贝那普利治疗慢性充血性心力衰竭患者最佳剂量

The best dose of benazepril in treatment of chronic congestive heart failure

目的观察不同剂量贝那普利治疗慢性充血性心力衰竭（CHF）的疗效。方法入选2013年3月至2015年5月在河北医科大学哈励逊国际和平医院门诊就医的轻中度CHF患者240例,其中男126例,女114例,年龄60-81岁,平均（73.40±6.35）岁,病程3-15年。按照随机对照的原则分为A组（76例）、B组（86例）、C组（78例）三个治疗组。三组间基础疾病、诱因、年龄、性别及心功能状况等临床资料比较,差异无统计学意义（P均〉0.05）,具有可比性。三组患者均进行基础治疗。同时A组给予贝那普利5 mg,1/日;B组给予贝那普利10 mg,1/日,观察3周后若收缩压〉90 mm Hg（1mm Hg=0.133k Pa）,未发生低血压,血肌酐升高不超过50%基线水平,则继续治疗;如果患者不耐受,贝那普利可恢复至5 mg治疗;C组给予贝那普利20 mg,1/日,同时观察患者耐受情况。连续治疗12个月后进行疗效评估和记录不良反应。治疗前后测定左室射血分数（LVEF）、左室舒张末期内径（LVEDD）及左室收缩末期内径（LVESD）,6 min步行试验距离和脑钠肽（BNP）水平。结果 A组患者总有效率为80.2%,B组为87.2%,C组为96.1%。总有效率C组较A组和B组升高,差异有统计学意义（P均〈0.05）。与治疗前比较,三组患者治疗后LVEDD、LVESD、LVEF均改善,差异有统计学意义（P均〈0.05）。与A组和B组比较,C组LVEDD、LVESD、LVEF指标改善更明显,差异有统计学意义（P均〈0.05）。与治疗前比较,三组治疗后BNP水平下降,6 min步行距离增加,差异有统计学意义（P均〈0.05）。与A组和B组治疗后比较,C组BNP水平下降,6 min步行距离增加,差异有统计学意义（P均〈0.05）。结论贝那普利20 mg较5 mg和10 mg治疗慢性充血性心力衰竭更有效,更有效地改善心功能,安全性较好。

Objective To observe the curative effect of benazepril in different doses in treatment of chronic congestive heart failure （CHF）. Methods CHF patients with disease course from 3 y to 15 y （n=240, male 126, female 114, aged from 60 to 81 and average age=73.40 ＋ 6.35） were chosen from Mar. 2013 to May 2015. The patients were randomly divided into group A （n=76）, group B （n=86） and group C （n=78）, and the comparison in basic diseases, cause, age, sex and heart function had no statistical difference among 3 groups （all P〉0.05）. Besides of basic therapy, group A were given benazepril （5 mg, qd）, group B, （10 rag, qd） and group C （20 mg, qd）. After treatment for 12 m, the curative effect was reviewed and adverse reactions were recorded. The levels of left ventricular ejection fraction （LVEF）, left ventricular end-diastolic inner diameter （LVEDd）, left ventricular end-systolic diameter （LVESd）, 6-minute walk test （6MWT） and brain natriuretic peptide （BNP） were detected before and after treatment. Results The total effective rate was 80.2% in group A, 87.2% in group B and 96.1% in group C, which was higher in group C than that in group A and group B （all P〈O.05）. LVEDd, LVESd and LVEF were improved in 3 groups after treatment （all P〈0.05）. Compared with group A and group B, the improvements of LVEDd, LVESd and LVEF were more significant in group C （all P〈O.05）. The level of BNP decreased and 6MWT increased in 3 groups after treatment （all P〈0.05）. The level of BNP decreased and 6MWT increased in group C compared with group A and group B after treatment （all P〈0.05）. Conclusion Benazepril in dose of 20 mg has higher curative effect than that in dose of 5 mg and that in 10 mg on CHF, and can improve more effectively heart function with higher safety.