长期应用西拉普利对血液透析病人心血管的保护作用

Clinical effect of cilazapril on cardiovascular protection in long-term hemodialysis patients

目的 :观察西拉普利对血液透析 (血透 )病人的心血管保护作用。方法 :70例血透病人分为治疗组 (n =36 ) ,用西拉普利 2 .5～ 5mg·d- 1和对照组(n =34) ,给予对心脏重构无影响的降压药。 6mo和 12mo时彩超测心脏指标 ,并测血透前后、血透次日血压。结果 :2组均有降压作用 ,治疗组等容舒张时间 (IRT)和左室重量指数 (LVMI)用药前及用药6 ,12mo分别为 (81±s 10 )ms ,(76± 10 )ms ,(6 9±10 )ms ,(2 18± 32 ) g·m- 2 ,(172± 30 ) g·m- 2 ,(15 3±32 ) g·m- 2 ;治疗后下降 (P <0 .0 5 )。左室射血分数(LVEF) ,心排量 (CO)和舒张早晚期速度比 (EV /AV)治疗前和用药 6 ,12mo分别为 (5 6 .2± 2 .1) % ,(6 0 .2± 1.8) % ,(74 .2± 1.6 ) % ;(5 .6± 1.2 )L·min- 1,(6 .3± 1.3)L·min- 1,(7.5± 1.5 )L·min- 1和 0 .91± 0 .0 4 ,1.0 1± 0 .0 4 ,1.2 1± 0 .0 3;治疗后升高 (P <0 .0 5 ) ,对照组无显著改变。结论 :长期应用西拉普利可有效降压、逆转血透病人的左室肥厚。

AIM: To investigate the effect of cilazapril on cardiovascular protection in hemodialysis (HD) patients. METHODS: Seventy HD patients with hypertension and left ventricular hypertrophy (LVH) were randomly divided into two groups. In group A(n=36), cilazapril was given 2.5-5 mg, qd. In group B (n=34), antihypertensive drugs without effect on left ventricular remodeling and function were administered. After 6 and 12 mo, the left ventricular mass and ventricular function were monitored by Doppler cardiography. RESULTS: BP of patients in both groups was decreased. But the cardiac parameters by cardiography after 6 and 12 mo of cilazapril administration, aortic dimension (AOD) IRT, LVmass and LVMI were significantly decreased (P< 0.05). The IRT was (81±10)ms,(76±10)ms, (69±10)ms and LVMI was (218±32) g·m -2,(172±30) g·m -2,(153±32)g·m -2, before and after 6 mo, 12 mo treatment in group A. EF, CO, AC, LVEF, LVFS and EV/AV were significantly increased (P<0.05). The LVEF was (56.2± 2.1)%,(60.2±1.8)%,(74.2±1.6)%. CO was (5.6±1.2)L·min -1, (6.3± 1.3)L·min -1, (7.5± 1.5)L·min -1, and EV/AV was 0.91± 0.04, 1.01± 0.04, 1.21± 0.03 before and after 6 mo, 12 mo treatment in group A. These parameters, except AOD, EF and IRT, changed more significantly in group A than those in group B. CONCLUSION: Cilazapril is not only effective and safe in long-term antihypertension treatment in HD patients, but also beneficial to left ventricular remodeling. The improvement to the heart systolic and diastolic function has also been observed.