早期应用螺内酯对急性心肌梗死患者心功能及心室重构的影响  

Effect of early use of spironolactone on left ventricular remodeling in patients with acute myocardial infarction

作　　者：李亚芹[1] 王乾一[1] 徐占稳[1] 康世鑫[1] 孙鹏[1] 孟小敏[1] 

机构地区：[1]河北大学附属医院心血管内二科,河北保定071000

出　　处：《岭南心血管病杂志》2015年第6期755-758,共4页South China Journal of Cardiovascular Diseases

基　　金：河北省科技厅科技支撑计划项目(项目编号:14277786D)

摘　　要：目的探讨早期应用螺内酯对急性心肌梗死(acute myocardial infarction,AMI)患者左心室重构的影响。方法将河北大学附属医院2012年1月至2013年6月确诊为AMI的患者按随机数字表法随机分为3组。对照组40例,接受血管紧张素转换酶抑制剂(ACEI)、β受体阻断药、抗血小板药物、他汀类药物调脂及稳定斑块等常规治疗;低剂量螺内酯组40例,在常规治疗基础上加用低剂量螺内酯(20 mg/d),高剂量螺内酯组40例(40 mg/d),在常规治疗的基础上加螺内酯40 mg/d。随访1年,并检测各组血清脑钠肽(brain natriuretic peptide)、氨基末端脑利钠肽前体(N-terminal pro-brain natriuretic peptide,NT-pro BNP)浓度及行超声心动图检查以评价左心室功能和左心室容积。结果 6和12个月时螺内酯组血清BNP、NT-pro BNP浓度明显低于对照组,差异有统计学意义(P<0.05);且12个月时螺内酯组较对照组左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)明显缩小,射血分数(EF)明显升高,差异有统计学意义(P<0.05);但螺内酯低剂量与高剂量之间上述指标比较,差异无统计学意义(P>0.05)。下壁心肌梗死患者与前壁心肌梗死患者相比,前壁心肌梗死患者受益更大。结论螺内酯可抑制AMI患者左心室重构,改善心功能,并且低剂量与高剂量疗效无显著性差异。Objectives To investigate the effect of spironolactone on cardiac function and left ventricular remodeling （LVRM） in patients with acute myocardial infarction （AMI）. Methods A total of 120 patients with AMI （diagnosed from January 2012 to June 2013 ） were randomly divided into three groups by stratified random sampling. Forty patients as control group received regular treatments of angiotensin-converting enzyme inhibitor （ACEI）, 13 receptor blocker, antiplatelet and lipid lowering drugs, 80 patients as experimental group were given spironolactone （20 mg/d and 40 mg/d respectively） on the basis of regular treatments. During the one-year follow-up,plasma concentrations of brain natriuretic peptide （BNP） and N-terminal pro-brain natriuretic peptide （NT-proBNP）were measured with electrochemical luminescent technique and echocardiogram was performed to evaluate left ventricular function and volume. Results Plasma concentrations of BNP and NT-proBNP in experimental group decreased significantly compared with those in control group at the 6th and 12th month （P〈0.05）. Left ventricular end-diastolic diameter （LVEDD） and left ventricnlar end-systolic diameter （LVESD） at the 12th month in experimental group decreased, ejection fraction increased significantly compared with those in control group （P〈0.05）, especially in patients with anterior wall myocardial infarction. However, there were no significant differences in these indexes between low-dose and high-dose spironolactone groups （P〉0.05）. Conclusions Spironolactone inhibits left ventricular remodeling in patients with AMI and improve their cardiac function. There is no significant difference between low-dose and high-dose effects.

关 键 词：心肌梗死 左心室重构 螺内酯 

分 类 号：R542.22[医药卫生—心血管疾病]