螺内酯治疗慢性心力衰竭对镁代谢的影响  

Influence of spironolactone therapy on magnesium metabolism in patients with chronic heart failure

作　　者：高修仁[1] 陶军[1] 李树彬[1] 曾群英[1] 张焰[1] 马虹[1] 

机构地区：[1]中山大学第一附属医院心血管内科,广东广州510080

出　　处：《中华老年心脑血管病杂志》2004年第6期387-389,共3页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：广东省自然科学基金资助 (3 173 1)

摘　　要：目的　探讨慢性心力衰竭在常规药物治疗的基础上加用与不加用螺内酯治疗 ,对 2 4h尿镁排泄量 (UMA)、血浆镁浓度 (PMC)、红细胞镁含量 (EMC)的影响。方法　 111例慢性心力衰竭患者随机分为 2组 ,常规治疗加螺内酯组 (第 1组 5 6例 )和不加螺内酯 (第 2组 5 5例 ) ,采用原子吸收光谱火焰法测定治疗前、治疗 1个月及 6个月时UMC、PMC、EMC的变化情况。动态心电图检测治疗 6个月后心律失常发生率评价心电的稳定性 ;比较两组治疗 1个月、6个月后的 6min步行距离 (6MWD) ,评价运动耐力。结果　 (1)第 1组治疗 1个月后 2 4hUMA与治疗前比较明显下降 (P <0 .0 1) ,治疗 6个月后与第 2组比较差异有显著性意义 (P <0 .0 5 ) ;PMC与EMC治疗 6个月后PMC与EMC的增高与治疗 1个月时及治疗前比较差异有显著性意义 (P <0 .0 1)、与第 2组比较差异有显著性意义(P <0 .0 1)。(2 )第 2组治疗后 2 4hUMA呈进行性增加 (P <0 .0 1) ;PMC治疗前后差异无显著性 ;而EMC治疗 1个月与治疗前无差异 ,治疗 6个月时有所下降 (P <0 .0 5 )。 (3)第 1组治疗 6个月后与第 2组比较 2 4h平均窦性心率及室性早搏发生率均较低 (分别P <0 .0 5 ) ;心房颤动 心房扑动、房性期前收缩及室性心动过速的发生率均低于第 2组 (分别P <0 .0 5 ) ;第 1?Objective To investigate the influence on the excretion of urine magnesium amount (UMA), plasma magnesium concentration (PMC), and erythrocyte magnesium content (EMC) in patients with chronic heart failure(CHF) after conventional treatment combined with or without aldosterone antagonist therapy.Methods 111 consecutive patients with CHF were divided into two groups randomly: group one (n=56), conventional treatment combined with spironolactone; group two (n=55),conventional treatment without addition of spironolactone. UMA, PMC and EMC were measured by atomic absorption spectrophotometer flame assay before and after treatment for 1 month and 6 months. Holter monitor was carried out after 6-month therapy and the arrhythmia in the 2 groups was compared before and after treatment. For identification of the endurance of movement, the distance after 6-minute walk(6MWD) was compared between the 2 groups after treatment. Results ① UMA in group one was significantly decreased after 1 month treatment (P<0.01), and was maintained at the same level after the following 6-month therapy. After 6-month treatment there was significantly higher PMC and EMC in group one as compared with group two and with 1-month treatment (P<0.01 respectively).②In group two,UMA showed increased excretion steadily after 1-and 6- month treatment (P<0.01,P<0.01) and led to decreased level of EMC after 6 months (P<0.05).③There was lower incidence of every kind of arrhythmia in group one after 6-month treatment as compared with group two(P< 0.05 respectively). There was significant improvement of 6MWD in group one after 6-month therapy as compared with 1-month therapy(411±93 vs 323±89,P<0.01). Conclusions ①After adding spironolactone therapy,excretion of UMA decreased,while PMC and EMC increased.②The stable myocardial electricity and enhancement of movement endurance in patients treated with spironolactone may be related to stable plasma magnesium concentration and cell magnesium content.

关 键 词：心力衰竭 充血性 螺内酯 镁 代谢 

分 类 号：R541.6[医药卫生—心血管疾病]