伊贝沙坦对扩张型心肌病患者心率变异性和血浆肾素血管紧张素醛固酮系统的影响

Influence of irbesartan on heart rate variability and renin-angiotensin-aldosterone system in patients with dilated cardiomyopathy

目的探讨血管紧张素Ⅱ受体拮抗剂伊贝沙坦对扩张型心肌病（DCM）患者心率变异性（HRV）、肾素、血管紧张素Ⅱ（AngⅡ）及醛固酮（ALD）的影响。方法47例DCM患者分为观察组（n=27例）和对照组（n=20例），对照组常规应用利尿剂、血管紧张素转换酶抑制剂、β-受体阻滞剂及硝酸酯类药物治疗，观察组在对照组用药基础上加用伊贝沙坦75—150mg，每日1次，连续治疗3个月。检测2组治疗前后HRV指标、肾素AngⅡ及ALD水平。结果2组治疗前HRV各指标、肾素、AngⅡ、ALD及LVEF比较差异无统计学意义（P〉0．05）；与治疗前比较，观察组治疗后NN间期标准差（SDNN）、NN间期平均值标准差（SDANN）、相邻NN间期差值的均方根（Rmssd）、相邻NN间期差值〉50ms的心搏数占NN间期总搏数的百分比（pNN50）均有显著提高（P〈0．05），对照组治疗后除rMSSD外，SDNN、SDANN、pNN50有显著提高（P〈0．05），2组治疗后血浆肾素活性、AngⅡ、ALD水平均明显降低（P〈0．05），LVEF明显提高（P〈0．05）；治疗后观察组SDNN、SDANN、rMSSD与pNN50明显高于对照组（P〈0．05），AngⅡ、ALD水平低于对照组（P〈0．05）。结论伊贝沙坦可以有效改善DCM患者的HRV并降低ALD，进一步改善患者的心功能。

Objective The investigate the influence of angiotensin Ⅱ type receptorblocker irbesartan on heart rate variability（ HRV）, renin, angiotensin Ⅱ（ Ang Ⅱ） and aldosterone （ALD） in patients with dilated cardiomyopathy （ DCM ）. Methods Forty-seven cases of DCM were divided into observation group （27 cases） and control group （20 cases）. The patients in both group were treated with diuretic,angiotensin-converting enzyme inhibitor,13-acceptor blocker and nitrates,based on this, the patients in observation group were treated with 75 -150 mg irbesartan for three months, once a day. HRV, Ang Ⅱand ALD were measured before and after treatment. Results There were no statistical significance in HRV, renin, Ang Ⅱ, ALD and left ventricular ejection fraction（LVEF） between two groups before treatment（P 〉 0.05 ）. Compared with pretreatment, standardized deviate of normal-to-normal interval （ SDNN）, standardized deviate of average normal-w-normal interval （ SDANN）, mean square of short value（rMSSD） and percentage of normal-to-normal interval exceed fifty（pNN50） were higher in observation group after treatment（P 〈0.05） ;Effect rMSSD,SDNN,SDANN and pNN50 were higher in control group after treatment（P 〈0.05） ;Plasma renin activity, Ang Ⅱand ALD degraded, LEVEF increased in two groups after treatment （ P 〈 0.05 ）. Compared with control group,SDNN ,SDANN,rMSSD and pNN50 were higher, Ang Ⅱand ALD were lower in observation group after treatment （P 〈 0. 05）. Conclusion Irbesartan may improve HRV and heart function, and decrease aldosterone in patients with DCM.