急性心肌梗死早期应用不同剂量AT_1受体拮抗剂对左室重构的临床研究  

A Clinical Study of the Effects of AngiotensinⅡ Receptor Blocker on the Left Ventricular Remodeling at the Early Stage of Acute Myocardial Infarction

作　　者：张辉[1] 赵旭兰[2] 郝玉明[1] 王建华[3] 李建华[2] 乔丽敏[4] 谢文丽[1] 

机构地区：[1]河北医科大学附属第二医院心内科,河北省石家庄市050000 [2]石家庄市第一医院内科 [3]河北医科大学附属第二医院功能科,河北省石家庄市050000 [4]河北医科大学附属第二医院同位素科,河北省石家庄市050000

出　　处：《中国全科医学》2005年第13期1058-1060,共3页Chinese General Practice

基　　金：河北省科委科研基金项目资助(99276134D)

摘　　要：目的探讨急性心肌梗死(AMI)早期应用不同剂量的AT1受体拮抗剂对左室重构的远期疗效.方法选择首次AMI患者120例,在常规治疗基础上(包括硝酸酯类、β受体阻滞剂、阿司匹林、低分子肝素),随机分为卡托普利(C)组:12.5～25.0 mg,3次/d;缬沙坦(D1)组:代文80 mg,1次/d;缬沙坦(D2)组:代文,起始量为80 mg,1次/d,2周后血压平稳且患者能耐受时增至160 mg,1次/d,患者均分别于治疗1、6、12、18个月对心室重构及心功能有关指标进行检测.结果 (1)短期应用(1年内)3组患者的LA、LVDd、IVSd、LVPWd、LVMI间差异无显著性意义;用药1年后,缬沙坦组与卡托普利组上述指标间差异有显著性意义(P＜0.05);(2)缬沙坦组治疗1年后与卡托普利组心功能差异有显著性意义(P＜0.05),且疗效与剂量相关.结论 AT1受体拮抗剂缬沙坦与血管紧张素转换酶抑制剂卡托普利一样,早期应用能有效防治AMI后心室重构,保护心功能,其远期疗效可能优于卡托普利,且疗效与剂量相关.Objective To investigate the long-term effects of angiotensinⅡ receptor blocker therapy with different dosages on left ventricular remodeling in patients with early stage of acute myocardial infarction.Methods In 120 patients with first acute myocardial infarction,on the basic medical therapy,including nitroxide drugs,beta-blockers and aspirin,the patients were randomly divided into captopril group and angiotensin Ⅱ receptor valsartan group(assigned to receive at 80mg daily or 160mg daily).The data of ventricular function were measured by echocardiography at 1,6,12 and 18 months after admission.Results Compared with a proven effective dose of captopril,there were significant differences in LA LVDd IVSd LVPWd LVMI and LVEF in valsartan group after one year's treatment (P<0.05).The clinical outcomes were related to dosage (P<0.05).Conclusion AngiotensinⅡ receptor blocker valsartan has a similar effects as captopril on preventing left ventricular remodeling and improving cardiac function.The improvement in long-term clinical outcomes is beyond angiotensin-converting enzyme inhibitors Captopril,and the effects are related to the dosage..

关 键 词：急性心肌梗死 心室重构 心功能 AT1受体拮抗剂 

分 类 号：R542.22[医药卫生—心血管疾病]