缬沙坦和卡托普利干预高血压左室心肌肥厚与血中某些活性因子的比较研究  

Valsartan and captopril in interfering left ventricularhypertrophy and some blood active factors in essential hypertensive patients:a comparative research

作　　者：潘海燕[1] 朱健华[1] 顾勇[1] 钮红音[1] 吴伟民[1] 

机构地区：[1]南通医学院附属医院心内科,南通226001

出　　处：《中华老年多器官疾病杂志》2003年第1期30-33,共4页Chinese Journal of Multiple Organ Diseases in the Elderly

摘　　要：目的　比较缬沙坦对心肌肥厚和纤维化的干预作用是否优于卡托普利 ,两者联用是否更为有益 ,并对作用机理进行分析探讨。方法　 79例伴有左室肥厚的轻、中度高血压病患者 ,随机分为 3组 :缬沙坦组 ,缬沙坦80～ 16 0mgqd ;卡托普利组 ,卡托普利 2 5～ 5 0mgbid ;卡托普利 +缬沙坦组 ,卡托普利 12 .5～ 2 5mgbid +缬沙坦4 0～80mgqd。治疗期为 8个月。另设正常对照组。观测室间隔厚度、左室重量指数、左室相关壁厚度、左室射血分数、二尖瓣口舒张早期和晚期血流速度比 (VE/VA)、血浆血管紧张素Ⅱ (AngⅡ )、醛固酮 (Ald)、血清Ⅰ型前胶原羧基端肽 (PⅠCP)和Ⅲ型前胶原氨基端肽 (PⅢNP)等指标 ,进行治疗前后及组间比较。另对各治疗组每组 6例患者 ,观察上述指标的动态变化。结果　各组治疗后反映心肌肥厚和纤维化以及左室舒张功能的各项指标均显著改善 (P <0 .0 5 ,P <0 .0 1) ,但未达正常。组间比较差异不显著。动态观察卡托普利组AngⅡ及Ald先下降 ,后出现“逃逸”现象 ,但此后血清PⅠCP、PⅢNP及超声心动图改变仍继续好转。结论　①缬沙坦和卡托普利单用或联用均能抑制和逆转高血压心肌肥厚与纤维化 ,改善舒张功能 ;②缬沙坦组短期治疗的益处未见明显优于卡托普利 ,两者联用未见明显优势 ;Objective To compare the interfering effects of valsartan ,captopril or a combination of the two drugs on left ventricular hypertrophy and fibrosis and to investigate the interfering mechanisms.Methods Seventy nine patients with mild to moderate hypertension accompanied left ventricular hypertrophy were randomized into three groups:group valsartan: valsartan 80 160mg qd,group captopril:captopril 25 50mg bid and group captopril+valsartan: captopril 12.5 25mg bid+valsartan 40 80mg qd. The treatment lasted 8 months. Twenty age matched healthy subjects served as a normal control group. The left ventricular size and function were evaluated with Doppler echocardiography before and after the therapy. The patients′venous blood was obtained to examine angiotensinⅡ(AngⅡ),aldosterone(Ald) and serum carboxyterminal peptide of type Ⅰ procollagen (PⅠCP) and aminoterminal peptide of type Ⅲ procollagen ( PⅢNP ). In addition,in 6 patients of each treated group the dynamic changes of indexes mentioned above were observed. Results The three therapeutic regimens were equally effective in improving ventricular remodeling and diastolic function,but all did not restore them to normal.Patients in group captopril showed continuous echocardiographic improvement and decrease in serum PⅠCP and PⅢNP even after the AngⅡ and Ald had reincreased.Conclusions ① Valsartan, captopril or a combination of the two drugs all could prevent and reverse myocardial hypertrophy and fibrosis and improve diastolic function in essential hypertension. ② Valsartan or a combination of the two drugs had no significant superiority to captoprol in interfering myocardial remodeling with short term treatment. ③ In group captopril the ventricular remodeling continued to improve even after the escape of plasma AngⅡ and Ald appeared. Further studies are required to ascertain the exact mechanisms of captopril in interfering myocardial remodeling.

关 键 词：缬沙坦 卡托普利 干预 高血压左室心肌肥厚 活性因子 比较研究 

分 类 号：R541.3[医药卫生—心血管疾病] R972[医药卫生—内科学]