螺内酯抑制急性前壁心肌梗死患者的左室重构

Spironolactone inhibits the left ventricular remodeling in patients with acute anterior myocardial infarction

目的探讨急性前壁心肌梗死患者口服螺内酯对于左室重构的影响。方法将急性前壁心肌梗死患者随机分为两组。对照组30例,接受血管紧张素转换酶抑制剂、β-受体阻滞剂、抗血小板、调脂药物等常规处理。螺内酯组30例,在常规治疗基础上加用螺内酯(40mg,每日1次)。随访1年,并检测脑钠尿肽(BNP)及超声心动图以评价左室功能和左室容积。结果6和12月时螺内酯组血清BNP水平明显低于对照组[(355±74)ng/Lvs(418±77)ng/L,P<0.05和(316±72)ng/Lvs(389±67)ng/L,P<0.05],且12月时螺内酯组较对照组左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)明显缩小[LVEDD:(49±6)mmvs(53±5)mm,P<0.05;LVESD:(37±5)mmvs(40±4)mm,P<0.05]。结论螺内酯可抑制急性前壁心肌梗死患者左室重构。

AIM To investigate the effect of Spironolactone on the left ventricular remodeling （LVRM） in patients with acute anterior myocardial infarction. METHODS Sixty patients with （AMI） were randomly divided into two groups by stratified random sampling. Thirty patients in contrast group received regular treatments of angiotensin converting enzyme inhibitor （ACEI） , β-receptor blocker, plus antiplatelet and lowering lipid drugs while 30 patients in experimental group were given Spironolactone （40 mg, qd） on the basis of the treatment in contrast group. During a one-year follow-up, plasma BNP levels were measured with eletrochemistry luminescent technique and echocardiogram was performed to evaluate the left ventricular function and volume. RESULTS The plasma BNP levels in experimental group decreased significantly compared with those in contrast group at the 6th and at the 12 th month [ （355 ±74） ng/L vs （418 ±77） ng/L, P 〈0.05 and （316 ±72） ng/L vs （389 ±67） ng/L, P 〈0.05]. The lift ventrieular end-diastolic diameter（LVEDD） and lift ventricular end-systolic diameter（LVESD） at the 12 th month in experimental group decreased significantly compared with those in contrast group. [LVEDD： （49 ±6） mm vs （53 ±5） ram, P 〈0. 05; LVESD： （37 ±5） mm vs （40 ±4） mm, P 〈0.05]. CONCLUSION Spironolaetone inhibits LVRM in patients with acute anterior myocardial infarction.