福辛普利与氯沙坦治疗冠心病心衰伴慢性阻塞性肺部疾病的长期疗效和安全性的比较

Comparison of efficacy and safety of fosinopril versus losartan for severe ischemic heart failure with chronic obstructive pulmonary disease

目的 比较福辛普利与氯沙坦治疗冠心病心衰伴慢性阻塞性肺部疾病的长期疗效和安全性。方法 2 17例冠心病心衰伴慢性阻塞性肺部疾病患者住院后经 14天常规抗心衰和抗炎治疗后 ,随机分为 2组 ,甲组加氯沙坦 5 0mg d(10 9例 ) ,乙组加用福辛普利 2 0mg d(10 8例 ) ,并作了长达 2年的远期随访。随访结束时复查了 6分步行试验、生活质量、炎性细胞因子、内皮素等。结果 两组 6分步行距离增加和生活质量改善相同 ,氯沙坦组炎性细胞因子减少显著 ,但是福辛普利减少内皮素更显著 ,差异均有显著性意义 (P <0 0 0 1)。随访结束时 ,仍能保持治疗 8周时的水平 ,氯沙坦组死亡 19例 (17 4 % ) ,福辛普利组死亡 2 3例(2 1 2 % ) ,差异无显著性意义 (P >0 0 5 )。咳嗽加重 :氯沙坦组 4例 ,福辛普利组 14例 ,其中 6例因为剧烈咳嗽退出治疗。结论 福辛普利与氯沙坦长期治疗都能改善冠心病心衰伴慢性阻塞性肺部疾病的生活质量 ,运动耐量 ,减少死亡率 ,但是氯沙坦降低血中炎性细胞因子更明显 。

Objective To compare the long term safety and efficacy of fosinopril and losartan in the treatment of ischemic heart failure with chronic obstructive pulmonary disease(COPD).Methods Two hundreds and seventeen patients with ischemic heart failure with COPD were randomly divided into two groups.All patients were given conventional therapy for congestive heart failure and anti inflammatory drugs consisting of digoxin, nitrates, and spirolactone Patients in the fosinopril group ( n =108) were also given fosinopril 20 mg/d The other 108 patients ( n =109) were given losartan 50 mg/d Symptoms, 6 minutes walk testing, left ventricular ejection fraction (LVEF), quality of life (QOL), and the levels of TNF α,IL 1β,IL 6, and ET were assessed after 8 weeks of treatment and during a mean of 24 months follow up.Results The improvement of quality of life and exercise tolerance were similar in two groups TNF α,IL 1β, and IL 6 levels in plasma in losartan group were more remarkably reduced than those in fosinopril group The decrease in plasma ET 1 level in fosinopril group was more apparently than that in losartan group There was not significant difference in mortality (19 in losartan group vs 23 in fosinopril one, P>0 05 ) during 24 months' treatment Cough aggravated in 4 patients in losartan group and 14 in fosinopril group in which 6 patients were withdrawn of treatment because of terrible cough Conclusion Fosinopril and losartan can improve QOL and decrease mortality, and losartan may be more safe and efficient in decreasing plasma proinflammatory cytokines for patients with ischemic heart failure and COPD