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
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摘要
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.
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.
引文
[1]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2010,38(8):675-690.
[2]黄明剑,温志浩,潘朝锌,等.急诊经皮冠状动脉介入治疗对急性心肌梗死患者N末端B型利钠肽原及左心室重构的影响[J].广西医学,2017,39(1):12-14.
[3]甘井山,徐亚洁,运乃茹,等.影响心肌梗死二级预防患者用药依从性的因素调查[J].中国药房,2016,27(3):292-294.
[4]张波.血管紧张素转化酶2过表达对心肌梗死后大鼠心室重构的影响[D].重庆:重庆医科大学,2014.
[5]崔贞玉,韩素霞.ARB与ACEI改善心肌梗死患者心室重构的Meta分析[J].实用药物与临床,2014,17(2):139-146.
[6]沈卫峰,张奇,张瑞岩,等.2015年急性ST段抬高型心肌梗死诊断和治疗指南解析[J].国际心血管病杂志,2015,42(4):217-219.
[7]霍西茜,刘佳敏,吴学坤,等.2001-2011年间中国中部农村急性心肌梗死患者血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂的应用及影响因素:China PEACE回顾性急性心肌梗死研究[J].中国循环杂志,2016,31(11):1045-1050.
[8]吴越,崔常雷,郑秋宇,等.贝那普利对心肌梗死大鼠心室重构及基质金属蛋白酶2表达的影响[J].中国老年学杂志,2013,33(6):1354-1355.
[9]光雪峰,戴海龙.2015年ACC/AHA/SCAI直接经皮冠状动脉介入治疗ST段抬高型心肌梗死指南解读[J].中国实用内科杂志,2016,36(4):281-283.
[10]孙佳音,翟琳,叶嘉欣,等.培哚普利对急性心肌梗死伴2型糖尿病患者内皮祖细胞动员及预后的影响[J].上海医学,2012,35(3):189-193.
[11]梁健球,白书昌,许顶立.心肌梗死后心力衰竭患者经不同剂量培哚普利治疗后心肌能量消耗水平的变化[J].南方医科大学学报,2012,32(12):1816-1819、1832.
[12]李守萍,胡晓梅.卡维地洛联合福辛普利对急性心肌梗死后血浆脑钠肽水平及心室重构的影响分析[J].医学信息,2015,28(6):205.
[13]赵小祺,王晓玲,焦宏,等.四逆汤与福辛普利预处理对急性心肌梗死大鼠氧化应激的影响[J].中国老年学杂志,2014,34(5):1323-1325.
[14]马素霞.蒙诺联合醛固酮受体阻滞剂治疗心肌梗死后心功能衰竭临床效果分析[J].中国实用医药,2014,9(7):24-25.
[15]魏梅,刘永升,马利祥,等.螺内酯联合贝那普利对急性前壁心肌梗死患者左心室重构及心率变异性的影响[J].山东医药,2015,55(36):51-52.
[16]金卫东,韩明磊,刘艳宾,等.贝那普利对心肌梗死大鼠心室重构及MMP-2表达影响的实验研究[J].中国实用医刊,2014,41(23):14-16.
[2]黄明剑,温志浩,潘朝锌,等.急诊经皮冠状动脉介入治疗对急性心肌梗死患者N末端B型利钠肽原及左心室重构的影响[J].广西医学,2017,39(1):12-14.
[3]甘井山,徐亚洁,运乃茹,等.影响心肌梗死二级预防患者用药依从性的因素调查[J].中国药房,2016,27(3):292-294.
[4]张波.血管紧张素转化酶2过表达对心肌梗死后大鼠心室重构的影响[D].重庆:重庆医科大学,2014.
[5]崔贞玉,韩素霞.ARB与ACEI改善心肌梗死患者心室重构的Meta分析[J].实用药物与临床,2014,17(2):139-146.
[6]沈卫峰,张奇,张瑞岩,等.2015年急性ST段抬高型心肌梗死诊断和治疗指南解析[J].国际心血管病杂志,2015,42(4):217-219.
[7]霍西茜,刘佳敏,吴学坤,等.2001-2011年间中国中部农村急性心肌梗死患者血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂的应用及影响因素:China PEACE回顾性急性心肌梗死研究[J].中国循环杂志,2016,31(11):1045-1050.
[8]吴越,崔常雷,郑秋宇,等.贝那普利对心肌梗死大鼠心室重构及基质金属蛋白酶2表达的影响[J].中国老年学杂志,2013,33(6):1354-1355.
[9]光雪峰,戴海龙.2015年ACC/AHA/SCAI直接经皮冠状动脉介入治疗ST段抬高型心肌梗死指南解读[J].中国实用内科杂志,2016,36(4):281-283.
[10]孙佳音,翟琳,叶嘉欣,等.培哚普利对急性心肌梗死伴2型糖尿病患者内皮祖细胞动员及预后的影响[J].上海医学,2012,35(3):189-193.
[11]梁健球,白书昌,许顶立.心肌梗死后心力衰竭患者经不同剂量培哚普利治疗后心肌能量消耗水平的变化[J].南方医科大学学报,2012,32(12):1816-1819、1832.
[12]李守萍,胡晓梅.卡维地洛联合福辛普利对急性心肌梗死后血浆脑钠肽水平及心室重构的影响分析[J].医学信息,2015,28(6):205.
[13]赵小祺,王晓玲,焦宏,等.四逆汤与福辛普利预处理对急性心肌梗死大鼠氧化应激的影响[J].中国老年学杂志,2014,34(5):1323-1325.
[14]马素霞.蒙诺联合醛固酮受体阻滞剂治疗心肌梗死后心功能衰竭临床效果分析[J].中国实用医药,2014,9(7):24-25.
[15]魏梅,刘永升,马利祥,等.螺内酯联合贝那普利对急性前壁心肌梗死患者左心室重构及心率变异性的影响[J].山东医药,2015,55(36):51-52.
[16]金卫东,韩明磊,刘艳宾,等.贝那普利对心肌梗死大鼠心室重构及MMP-2表达影响的实验研究[J].中国实用医刊,2014,41(23):14-16.