血管紧张素Ⅱ受体拮抗剂对心力衰竭患者的疗效

Effect of angiotensin-Ⅱ-receptor antagonists used in patients with chronic congestive heart failure

目的:探讨不能耐受血管紧张素转换酶抑制剂(ACEI)的慢性充血性心力衰竭(CHF)患者(NYHA分级Ⅲ～Ⅳ级,射血分数<40%)血管紧张素Ⅱ受体拮抗剂(ARB)治疗和长期规律随访的效果。方法:前瞻性长期随访23例不能耐受ACEI的CHF患者接受ARB治疗和31例应用ACEI治疗患者的疗效,并比较两组患者的临床资料和ARB组生存患者治疗5年前后的临床资料。结果:(1)ARB组与ACEI组5年死亡率无明显差别(52.17%∶48.39%,P>0.05);(2)ARB组中高龄、肌酐清除率(Ccr)降低的患者死亡率高(P<0.01);(3)ARB组中NYHA分级Ⅲ～Ⅳ级、射血分数<40%的患者大多死于心力衰竭恶化(75%),而猝死和明确死于室性心律失常的患者占死亡总数的25%;尽管规范地进行抗心力衰竭药物治疗,5年死亡率仍高达52.17%。长期接受ARB治疗的生存患者,其射血分数较治疗前明显增加[(32.5±1.6)%∶(44.5±3.2)%,P<0.01]、左心室舒张末期内径明显缩减[(66.3±2.0)%∶(60.2±2.9)%,P<0.05],NYHA分级显著改善(P<0.05)。结论:部分不能耐受ACEI的CHF患者可能从ARB长期治疗中获益。

Objective： To evaluate the effect of angiotensin- Ⅱ -receptor antagonists （ARB） in patients with chronic congestive heart failure （CHF） who were intolerant to angiotensin-converting enzyme inhibitors （ACEI）. Methods.. The 23 cases （NYHA Ⅲ-Ⅳ, ejection fraction〈40%） intolerant to ACEIs and given by ARBs had been regularity followed up for 5 years （ARB group）. The CHF cases treated with ACEI were regard as control group. Clinical characteristics were compared between two groups. The data before and after five years in survival CHF patients of ARB group were also studied. Results： （1） The mortality of ARB group was not significantly different from that of ACEI group （52.17% ： 48.39%, P〉0.05） ; （2） There were higher mortality in older patients and with lower creatinine clearance rate （Ccr） （P〈0. 01） in patients used ARBs; （3） The patients mostly died from deterioration of heart function （75 % ） and the five-year mortality was 52.2 % in ARB group. The LVEF and left ventricular end-diastolic dimension （LVEDd） of the survival CHF patients were better than those of five-year before in ARB group （P〈0.05-〈 0.01）. Conclusion： Patients with CHF intolerant to ACEI would have a better prognosis if given ARB long-term.