培哚普利和氯沙坦治疗心肌梗死抑制心肌重构的前瞻性随机对比研究

【摘要】  　　目的： 比较血管紧张素转换酶抑制剂（ACEI）培哚普利和血管紧张素Ⅱ（AngⅡ）受体拮抗剂氯沙坦治疗冠心病心肌梗死抑制左室重构的效果。方法: 将277例冠心病心肌梗死患者随机分为常规治疗组64例、培哚普利治疗组108例、氯沙坦治疗组105例，并于治疗前及治疗一年后分别进行超声心动图，测定左室内径、左室肌重量指数和左室射血分数等指标，并对患者的心功能在相应时间进行NYHA评级，以了解三者对心肌梗死患者左室心功能的影响和左室重构的阻抑作用，同时对服药的耐受性进行观察记录。结果: 一年后培哚普利组和氯沙坦组与常规治疗组比较室间隔厚度、左室后壁厚度、左室舒张末内径、左室舒张末期容积和左室心肌重量指数均明显降低；与治疗前比较，培哚普利组和氯沙坦组LVEF有明显提高，与常规治疗组比较，左室射血分数分别增加8.58和8.91（20.6%和21.5%）；培哚普利组和氯沙坦组心衰评级明显改善，而常规治疗组在上述指标上有加重趋势；培哚普利组与氯沙坦组间各主要指标的在相同时期比较差异无显著性，但培哚普利组在咳嗽副作用上高于氯沙坦及常规治疗组；常规治疗组有较高死亡率。结论: ACEI类药物培哚普利和AngⅡ受体拮抗剂氯沙坦均能明显减轻心肌梗死后心肌肥厚和左室重塑，阻抑左室重塑过程，提高左室收缩的同步性，改善左室功能，改善预后，且其效果相近。

【关键词】  培哚普利 氯沙坦 心肌梗死 慢性心力衰竭 心室重构

　　A Prospective, Randomized, Open-label Study of Examinning the Effectiveness of Perindopril Versus Losartan on Reducing Remodeling after Myocardial Infarction in Patients with Left Ventricular Dysfunction

　　Deng Jin-long,Wu Yin-xiong,Zhao Yi-lan,et al.

　　Department of Cardiology，the People’s Hospital of Guangxi Zhuangzu Autonomous Region, Nanning 530021, China

　　【ABSTRACT】 Objective: The present study was undertaken to compare the effectiveness of angiotensin-converting enzyme inhibitor(ACEI)-perindopril versus angiotension II antagonist (AIIA)-losartan on reducing remodeling after myocardial infarction in patients with left ventricular dysfunction.Methods: Perindopril, losartan and remodeling in patients with myocardial infarction, a single-center, prospective, randomized, open-label study was performed, determined whether similar benefits occur in post infarction patients with preserved left ventricular function. A total of 277 patients with recent acute myocardial infarction were randomized to receive perindopril erbumine (4~8mg/day) or losartan (50mg/day), or routine treatment for 12 months. Namely, 64 patients were randomized into conventional treatment group, 108 into perindopril group and the other 105 into losartan group.The systolic function and geometric patterns of left vent

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