螺内酯对急性心肌梗死患者心室重塑的影响

Effect of Spironolactone on the left ventricular remodeling of patients with acute myocardial infarction

目的:探讨早期应用醛固酮受体拮抗剂螺内酯干预对急性心肌梗死患者左室重构(LVRM)的影响。方法:93例急性心肌梗死患者随机分为螺内酯组(49例)和对照组(44例),螺内酯组在常规治疗的基础上加用螺内酯40mg/d,对照组给予常规治疗。分别在发病1周、3个月、6个月干预期内检测两组左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)和左心室射血分数(LVEF)。结果:治疗6个月时螺内酯组左室舒张末期内径、左室收缩末期内径较对照组明显降低[两组左室舒张末期内径分别为(51.1±4.3)mm和(54.4±4.8)mm,P<0.05;左室收缩末期内径分别为(37.3±4.6)mm和(41.8±4.9)mm,P<0.05]。左心室射血分数明显升高[分别为(52.6±4.6)%和(47.2±4.9)%,P<0.05]。结论:急性心肌梗死患者在常规治疗基础上早期加用小剂量醛固酮受体拮抗剂螺内酯治疗后可抑制心肌梗死患者左室的扩张和纤维化,防止发生左室重构。

Objective： To investigate the effect of aldosterone receptor antagonist Spironolactone on the left ventricular remodeling （LVRM） of patients with acute myocardial infarction （AMI）. Methods： 93 cases of AMI were randomly divided into Spironolactone group （n=49） and control group （n=44）. The Spironolactone group was given 40 mg/d Spironolactone on the basis of routine treatment, and the control group was given only routine treatment. All patients of the two groups were measured left ventricular end-diastolic diameter （LVEDD）, left ventricular end-systolic diameter （LVESD） and ejection fraction （LVEF） on the 1 st week, 3rd and 6th month. Results： After intervention for 6 months, the Spironolactone group had a lowered LVEDD and LYESD compared with the control group [the LYEDD were （51.1±4.3） mm and （54.4±4.8） mm respectively, P〈0.05; the LVESD were （37.3±4.6） mm and （41.8±4.9） mm respectively, P〈0.05]; LVEF was significant improved [the LVEF were （52.6±4.6）% and （47.2±4.9）% respectively, P〈0.05]. Conclusion： These findings indicate that in patients with AMI, Spironolactone combined with routine treatment can restrain left ventricular dilatation and fibrosis, and prevent left ventricular remodeling.