急性心肌梗死后不同剂量血管紧张素Ⅱ1型受体拮抗剂早期干预对心功能和神经激素的影响

Long-term effects of angiotensinⅡ receptor blocker therapy on cardiac function and neurohormones at early stage of acute myocardial infarction

目的探讨急性心肌梗死后不同剂量的血管紧张素Ⅱ1型(AT1)受体拮抗剂早期干预对心功能和神经激素的影响。方法选择首次急性心肌梗死患者120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(C)组40例,口服卡托普利12.5～25mg,每日3次;缬沙坦(D1)组40例,口服缬沙坦80mg,每日1次;缬沙坦(D2)组40例,口服缬沙坦160mg,每日1次。分别于治疗1、6、12、18个月对所有患者的心功能有关指标进行检测,并同时检测血浆血管紧张素Ⅱ、醛固酮浓度。结果治疗12、18个月,缬沙坦D1、D2组与卡托普利组比较,心功能各项指标(除外缬沙坦D1组12个月左心室射血分数、左心室舒张末期容量)差异均有统计学意义(P<0.05,P<0.01);用药18个月缬沙坦不同剂量组间比较,D2组较D1组上述指标差异亦均有统计学意义(P<0.05)。缬沙坦两组和卡托普利组血浆血管紧张素Ⅱ(AngⅡ)水平治疗6、12、18个月均较治疗前升高,其中缬沙坦两组升高明显,差异有统计学意义(P<0.01);3组血浆醛固酮水平与治疗前相比,治疗1、6个月时开始降低,治疗12个月时卡托普利组逐渐升高,缬沙坦两组仍明显减低,差异有统计学意义(P<0.001)。结论AT1受体拮抗剂缬沙坦与血管紧张素转换酶抑制剂卡托普利一样,早期应用能有效改善急性心肌梗死后心室重构,保护心功能,其远期疗效可能优于卡托普利,且随着剂量增加疗效增强。

Objective To investigate the long-term effects of angiotensin Ⅱ receptor blocker therapy with different dosages on the cardiac function and neurohormones at the early stage of acute myocardial infarction. Methods In 120 patients with first acute myocardial infarction, in addition to conventional therapy, including nitroxide drugs, beta-blockers, aspirin,the patients were divided into captopril group and angiotensin Ⅱ receptor valsartan group (assigned to receive 80 mg or 160 mg daily) at random. The parameters of ventricular function were measured by echocardiography at 1,6,12 and 18 months after treatment. In the meantime, plasma aldosterone and angiotensinⅡ were measured. Results Compared with a proven effective dose of captopril, there were significant differences in LVEF,LVCO,LVEsV,LVEdV in valsartan group after one-year treatment(P< 0.05,P< 0.01). The clinical outcomes were related to dosages(P< 0.05,P< 0.01). The level of angiotensin Ⅱ increased in the three groups at 6,12 and 18 months. At the end point,the level of aldosterone increased in 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 outcomes may be superior to that of angiotensin-converting enzyme inhibitors captopril.