培哚普利联合安体舒通对高血压致左心房重塑的影响

Effects of perindopril plus spironolactone on left atrial remodeling in hypertension patients with enlarged left atrium

目的探讨培哚普利联合安体舒通在高血压致左心房增大时对左房重塑的影响,从而认识血管紧张素受体拮抗剂及醛固酮受体拮抗剂在心房重塑中的作用。方法106例高血压致左心房增大患者随机分为观察组和对照组,每组53例。观察组用培哚普利4～8mg.d-1联合安体舒通20mg.d-1治疗,对照组用其他降压药治疗,观察治疗前、治疗1年后心房大小的改变及血脑钠肽、血管紧张素Ⅱ、醛固酮、血清钾浓度的变化。采用竞争酶联免疫分析测定法测定血脑钠肽水平,采用放射免疫分析法测定血管紧张素Ⅱ、醛固酮水平。结果治疗1年后观察组左心房内径与治疗前比较明显减小[分别为(36.02±1.79)和(36.91±2.20)mm,P<0.05];血脑钠肽、血管紧张素Ⅱ,醛固酮水平也明显降低[分别为(78.41±11.02)和(86.58±9.45)pg.ml-1,(89.88±10.13)和(94.49±8.76)pg.ml-1,(69.82±11.30)和(77.83±10.93)pg.ml-1,均P<0.05]。治疗1年后对照组左心房内径减小不明显[分别为(36.89±2.38)和(37.26±2.41)mm,P>0.05];血浆脑钠肽、血管紧张素Ⅱ、醛固酮水平升高[分别为(89.40±10.78)和(85.26±8.29)pg.ml-1,(97.48±13.84)和(92.08±7.13)pg.ml-1,(82.23±10.37)和(77.13±10.41)pg.ml-1,均P<0.05]。两组之间比较,治疗1年后观察组左房内径小于对照组(P<0.05),血浆脑钠肽、血管紧张素Ⅱ、醛固酮水平低于对照组(均P<0.01)。结论血管紧张素受体拮抗剂培哚普利、醛固酮受体拮抗剂安体舒通对左房重塑有治疗意义。

Objective To explore the effects of perindopril plus spironolactone on left atrial remodeling in hypertension patients with enlarged left atrium.Methods One hundred and six hypertension patients with enlarged left atrium were randomly divided into trail group and contral group.53 patients in trail group were treated with perindopril 4~8 mg·d-1 combined with spironolactone 20 mg·d-1 for one year,and 53 patients in contral group were treated with other drugs.Left atrium size,blood brain natriuretic peptide(BNP),Angiotensin Ⅱ(AngⅡ)and Aldosterone(Ald)were obtained to analysis.Blood BNP level was determined by competitive enzyme-labeled immunosorbent assay,Ang Ⅱ and Ald levels were determined by radioimmunoassay.Results After therapy,the left atrium size in trail group was significantly shorter than before therapy[(36.02±1.79)vs(36.91±2.20)mm,P<0.05],and blood BNP,Ang Ⅱ,Ald were significantly decreased [(78.41±11.02)vs(86.58±9.45)pg·ml-1,(89.88±10.13)vs(94.49±8.76)pg·ml-1,(69.82±11.30)vs(77.83±10.93)pg·ml-1 respectively,all P<0.05].For contral group,there was no significant differences in left atrium size[(36.89±2.38)vs(37.26±2.41)mm,P>0.05];there were significant differences in blood BNP,Ang Ⅱ,Ald[(89.40±10.78)vs(85.26±8.29)pg·ml-1,(97.48±13.84)vs(92.08±7.13)pg·ml-1,(82.23±10.37)vs(77.13±10.41)pg·ml-1 respectively,all P<0.05].Significant differences were also oberseved between theary group and control group in left atrium size,blood BNP,Ang Ⅱand Ald after therapy.Conclusion It is an effective and reasonable way to treat the hypertension patients with enlarged left atrium with combination therapy of perindopril plus spironolactone.