螺内酯联合美托洛尔对急性心肌梗死急诊介入治疗后晚期左心室重构的影响  

Effect of spironolactone combined with metoprolol on left ventricular remodeling after emergency intervention therapy in patients with acute myocardial infarction

作　　者：谢晓春[1] 芦炳蒋[1] 张丽娜[1] 

机构地区：[1]中国人民解放军第二炮兵总医院心内科,北京市100088

出　　处：《中国心血管病研究》2012年第5期350-354,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的探讨急性心肌梗死（AMI）患者直接急诊介入治疗（PCI）后应用螺内酯联合美托洛尔与单用美托洛尔对晚期左心室重构的影响。方法102例AMI患者直接急诊PCI血管再通后，用随机、对照的方法，随机分成治疗组（螺内酯联合美托洛尔）51例和对照组（美托洛尔）51例，在早期（〈24h），3、6个月末3个时点分别检测两组血清Ⅲ型前胶原氨基末肽（PⅢNP）、脑纳肽（BNP）和醛固酮（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、6个月末血清PⅢNP和BNP显著降低[PⅢNP（ng／L）分别为259．1±60．1比289．3±69．4，P〈0．05；195．2±43．1比222．6±47．4，P〈0．01。BNP（ng／L）分别为334．2±82．5比370．8±72．9，P〈0．05；237．6±67．1比278．6±65．4，P〈0．01]。形态学上，两组左心室均逐渐扩大，6个月末最大，两组差异有统计学意义（P〈O．05）。左心室射血分数同组和两组间对应比较均有明显改善（P〈O．05）。结论AMI直接急诊PCI后应用螺内酯联合美托洛尔，对晚期左心室重构的抑制作用优于单用美托洛尔。Objective To investigate the effect of spironolactone in combination with metoprolol and sin- gle metoprolol on left ventricular remodeling （LVR） using direct percutaueous coronary intervention （PCI） after acute myocardial infarction （AMI）. Methods In this randomized and controlled study, 102 patients were random- ly administered in treatment group （spironolactone and metoprolol） 51 and control group （metoprolol） 51. During the 6 months the serum PⅢNP, BNP and the echocardiography were respectively examined in two groups to assess the changes of left ventricular shape and geometry. Results Both groups received direct PCI and routine treat-ment.At 3rd,6rd month Pig NP and BNP serum levels were significantly lower in the treatment group compared with those in control[PigNP（ng/L）259.1±60.1 vs 289.3±69.4,P〈0.05,195.2±43.1 vs 222.6±47.4,P〈0.01. BNP （ng/L）334.2±82.5 vs 370.8±72.9,P〈0.05,237.6±67.1 vs 278.6±65.4,P〈0.01 ±. The changes of left ventricular shape and geometry in control group were more obvious than those in treatment group from early phase to 6 months （P〈0.05）. Conclusion The spironolactone in combination with metoprolol was. effective in inhibition of LVR than single metoprolol in late stage of AMI.

关 键 词：螺内酯 美托洛尔 心肌梗死 心室重构 脑钠肽 llI型前胶原氨基末肽 

分 类 号：R542.22[医药卫生—心血管疾病]