氯沙坦(科素亚)对充血性心力衰竭患者肾素—血管紧张素系统的影响

The efficacy of losartan on renin-angiotension system of patients with congestive heart failure

目的 :研究氯沙坦 (Losartan)对充血性心力衰竭 (CHF)患者心功能以及肾素—血管紧张素系统 (RAS)的影响 ,并与卡托普利 (Captopril)比较 ,联合用药是否更具优越性。方法 :将 90例患者随机分成氯沙坦组 (A组 ,n =30 ) ,给予氯沙坦 2 5mgqd ,无不良反应 ,1周后增加至 5 0mg ;卡托普利组 (B组 ,n =30 )给予卡托普利 12 .5～ 2 5mgtid ;氯沙坦联合卡托普利组 (C组 ,n =30 ) ,给予氯沙坦 2 5mgqd .卡托普利 12 .5mg～ 2 5mgtid。三组疗程均为 8周。治疗前后观察临床疗效、心率、血压、左室射血分数(LVEF)、X线心胸比和RAS指标 ;血浆肾素活性 (PRA)、血管紧张素Ⅱ (AngⅡ )、醛固酮 (ALD)的变化。结果 :A组总有效率 93.3% ;B组总有效率 90 .0 % ;C组总有效率 96 .7%。心功能指标LVEF、X线心胸比、心率三组治疗后与治疗前相比 ,均明显改善 (P <0 .0 5 ) ,治疗后C组均优于A、B组 (P <0 .0 5 ) ,RAS指标治疗后与治疗前相比 :A组浆PRA升高 (P <0 .0 5 ) ,AngⅡ升高、ALD降低 (P <0 .0 1) ;B组血浆PRA升高 (P <0 .0 5 )、AngⅡ、ALD降低 (P <0 .0 1) ;C组血浆PRA升高 (P <0 .0 5 ) ,AngⅡ、ALD降低 (P <0 .0 1)。结论 :氯沙坦能有效治疗CHF及改善RAS ,而其联合卡托普利效果优于二者单独应用。

Objective: To investigate the efficacy on cardiac function and activity of renin-angiotension system ( RAS ) of patients with congestive heart failure(CHF)after taking oral dose of losartan、 captopril and both of them,respectively,and to examine whether combination of two drugs may have superiority. Methods: 90 patients with CHF were divided randomly into 3 groups:losartan group(group A)was treated with losartan(n=30,25mg,1/d);captopril group(group B) was treated with captopril(n=30,12.5mg～25mg,3/d);a combination of the two drugs( group C) was treated with losartan(25mg,1/d)and captopril(12.5mg～25mg,3/d).Before and 8 weeks after treatment their clinical effect , heart rate,blood pressure, the left ventricular ejection fraction (LVEF) , heart-thorax ratio were measured, and levels of plasma rennin activity(PRA),angiotensionⅡ(AngⅡ), aldosterone(ALD)were estimated. Results: The total effective rate of group A was 93.3%,the total effective rate of group B was 90.0%,and the total effective rate of group C was 96.7%,respectively.and LVEF, heart-thorax ratio were significantly improved than those before the treatment in three groups(P<0.05) , the group C was superior to group A and group B (P<0.05). Compare to those before the treatment,there were statistical different of markers of RAS: A distinct decline of ALD levels (P<0.05) and mild elevation PRA were observed in three groups(P<0.05),group A caused a rise of AngⅡ level(P<0.01), while other groups were decreased(P<0.01).Conclusion: Losartan have a benefit on CHF, as well as improve the activity of RAS;and combination therapy with losartan and captopril were more effecttive than other groups.