CAJ | 학술논문

目的探讨急性心肌梗死(AMI)患者早期应用醛固酮受体拮抗剂(AB)螺内酯对心脏重构的影响.方法前瞻性研究,采用随机(随机数字法)、对照的方法,入选哈尔滨医科大学附属第一医院CCU病房2008年1月至2010年1月所有初次发病并且在24 h内住院的616例急性ST段抬高型心肌梗死(STEMI)患者.纳入标准:入选病例均为初发并且在24h内入院且符合急性STEMI诊断和治疗指南中的诊断标准.排除标准:排除非ST段抬高型心肌梗死,单纯右室梗死及陈旧性心肌梗死者；心功能分级(Killip)Ⅳ级或低血压状态者；肾功能不全者(血肌酐＞221 μmol/L)；血钾＞5.0 mmol/L者；发病距就诊时间超过24h及年龄＞75岁者.入选病例按照随机数字表归入对照组及治疗组,共528例受试者完成1年观察治疗,其中对照组266例,治疗组262例,两组患者在年龄、性别、既往病史,入院时情况、治疗情况等方面差异无统计学意义.治疗组(n=262)AMI患者在常规治疗的基础上加用螺内酯20 mg/d,对照组(n =266)行常规治疗.在发病后1个月和1年检测两组超声心动图、血钾、血肌酐,以评价螺内酯对心脏重构、左室功能和肾功能及血钾的影响.统计学方法应用PASW statistics 18.0软件进行统计处理.组间差异及组内差异应用t检验,如方差不齐时可用t检验.计数资料应用x2检验.结果治疗组在、1年时超声指标LVESD、LVEDD、LVEF、LAD-ML、LAD-SI较对照组有显著改善(P＜0.05),治疗组在1年时LVESD、LVEDD、LVPWT、LVEF、LAD-ML、LAD-SI均较1个月时明显改善(P＜0.05,其中LVEF P=0.007),对照组LVEF在1年时较1个月时有明显改善(P=0.0277).两组肌酐、血钾水平差异无统计学意义.结论 AMI患者在常规治疗的基础上早期联合应用小剂量(20 mg/d)螺内酯,可明显抑制AMI后的晚期重构,防止心力衰竭的发生.
목적 탐토급성심기경사(AMI)환자조기응용철고동수체길항제(AB)라내지대심장중구적영향.방법 전첨성연구,채용수궤(수궤수자법)、대조적방법,입선합이빈의과대학부속제일의원CCU병방2008년1월지2010년1월소유초차발병병차재24 h내주원적616례급성ST단태고형심기경사(STEMI)환자.납입표준:입선병례균위초발병차재24h내입원차부합급성STEMI진단화치료지남중적진단표준.배제표준:배제비ST단태고형심기경사,단순우실경사급진구성심기경사자；심공능분급(Killip)Ⅳ급혹저혈압상태자；신공능불전자(혈기항＞221 μmol/L)；혈갑＞5.0 mmol/L자；발병거취진시간초과24h급년령＞75세자.입선병례안조수궤수자표귀입대조조급치료조,공528례수시자완성1년관찰치료,기중대조조266례,치료조262례,량조환자재년령、성별、기왕병사,입원시정황、치료정황등방면차이무통계학의의.치료조(n=262)AMI환자재상규치료적기출상가용라내지20 mg/d,대조조(n =266)행상규치료.재발병후1개월화1년검측량조초성심동도、혈갑、혈기항,이평개라내지대심장중구、좌실공능화신공능급혈갑적영향.통계학방법응용PASW statistics 18.0연건진행통계처리.조간차이급조내차이응용t검험,여방차불제시가용t검험.계수자료응용x2검험.결과 치료조재、1년시초성지표LVESD、LVEDD、LVEF、LAD-ML、LAD-SI교대조조유현저개선(P＜0.05),치료조재1년시LVESD、LVEDD、LVPWT、LVEF、LAD-ML、LAD-SI균교1개월시명현개선(P＜0.05,기중LVEF P=0.007),대조조LVEF재1년시교1개월시유명현개선(P=0.0277).량조기항、혈갑수평차이무통계학의의.결론 AMI환자재상규치료적기출상조기연합응용소제량(20 mg/d)라내지,가명현억제AMI후적만기중구,방지심력쇠갈적발생.
Objective To investigate the effect of early application of aldosterone receptor blockade-spironolactone on cardiac remodeling in patients with acute myocardial infarction.Methods A total of 616 patients were enrolled in this prospective study,who were admitted to the CCU Division of the First Affiliated Hospital of Harbin Medical University from January 2008 to January 2010.Inclusive criteria were as follows:First-onset STEMI according to the diagnostic criteria in ST-segment elevation acutemyocardial infarction diagnosis and treatment guidelines and admitted within 24 hours from onset.Exclusive criteria were as follows:Non-STEMI,only right ventricular infarction and old myocardial infarction; cardiac function Killip Class Ⅳ or hypotensive state; renal dysfunction(serum creatinine ＞ 221 μmol / L); serum potassium ＞5.0 mmol / L; longer than 24 hours from onset and older than 75 years of age.All the patients were randomly divided into a control group of standard therapy and a treatment group of standard therapy combined with spironolactone 20 mg per day.Totally 528 patients were observed completely,including 266 patients in the control group and 262 patients in the treatment group.There was no statistical difference of clinical characteristics between the two groups,including age,gender,past medical history,admission situation,and treatment(P ＞ 0.05).The effect of spironolactone on cardiac remodeling、left ventricular function、renal function and blood levels of potassium were evaluated by detecting echocardiography,serum potassium and serum creatinine at one month and one year follow-up.Results Compared with the control group,the echocardiography indicators such as LVESD,LVEDD,LVEF,LAD-ML and LAD-SI were significantly improved in treatment group at one year(P ＜ 0.05).In treatment group,LVESD,LVEDD,LVPWT,LVEF,LAD-ML and LAD-SI were significantly improved at one year than one month(P ＜ 0.05,and P =0.007 to LVEF),and LVEF was significantly improved at one year than one month in control group(P =0.0277).There were no statistical differences of serum potassium and serum creatinine between the two groups.Conclusions On the basis of conventional treatment,the early combination of low dose spironolactone(20 mg/d)could inhibit cardiac remodeling at late stage and prevent heart failure.