (Ⅶ). Conclusion All the compounds are isolated from H. hookerianum for the first time. Compounds Ⅲ and Ⅴ are isolated from the plants of Hypericum Linn. for the first time. In addition, the fractions by chlorform and ethylacete extracting, quercetin, and luteolin possess the cytotoxicity.