氯沙坦和卡托普利对急性心肌梗死后左室重塑影响的对比研究

Effects of losartan and captopril on the left ventricular remodeling following acute myocardial infarction

目的 对比血管紧张素II(AngII)受体拮抗剂和血管紧张素转换酶抑制剂 (ACEI)对急性心肌梗死 (AMI)后左室重塑的阻抑作用。方法 将 10 0例AMI患者随机分为常规治疗组 2 0例、卡托普利治疗组 40例、氯沙坦治疗组 40例 ,并于AMI后 1周、4周、2 8周分别进行超声心动图、平衡法核素心室造影和心室相位分析 ,测定左室心肌重量、左室收缩功能、舒张功能和左室收缩同步性功能参数 ,了解二者对AMI后左室重塑的阻抑作用。结果 ⑴AMI后 2 8周时卡托普利组和氯沙坦组与常规治疗组比较室间隔厚度、左室后壁厚度、左室舒张末内径和左室心肌重量指数均明显降低 ,且卡托普利与氯沙坦作用相似。⑵AMI后 2 8周时 ,氯沙坦治疗组与对照组比较左室射血分数增加 32 .3 %(P <0 .0 1) ,左室峰射血率时间下降 15 .3 % (P <0 .0 5 ) ,同时左室高峰充盈率升高 44 .8% (P <0 .0 1) ,左室高峰充盈率时间下降 2 1.3% (P <0 .0 1)。⑶AMI后 2 8周时氯沙坦组和卡托普利组相位延迟减轻 ,左室相角程、左室半高宽、左室峰相位标准差亦明显减少 ,且两药间差别无显著性。结论 AngII受体拮抗剂氯沙坦能明显减轻心肌梗死后心肌肥厚和左室重塑 ,阻抑左室重塑过程 ,提高左室收缩的同步性 ,改善左室功能 。

Objective To compare the inhibitory effects of angiotension II antagonist(AngIIA) losartan versus angiotensin converting enzyme inhibitors(ACEI) captopril on left ventricular remodeling(LVRM) after acute myocardial infarction(AMI). Methods A total of 100 patients with AMI were entered into the study. 20 patients were randomized to conventional treatment group, 40 patients to captopril treatment group and 40 patients to losartan treatment group. At 1st week, 4th week and 28th week after AMI, the left ventricular myocardium weight(LVMW) were measured by echocardiogram,and the parameters of left ventricular systolic and diastolic function (LVSF and LVDF) were measured by equilibrium radionuclide angiography(ERNA) with the ventricular phase analysis(PA). Results ⑴ At 28th week, IVST, LVPWT, LVDd and LVMI in losartan and captopril treatment groups were significantly decreased as compared with conventional treatment group ,and there was no difference in all of the parameters between the losartan and captopril treatment groups. ⑵ At 28th week, LVEF and LPFR in losartan treatment group were significantly increased by 32.32% and 44.78%( P <0.01) as compared with those in conventional treatment group, respectively. LPS, LFWHM and LPSD in losartan group were decreased by 29.8%, 50.8% and 23.3% as compared with the conventional treatment group, respectively. But there was no difference in the parameters between losartan and captopril groups. Conclusion Losartan might significantly reduce myocardial hypertrophy and dilatation of left ventricle,inhibit LVRM following AMI and improve the left ventricular systolic synchrony ,LVSF and LVDF,while the inhibitory effect on LVRM of losartan was similar to captopril.