不同剂量血管紧张素Ⅱ1型受体拮抗剂对急性心肌梗死后左心室重构的远期疗效

The Long-Term Effects of the AngiotensinⅡ Receptor Blocker Therapy on the Left Ventricular Remodeling and Function After Acute Myocardial Infarction

目的 :探讨不同剂量的血管紧张素Ⅱ1型 (AT1)受体拮抗剂对急性心肌梗死后左心室重构及心功能保护的远期疗效。 方法 :选择首次急性心肌梗死患者 12 0例 ,所有病例在常规治疗基础上 (包括硝酸酯类、β受体阻滞剂、阿司匹林、低分子肝素 ) ,随机分为卡托普利组 :12 5～ 2 5mg ,每日 3次 ;缬沙坦 1组 :缬沙坦 80mg ,每日 1次 ;缬沙坦 2组 :缬沙坦 160mg ,每日 1次。所有患者分别于治疗 1、 6、 12、 18个月对心室重构及心功能有关指标进行检测 ,并同时检测血浆血管紧张素Ⅱ (AngⅡ )、醛固酮浓度。 结果 :治疗 12、 18个月 ,缬沙坦 1、 2组与卡托普利组比较 ,左心室重构各指标 (除外缬沙坦 1组 12个月左心室舒张末期内径指标 )、心功能各指标 (除外缬沙坦 1组 12个月左心室射血分数、每搏输出量指标 )均有显著性差异 (P <0 0 5 ,P <0 0 1) ;用药 18个月不同剂量缬沙坦比较 ,缬沙坦 2组较缬沙坦 1组上述指标亦均有显著性差异 (P <0 0 5 )。血浆AngⅡ水平治疗 6、 12、 18个月缬沙坦 1、 2组和卡托普利组均较治疗前升高 ,其中缬沙坦 1、 2组升高明显 ,且有极显著性差异 (P <0 0 1) ;血浆醛固酮水平与治疗前相比 3组治疗 1、 6个月时开始降低 ,治疗 12、 18个月时卡托普利组逐渐升高

Objective:To investigate the long term effects of angiotensin Ⅱ receptor blocker therapy with different dosages to prevent left ventricular remodeling and protect cardiac function in patients with acute myocardial infarction. Methods:In 120 patients with first acute myocardial infarction,in addition to conventional therapy, including nitroxide drugs,beta blockers and aspirin,the patients were randomly divided into captopril group and angiotensin Ⅱ receptor valsartan group (assigned to receive 80 mg or 160mg daily) .The parameters of ventricular function were measured by echocardiography at 1,6,12 and 18 months after treatment.In the meantimes,plasma aldosterone and angiotensinⅡ were measured. Results:Compared with a proven effective dose of captopril,there were significant differences in le t atrial dimen ion (LA) ,le t ventricular end dia tolic dimen ion (LVEDd) ,intervencricular eptal dia tolic thickne (IVSd) ,le t ventricular po terior wall dia tolic thickne (LVPWd) ,le t ventricular ma inde (LVMI) Q and le t ventricular ejection raction (LVEF) in valsartan group after one year treatment ( p<0 05,p<0 01 ) Q .The clinical outcomes were related to dosages ( p<0 05 ) .The level of angiotensinⅡ increased in the three groups at 6,12 and 18 months.At end point,aldosterone increased in the captopril group and decreased in the valsartan group ( p <0 001) . Conclusion:AngiotensinⅡ receptor blocker valsartan is as effective as captopril in preventing left ventricular remodeling and improving cardiac function.The long term improved outcome may be superior to that of angiotensin converting enzyme inhibitor captopril.