芬氟拉明治疗单纯性肥胖时心瓣膜返流的再评价  

Re-evaluating the effect of fenfluramine treatment on regurgitation of cardiac valves in simple obesity patients

作　　者：沈稚舟[1] 刘志民[2] 邹大进[3] 单玉明[1] 杨叶虹[1] 胡吉[1] 姜文宇[1] 张琳[1] 张朝云[1] 石勇铨[2] 刘颖[2] 沈玉美[2] 高从容[3] 徐茂锦[3] 赵宝珍[3] 

机构地区：[1]复旦大学附属华山医院内分泌科,上海200040 [2]第二军医大学附属长征医院内分泌科 [3]第二军医大学附属长海医院

出　　处：《中华内分泌代谢杂志》2003年第3期187-190,共4页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的 在肥胖患者对芬氟拉明治疗时的心瓣膜返流一度引起争议,现对此进行再评价。方法 为随机、单盲、多中心、减肥药西布曲明及安慰剂平行对照的临床试验。183例18～60岁的单纯性肥胖患者,分别给予芬氟拉明(64例)、西布曲明(63例)、安慰剂(56例)治疗3个月。以超声心动图观察治疗前后心瓣膜返流情况。结果 芬氟拉明组、西布曲明组和安慰剂组患者的二尖瓣膜返流治疗前后出现有意义改善分别为1、0和0例,有意义减退均为0例;主动脉瓣发生有意义改善分别为3、0和1例,有意义减退分别为2、0和0例。3组间差异无统计学意义。在体重下降量方面,用药组优于安慰剂组,其中芬氟拉明组更甚。心瓣膜返流3组间差异无显著性。结论 本研究不支持短期、常规剂量应用芬氟拉明会引起心瓣膜返流的结论。Objective To r-evaluate the effect of fenfluramine treatment on regurgitation of cardiac valves in patients with obesity, which was a controversial issue. Methods This was a randomized, single-blind, multi-center trial with parallel control groups of sibutramine and placebo. A total of 183 patients with obesity aged 18-60 years received fenfluramine (64 cases) , sibutramine (63 cases) and placebo (56 cases) for 3 months. Cardiac valve regurgitation was observed by echocardiography. Results There were respectively 1,0 and 0 cases showing significant improvement in mitral regurgitation in the 3 groups, but none had a significant deterioration. And there were respectively 3, 0 and 1 cases showing significant improvement of regurgitation from aortic valves, while the cases with significant deterioration were 2, 0 and 0 respectively. There was no statistical difference among the 3 groups. The body weight loss in therapeutic groups (especially the fenfluramine group) was more significant than that in the placebo group. There was no significant difference in the regurgitation of the 2 valves among the 3 groups. Conclusion This study does not support the verdict that a short-term administration of fenfluramine with an ordinary dosage will cause regurgitation of the valves in patients with obesity.

关 键 词：单纯性肥胖 心瓣膜返流 芬氟拉明 治疗 超声心动图 

分 类 号：R589.2[医药卫生—内分泌]