大剂量缬沙坦治疗慢性心力衰竭的疗效和安全性

Therapeutic effect and safety of large dosage of valsartan on chronic heart failure

目的:分析大剂量缬沙坦治疗慢性心力衰竭的临床疗效及安全性。方法:选择我科住院106例慢性心衰患者,根据数字表法随机分为两组:常规剂量组,53例,予以常规剂量(80mg)缬沙坦治疗,1次/d;大剂量组,53例,予以大剂量缬沙坦治疗,80mg,2次/d。两组均按照指南予以抗心衰治疗,疗程6个月。在治疗后测定两组血浆氨基末端脑钠肽前体(NT-proBNP)水平,应用心脏彩色多普勒检测左心室收缩末期内径(LVESd)、舒张末期内径(LVEDd)、室间隔厚度(IVST)和左室后壁厚度(LVPWT)值,以及进行6min步行试验。分析两组治疗后临床疗效及不良反应发生率。结果:与常规剂量组相比,治疗后大剂量组的NT-proBNP水平[(3042.6±116.3)pmol/L比(2565.8±98.2)pmol/L]及LVESd[(34.5±2.2)mm比(29.4±2.0)mm]、LVEDd[(55.1±2.9)mm比(50.2±2.5)mm]、IVST[(12.9±1.8)mm比(10.7±1.2)mm]、LVPWT[(11.8±1.1)mm比(10.9±0.9)mm]显著降低(P均<0.05);大剂量组的6min步行距离[(271.2±24.9)m比(367.7±22.3)m]显著增加,治疗总有效率显著升高(43.40%比62.26%)(P均<0.05),而主要不良反应发生率两组无显著差异(P>0.05)。结论:大剂量缬沙坦治疗慢性心衰更加有效且安全性也较好。

Objective：To analyze the clinical therapeutic effect and safety of large dosage of valsartan on chronic heart failure （CHF）.Methods：A total of 106 CHF patients hospitalized in our department were chosen and ran-domly divided into routine dose group （n=53,received routine dosage of valsartan,80mg,once/d）and large dose group （n=53,received large dosage of valsartan,80mg,twice/d）accerding to number table.Both groups received anti-heart failure treatment for six months according to the guidelines.After treatment,plasma N terminal pro brain natriuretic peptide （NT-proBNP）level was measured,left ventricular end-systolic diameter （LVESd）,left ventricu-lar end-diastolic diameter （LVEDd）,interventricular septal thickness （IVST）and left ventricular posterior wall thickness （LVPWT）were measured by color Doppler echocardiography,and all patients received 6min walking test. Therapeutic effect and incidence rates of adverse reactions were compared and analyzed between two groups after treatment.Results： Compared with routine dose group,there were significant reductions in NT-proBNP level [（3042.6±116.3）pmol/L vs.（2565.8±98.2）pmol/L],LVESd [（34.5±2.2）mm vs.（29.4± 2.0）mm], LVEDd [（55.1±2.9）mm vs.（50.2±2.5）mm],IVST [（12.9±1.8）mm vs.（10.7±1.2）mm]and LVPWT [（11.8±1.1）mm vs.（10.9±0.9）mm];significant rise in 6min walking distance [（271.2±24.9）m vs.（367.7 ±22.3）m]and total effective rate （43.40% vs.62.26%）in large dose group,P 〈0.05 all.There was no signifi-cant difference in incidence rates of major adverse reactions between two groups （P 〉0.05）.Conclusion：Large dos-age of valsartan is more effective and is safe in treatment of chronic heart failure.