洛沙坦和培哚普利对急性心肌梗死后左心室重塑的疗效比较

Effect of Losartan and Perindopril on left ventricular remodeling in patients with acute myocardial infarction

目的 观察洛沙坦和培哚普利对急性心肌梗死 (AMI)患者 ,左心室重塑 (LVRM)的治疗效应并进行比较。方法 AMI患者 6 5例 ,随机分为 3组。洛沙坦组 2 2例 ,培哚普利组 2 2例 ,对照组 2 1例。对照组仅给予硝酸酯类、肠溶阿司匹林、肝素等常规治疗 ;洛沙坦组在常规治疗基础上加用洛沙坦 2 5mg口服 ,每日 1次 ;培哚普利组在常规治疗基础上加用培哚普利 4mg口服 ,每日 1次。分别在入院后第 1天、14天、6个月时采用超声心动图 ,测定左心室舒张末期内径 (LVDd)、左心室收缩末期内径 (LVDs)、左心室射血分数 (LVEF)并进行比较。结果 对照组 14天及6个月时LVDd、LVDs较基础值增加 ,有显著性差异 (P <0 .0 5 ) ;洛沙坦组与培哚普利组 14天及 6个月时LVDd、LVDs与基础值比较轻度增加 ,与对照组比较明显缩小 ,有显著性差异 (P <0 .0 5 ) ;洛沙坦组与培哚普利组LVDd、LVDs变化无显著性差异 (P >0 .0 5 )。培哚普利组咳嗽发生率 18% ,洛沙坦组无 1例发生副反应。结论 洛沙坦与培哚普利具有相似的抗左心室重塑的治疗效应 。

Objective To investigate the effect of angiotensin Ⅱsubtype 1 (AT1) antagonist Losartan and angiotensin coverting enzyme inhibitor (ACEI) Perindopril on left ventricular remodeling(LVRM) in patients with acute myocardial infarction(AMI).Methods Sixty five patients with AMI were divided into three groups randomly. The control group,21 cases, received routine treatment: nitroglycerin, aspirin, heparin. The Losartan group,22 cases, received Losartan and the Perindopril group,22 cases, received perindopril besides routine treatment. Left ventricular end diastolic diameter (LVDd),left ventricular end systolic diameter(LVDs) and left ventricular ejection fraction(LVEF) were measured by echocardiogram on day 1,14 and month 6. Results In control group, LVDd and LVDs increased significantly on day 14 and month 6. In Losartan and Perindopril groups, LVDd and LVDs increased mildly on day 14 and month 6,whereas were significantly lower than those of the control group. There were no significant differences between Losartan and Perindopril groups. There was no side effect in Losartan group while the incidence of cough in Perindopril group was 18%.Conclusion Losartan and Perindopril have similar anti LVRM effects.But Losartan is more tolerable.