咪达普利和氨氯地平对高血压病左室肥厚患者QT离散度及室性心律失常影响的研究

Effect of Imidapril on QT interval dispersion and ventricular arrhythmia in patients with left ventricular hypertrophy caused by hypertension

目的 探讨咪达普利对高血压病左室肥厚(LVH)患者左室质量指数(LVMI)、心率较正的QT间期离散度(QTcd)及室性心律失常(VA)的影响。方法 高血压病LVH患者共170例,随机分为氨氯地平组(n=86),咪达普利组(n=84)。两组分别于治疗前、治疗1 a后用彩色多普勒Penn法测定LVMI,分析体表标准12导联心电图QTcd并用Halter记录VA发生的情况。结果 氨氯地平组治疗前、后LVMI变化无显著差异(P>0.05);咪达普利组治疗前、后LVMI分别为153±18g/m2和140±16g/m2,P<0.01。氨氯地平组治疗前后QTcd变化无显著差异(P>0.05);咪达普利组治疗前后QTcd无显著性差异(P>0.05)。治疗后两组间QTcd存在显著性差异(P<0.05)。氨氯地平组及咪达普利组治疗后前QTcd分别为74±12 ms和65±9ms,P<0.05。治疗前氨氯地平组与咪达普利组间QTcd无显著性差异,治疗后两者间QTcd存在显著性差异(P<0.05)。氨氯地平组及咪达普利组治疗前VA恶性程度无显著性差异(P>0.05),治疗后两组间VA恶性程度比较有显著性差异(P<0.05)。LVH患者LVMI与QTcd间有显著相关性(r=0.33,P<0.01)。结论 咪达普利治疗可显著降低LVMI和QTcd,从而降低VA的恶性程度。

Objective To investigate the effect of Imidapril on left ventricular mass index(LVMI), heart rate corrected QT interval dispersion(QTcd)and ventricular arrhythmia(VA)in patients with left ventricular hypertrophy(LVH)caused by essential hypertension.Methods 170 hypertenstion patients with LVH were divided randomly into two groups. 86 patients in Amolodipine group were treated routinely. 84 patients in Imidapril group were treated with routine drugs plus Imidapril. LVMI,QTcd of 12 - lead surface ECC and VA malignant degree recorded by Holter were analyzed before therapy and 1 year after therapy.Results In the Amolodipine group, the change of LVMI before and after the therapy was not significant(152±17 g/m2vs 151±17 g/m2, P > 0.05), the change of QTcd before and after the therapy was not significant(75±12 ms vs 73±12ms, P > 0.05). In the Imidapril group, the change of LVMI before and after the therapy was not significant ( 153 ±18 g/m2 vs 140 ?16 g/m2 , P < 0.01) ,the change of QTcd was significant More and after the therapy(74±12 ms vs 65±9 ms, P < 0.05). Before the therapy, QTcd and the malignant degree of VA between the two groups were not significantly different, but both of the indexes between the two groups were significantly different after the therapy. There were significant difference between LVMI and QTcd in patients with LVH caused by hypertension ( r =0.33,P < 0.01) .Conclusion Treatment with Imidapril can significantly reduce the QTcd and the malignant degree of VA in patients with LVH caused by hypertension.