螺内酯对高血压患者心室及血管重构的影响被引量：4

Influece of spironolactone on ventricular and vascular remodeling in hypertension patients

下载PDF

导出

摘要目的观察螺内酯对心室及血管重构的影响。方法选取伴左心室肥厚(LVH)及颈动脉内中膜(IMT)增厚患者106例,在经两周药物洗脱期后,平分为观察组(53例)与对照组(53例)。观察组给予硝苯地平控释片(拜新同)30mg/d,螺内酯10～20mg/d,倍他乐克12.5～25mg/d;对照组给予硝苯地平控释片(拜新同)30mg/d,氢氯噻嗪12.5～25mg/d,倍他乐克12.5～25mg/d;所有对象治疗前后均测左室舒张末内径(LVEDd)、室间隔厚度(IVST)、左室后壁舒张末期厚度(LVPWT),左心室重量指数(LVMI),射血分数(EF),颈动脉内中膜厚度(IMT),颈动脉内径,颈动脉内中膜/血管内径(IMT/R),使用EpiData(中文版)进行数据管理并行统计分析。结果两组治疗后各指标有明显差异(P<0.05),IMT、IMT/R的变化值与LVMI呈正相关,与EF的变化值呈负相关。结论 IMT、颈动脉内径、IMT/R的变化值水平可反映左室重构和左心功能。螺内酯对血管重构抑制和逆转心室,改善心功具有显著作用。 Objective To observe influece of spironolactone on ventricular and vascular remodeling in hypertension patients. Methods 106 hypertension patients with left ventrieular hypertrophy （LVH） and carotid artery intima （IMT） thickening were divided into observation group （53 eases） and control group （53 cases）. Observation group were given nifedipine GITS （Adalat） 30mg/d, spironolactone 10-20rag/d, metoprolol 12.5-25mg/d and the control group were given nifedipine GITS （Adalat） 30mg/d, hydrochlorothiazide 12.5-25mg/d, metoprolol 12.5-25mg/d. The left ventricular enddiastolic diameter （LVEDd）, interventricular septal thickness （IVST）, left ventricular posterior wall diastolic thickness （LVPWT）, left ventricular mass index （LVMI）, ejection fraction （EF）, carotid intima-media thickness （1MT）, carotid diameter, carotid artery intima/vessel diameter （IMT/R） were measured with EpiData （Chinese version） for data management. Results After treatment, all indicators were significant differences （P〈0.05）. IMT and IMT/R were positively correlated with LVMI and negatively correlated with EF. Conclusion IMT, carotid diameter and IMT/R value level may reflect changes in left ventricular remodeling and left ventricular function. Spironolaetone has a significant effect on inhibition and reversal of ventricular and vascular remodeling and improvement of cardiac function.

作者朱秀兰

机构地区璧山县人民医院心内科

出处《西部医学》 2012年第7期1334-1336,共3页 Medical Journal of West China

关键词螺内酯高血压心室重构 Spironolactone Hypertension Ventricular remodeling

分类号 R544.1 [医药卫生—心血管疾病]

引文网络
相关文献

参考文献13

1Ouvrard-Pascaud A,Sainte- Marie Y, Bhnitah JP, et al. Condi- tional mineralocortieoid receptor expression in the heart leads to life-, threatening arrhythmias [J]. Circulation, 2005,111 : 3025- 3033.
2Uzunhasan I, Yildiz A, Coskun U, et al. Effects of aldosterone blockade on left ventrieular function and clinical status during a- cute myocardial infarction [J]. Scand J Clin Lab Invest,2009, 69:545- 549.
3UdeLson JE,Patten RD,Konstam MA. New concepts in post- in- farction ventrie-ular remodeling[J]. Rev Cardiovasc Med,2003, 4(3) :3-12.
4Brilla CG,Pick R,Tan LB,etal. Remodeling of the rat right and left ventricle in experimental hypertension[J]. Circ Res, 1990, 67:1335-1364.
5Muto T,Ueda N,Opthof T,et al. Aldosterone modulates I(f) current through gene expression in cultured neonatal rat ventric- ular myocytes[J]. Am J Physiol Heart Circ Physiol, 2007,293 : 2710- 2718.
6冯惠平,崔炜,单保恩,都军,郝玉明.醛固酮对新生大鼠心肌成纤维细胞分泌ET、NO和TGF-β_1功能的影响[J].高血压杂志,2004,12(5):432-435. 被引量：5
7常连庆,谢晓华.醛固酮诱导心肌肥大的机[J].高血压杂志,2003,11(5):415-418. 被引量：12
8Khan NU,Movahed A. The role of aldosterone and aldosterone receptor antagonists in heart failure[J]. Rev Cardiovasc Med, 2004,5: 71-81.
9Cicoira M,Zanolla L,Rossi A,et al. Failure of aldosterone sup- pression despite angiotensin 2 converting enzyme (ACE) inhibi- tor administration in chronic heart failure is associated with ACE DD genotype[J]. J Am Coil Cardiol,2001,37 : 1808-1812.
10Hayashi M, Tsutamoto T, Wada A, et al. Relationship be- tween transcardiac extraction of aldosterone and left ventricular remodeling: extracting aldosterone through the heart promotes ventrieular remodeling after acute my ocardial in farction[J]. J Am C oll Cardiol, 2001,38(5) :1375.

二级参考文献47

1刘力生.2004年中国高血压防治指南(实用本)[J].中华心血管病杂志,2004,32(12):1060-1064. 被引量：2619
2Takeda Y, Yoneda T, Demura M, et al. Calcineurin inhibition attenuates mineralocorticoid-induced cardiac hypertrophy [J ]. Circulation ,2002,105(6) :677 - 9.
3Muscholl MW, Schunkert H, Muders F, Elsner D, et al. Neuro-hormonal activity and left ventricular geometry in patients with essential arterial hypertension[J ]. Am Heart J, 1998,135( 1 ) : 58 - 66.
4Tsutamoto T, Wada A, Maeda K, et al. Effect of spironohctone on plasma brain natriuretic peptide and left ventricular remodeling in patients with congestive heart failure[J ]. J Am Coil Cardiol, 2001,37(5) : 1228 - 33.
5Pitt B, Zannad F, Remme WJ, et al. The effect of spironolaetone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators[J ]. N Engl J Med,1999,341(10) :709 - 17.
6TakedaY, Miyamori I, InabaS, et al. Vascular aldoaterone in gentically hypertensive rats[J ]. Hypertens, 1997,29:45 - 48.
7Weber KT, Sun Y,Guarda E. Structural remodeling in hypertensive heart disease and the role of hormones[J]. Hypertens, 1994,23 (part 2) :869 - 877.
8Takeda Y, Yoneda T, Demura M, et al. Cardiac aldosterone production in genetically hypertensive rats[ J ]. Hypertens, 2000,36 ( 4 ) : 495 - 500.
9Pasquale PD, Stefano GD, Paterna S. Mineralocorticoids and cardiovascular diseases. Status of knowledge from experimental and clinical studies[ J ]. Ital Heart J, 2000,1 (9) : 595 - 604.
10Tanabe A, Naruse M, Naruse K, et al. Left ventricular hypertrophy is more prominent in patients with primary aldosternism than in patients with other types of secondary hypertension [ J ]. Hypertens Res, 1997, Jun, 20(2) :85 - 90.