螺内酯联合卡维地洛对急性心肌梗死晚期左心室重构的影响  

Effect of spironolactone combined with carvedilol on left ventricular remodeling after acute myocardial infarction

作　　者：谢晓春[1] 赵贵峰[1] 杨军珂[1] 刘胜林[1] 丁力平[1] 白玉蓉[1] 王嵬民[2] 

机构地区：[1]中国人民解放军第二炮兵总医院心内科,北京100088 [2]黑龙江省医院心内科,哈尔滨100036

出　　处：《中国临床药学杂志》2008年第3期151-154,共4页Chinese Journal of Clinical Pharmacy

摘　　要：目的探讨急性心肌梗死(AMI)患者直接急诊介入治疗(PCI)后应用螺内酯联合卡维地洛与单用卡维地洛对晚期左心室重构的影响。方法103例AMI患者直接急诊PCI血管再通后,用随机、对照的方法,分成治疗组(螺内酯联合卡维地洛)52例和对照组(卡维地洛)51例,于早期(<24 h)、3、6 mo在3个时间点分别检测2组血清Ⅲ型前胶原氨基末肽(PⅢNP)、脑利钠肽(BNP)、醛固酮(ALD)水平,并采用彩色多普勒心动超声仪连续随访并测量、计算左心室形态、构型等多项指标。结果治疗组与对照组比较,3、6mo血清PⅢNP和BNP显著降低(P<0.05;P<0.01),对照组ALD与基线比较明显下降,而治疗组有显著升高。形态学上,2组左心室形态均呈逐渐扩大,对照组与治疗组3、6 mo同期对应比较,左心室扩大程度更明显,mo 6最大,2组差异有统计学意义(P<0.05)。同时左心室射血分数同组和2组间对应比较均有明显改善(P<0.05)。结论AMI直接急诊PCI后,应用螺内酯联合卡维地洛对晚期左心室重构的抑制作用优于单用卡维地洛。AIM To investigate the effect of spironolactone in combination with carvedilol and single carvedilol on left ventricular remodeling （LVR） using direct percutaneous coronary intervention （PCI） after acute myocardial infarction （AMI）. METHODS After coronary recanalization in 103 patients with AMI treated by direct PCI,52 patients were administered in treatment group （spironolactone and carvedilol） and 51 in control group （carvedilol） in this randomized andcontrolled study. During the early（ 〈 24 h）,3,6 mo, the serum procollagen type m aminoterminal peptide（PⅢNP）, brain natriuretie peptide（ BNP ）, aldosterone（Aid）） and echecardiography were respectively examined in 2 groups to assess the changes of left ventricular shape and geometry. RESULTS At 3,6 mo PⅢNP and BNP serum levels were significandy lower in the treatment group as compared with those in control group（ P 〈 0.05 ; P 〈 0.01 ）, ALD was significantly lower in control group as compared with base, ALD in treatment group reversed. Both groups left ventricular shape expands. The changes of left ventricular shape and geometry in control group were more obvious than those in treatment group from early phase to 6 mo, the most obvious at mo 6 （ P 〈 0.05）. CONCLUSION The spironolactone in combination with carvedilol is effective in inhibition of LVR than single carvedilol in late stage of AMI.

关 键 词：螺内酯 卡维地洛 心肌梗死 心室重构 脑利钠肽 Ⅲ型前胶原氨基末肽 

分 类 号：R542.22[医药卫生—心血管疾病] R541.6[医药卫生—内科学]