3种血管紧张素转换酶抑制药对急性心肌梗死患者心室重构的改善作用

Improvement Effects of 3 Kinds of Angiotensin Converting Enzyme Inhibitor on Ventricular Remodeling in Patients with Acute Myocardial Infarction

目的:观察血管紧张素转化酶抑制药(ACEI)福辛普利、培哚普利、贝那普利对急性心肌梗死(AMI)患者心室重构的改善作用,并评价其安全性。方法:选取2014年1月-2016年10月我院收治的AMI患者96例作为研究对象,按随机数字表法分为A、B、C组,各32例。所有患者均接受对症治疗,并行经皮冠状动脉介入治疗术,在血管再通且血压稳定后开始使用ACEI类药物:A组患者服用福辛普利钠片10 mg,qd;B组患者服用培哚普利叔丁胺片4 mg,qd;C组患者服用盐酸贝那普利片10 mg,qd。3组患者均连续治疗6个月。观察3组患者治疗前后心脏结构及功能指标[左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、室间隔厚度(IVSD)、左心室后壁厚度(LVPWD)、左室射血分数(LVEF)和心排血量(CO)]、血流动力学指标[收缩压(SBP)、舒张压(DBP)和心率(HR)]和相关实验室指标[空腹血糖(FPG)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、血肌酐(Scr)和尿素氮(BUN)],并记录不良反应发生情况。结果:治疗前,3组患者心脏结构及功能指标、血流动力学指标和相关实验室指标比较,差异均无统计学意义(P>0.05)。治疗后,3组患者的LVESD、LVEDD、LVPWD、CO、HR、FPG、TG、TC、LDL-C水平显著降低,LVEF、SBP显著升高,差异均有统计学意义(P<0.05);但3组患者治疗后上述指标水平组间比较,差异均无统计学意义(P>0.05)。治疗后,B组患者的Scr水平显著升高,且显著高于A、C组,差异均有统计学意义(P<0.05)。3组患者治疗前后IVSD、DBP、HDL-C、AST、ALT、BUN水平比较,A、C组患者治疗前后Scr水平比较,差异均无统计学意义(P>0.05)。3组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论:福辛普利、培哚普利和贝那普利对AMI患者心室重构均有显著的改善作用,可使其心腔缩小、收缩压升高、心率降低、心室耗氧量降低,且作用相当。培哚普利可能会导致Scr水平升高,故对于存在肾功能异常的AMI患者,选择福辛普利和贝那普利的安全性更高。

OBJECTIVE:To observe the improvement effects of angiotensin converting enzyme inhibitor(ACEI)fosinopril,perindopril and benazepril on ventricular remodeling in patients with acute myocardial infarction(AMI),and to evaluate its safety. METHODS:A total of 96 AMI patients selected from our hospital during Jan. 2014-Oct. 2016 were divided into group A,B,C according to random number table,with 32 cases in each group. All patients received symptomatic treatment,underwent percutaneous coronary intervention,and then given ACEI after blood vessels recanalization and keeping blood pressure stable.Group A was given Fosinopril sodium tablets 10 mg,qd;group B was given Perindopril tert-butylamine tablets 4 mg,qd;group C was given Benazepril hydrochloride tablets 10 mg,qd. All groups were treated for consecutive 6 months. Cardiac structure and function indexes(LVESD,LVEDD,IVSD,LVPWD,LVEF,CO),hemodynamic indexes(SBP,DBP,HR) and related lab indexes(FPG,TG,TC,HDL-C,LDL-C,AST,ALT,Scr,BUN)of 3 groups were observed before and after treatment. The occurrence of ADR was recorded. RESULTS:Before treatment,there was no statistical significance in cardiac structure and function indexes,hemodynamic indexes or related lab indexes among 3 groups(P>0.05). After treatment,the levels of LVESD,LVEDD,LVPWD,CO,HR,FPG,TG,TC and LDL-C in 3 groups were decreased significantly,while the levels of LVEF and SBP were increased significantly,with statistical significance(P<0.05). There was no statistical significance in above indexes among 3 groups after treatment(P>0.05). After treatment,the level of Scr in group B was significantly increased and higher than group A and C,with statistical significance(P<0.05). There was no statistical significance in the levels of IVSD,DBP,HDL-C,AST,ALT or BUN among 3 groups before and after treatment as well as the level of Scr between group A and C(P>0.05). There was no statistical significance in the incidence of ADR among 3 groups(P>0.05). CONCLUSIONS:Fosinopril,perindopril and benazepril can significantly improve ventricular remodeling in AMI patients, narrowing the heart cavity,increasing systolic pressure, lowering heart rate, reducing the oxygen consumption of the ventricle, with similar effects.Perindopril may increase the level of Scr,so fosinopril and benazepril are safe and suitable for AMI patients with renal function disorder.