不同剂量缬沙坦对急性心肌梗死患者影响的对比研究

Comparative Study for Impact on Patients with Acute Myocardial Infarction in Different Doses of Valsartan

目的比较不同剂量缬沙坦对急性心肌梗死(AMI)患者的影响。方法选取重庆市巴南区人民医院2013年1月—2016年1月收治的AMI患者90例,采用随机数字表法分为对照组和观察组,每组45例。两组患者入院后均给予溶栓治疗,溶栓治疗效果不理想者进一步行经皮冠状动脉介入治疗(PCI);同时对照组患者给予小剂量缬沙坦(80 mg/次),而观察组患者给予大剂量缬沙坦(160 mg/次);两组患者均连续治疗6个月。比较两组患者治疗前后收缩压(SBP)、舒张压(DBP)、心率(HR)、心脏结构和功能指标[包括左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、左心室后壁舒张末期厚度(LVPWD)、舒张末期室间隔厚度(IVSD)、心输出量(CO)、左心室收缩末期容积(LVESV)、左心室舒张末期容积(LVEDV)、左心室射血分数(LVEF)]、心肌损伤标志物[包括血浆肌酸激酶同工酶(CK-MB)、肌红蛋白(Mb)、心肌肌钙蛋白Ⅰ(cTnⅠ)水平],入院第1天及治疗3、6个月血清生长分化因子15(GDF-15)水平,并记录两组患者治疗期间不良反应发生情况。结果治疗前后两组患者SBP、DBP、HR比较,差异均无统计学意义(P>0.05)。治疗前两组患者LVESD、LVEDD、LVPWD、IVSD、CO、LVESV、LVEDV、LVEF比较,差异均无统计学意义(P>0.05);治疗后观察组患者LVESD、LVEDD、LVPWD、IVSD、CO小于对照组,LVESV、LVEDV、LVEF高于对照组(P<0.05)。治疗前两组患者血浆CK-MB、Mb、cTnⅠ水平比较,差异无统计学意义(P>0.05);治疗后观察组患者血浆CK-MB、Mb、cTnⅠ水平低于对照组(P<0.05)。时间与方法在血清GDF-15水平上存在交互作用(P<0.05);时间在血清GDF-15水平上主效应显著(P<0.05);方法在血清GDF-15水平上主效应显著(P<0.05);治疗3、6个月观察组患者血清GDF-15水平低于对照组(P<0.05)。两组患者治疗期间不良反应发生率比较,差异无统计学意义(P>0.05)。结论与小剂量缬沙坦(80 mg/次)相比,大剂量缬沙坦(160 mg/次)能更有效地抑制AMI患者心室重构并改善患者心功能,减轻心肌损伤并降低血清GDF-15水平,且未增加不良反应发生风险。

Objective To compare the impact on patients with acute myocardial infarction in different doses of valsartan. Methods From January 2013 to January 2016,a total of 90 patients with acute myocardial infarction were selected in the People's Hospital of Ba'nan District,Chongqing,and they were divided into control group and observation group according to random number table,each of 45 cases. Patients of the two groups received thrombolytic therapy and PCI(for patients without prospective thrombolytic effect) after admission,meanwhile patients of control group received low-dose valsartan(80 mg per time),while patients of observation group received high-dose valsartan(160 mg per time); both groups continuously treated for 6 months. SBP,DBP,HR,index of cardiac structure and function(including LVESD,LVEDD,LVPWD,IVSD,CO,LVESV,LVEDV and LVEF),myocardial injury markers(including plasma levels of CK-MB,Mb and cTnⅠ) before and after treatment,and serum GDF-15 level at the first day of admission,after 3 and 6 months of treatment were compared between the two groups, and incidence of adverse reactions during the treatment was observed. Results No statistically significant differences of SBP,DBP or HR was found between the two groups before or after treatment(P > 0. 05). No statistically significant differences of LVESD, LVEDD, LVPWD, IVSD, CO, LVESV, LVEDV or LVEF was found between the two groups before treatment(P > 0. 05); after treatment,LVESD,LVEDD,LVPWD,IVSD and CO of observation group were statistically significantly smaller than those of control group, while LVESV, LVEDV and LVEF of observation group were statistically significantly higher than those of control group(P < 0. 05). No statistically significant differences of plasma level of CK-MB,Mb or cTnⅠ was found between the two groups before treatment(P > 0. 05),while plasma levels of CK-MB,Mb and cTnⅠ of observation group were statistically significantly lower than those of control group after treatment(P < 0. 05). There was interaction between time and method in serum GDF-15 level(P < 0. 05); main effects of time and method were significant in serum GDF-15 level(P < 0. 05); serum GDF-15 level of observation group was statistically significantly lower than that of control group after 3 and 6 months of treatment,respectively(P < 0. 05). No statistically significant differences of incidence of adverse reactions was found between the two groups during the treatment(P > 0. 05). Conclusion Compared with low-dose valsartan(80 mg per time),high-dose valsartan(160 mg per time) can more effectively inhibit the ventricular remodeling and improve the cardiac function of patients with acute myocardial infarction,relive the myocardial injury and reduce the serum GDF-15 level,without increasing the risk of adverse reactions.