中国医药
中國醫藥
중국의약
CHINA MEDICINE
2014年
8期
1093-1097
,共5页
何水波%孟锐%刘慧敏%闫新欣%茹松伟%张然%郁水华%王昱%穆兰
何水波%孟銳%劉慧敏%閆新訢%茹鬆偉%張然%鬱水華%王昱%穆蘭
하수파%맹예%류혜민%염신흔%여송위%장연%욱수화%왕욱%목란
心力衰竭,舒张性%高血压%利钠肽,脑
心力衰竭,舒張性%高血壓%利鈉肽,腦
심력쇠갈,서장성%고혈압%리납태,뇌
Heart failure,diastolic%Hypertension%Natriuretic peptide,brain
目的 探讨血管紧张素Ⅱ受体拮抗剂(ARB)联合β1受体阻滞剂方案与ARB、β1受体阻滞剂联合醛固酮拮抗剂方案在控制高血压继发左心室舒张功能不全患者血压及心力衰竭风险方面的差异.方法 选取2010年10月至2012年4月航天中心医院门诊及住院的高血压继发左心室舒张功能不全患者249例,采用随机数字表法分为观察组(121例)和对照组(128例).对照组给予ARB联合β1受体阻滞剂方案,观察组在对照组的基础上加用醛固酮拮抗剂.2组患者均治疗24个月.分析2组血压、左心室功能、脑钠肽等的变化.结果 入组前和治疗24个月后,观察组患者血清脑钠肽分别为(204±34)、(128±25) ng/L,对照组分别为(200 ±33)、(156±27) ng/L.2组患者治疗后血清脑钠肽均较本组治疗前明显降低,治疗前后差异均有统计学意义(P＜0.05);观察组治疗后血清脑钠肽明显低于对照组治疗后,组问差异有统计学意义(P＜0.05).观察组和对照组患者治疗后血压较本组治疗前明显下降,左心室射血分数、二尖瓣舒张早期最大血流速度/舒张晚期最大血流速度比值较本组治疗前明显提高,治疗前后差异均有统计学意义[收缩压:(139±16) mmHg(l mmHg=0.133 kPa)比(163±25) mmHg,(137±17) mmHg比(162±25) mmHg;舒张压:(89±14) mmHg比(98±19) mmHg,(89 ± 13) mmHg比(98±20) mmHg;左心室射血分数:(58±5)％比(53±4)％,(52±5)％比(46±5)％;二尖瓣舒张早期最大血流速度/舒张晚期最大血流速度比值:(1.34±0.68)比(0.68±0.23),(1.06±0.55)比(0.71±0.21),均P＜0.05].观察组治疗后血压下降、左心室射血分数及二尖瓣舒张早期最大血流速度/舒张晚期最大血流速度比值的改善明显优于对照组,组间差异有统计学意义(P＜0.05).观察组和对照组累计发生心力衰竭例数分别为21例和44例,对照组治疗期间发生心力衰竭风险明显高于观察组(风险比=0.41,95％置信区间:0.25 ～ 0.66,P＜0.01).结论 ARB联合β1受体阻滞剂方案与ARB、β1受体阻滞剂联合醛固酮拮抗剂方案对高血压继发左心室舒张功能不全患者均有一定临床疗效,但ARB、β1受体阻滞剂联合醛固酮拮抗剂方案可明显降低治疗期间心力衰竭发生风险.
目的 探討血管緊張素Ⅱ受體拮抗劑(ARB)聯閤β1受體阻滯劑方案與ARB、β1受體阻滯劑聯閤醛固酮拮抗劑方案在控製高血壓繼髮左心室舒張功能不全患者血壓及心力衰竭風險方麵的差異.方法 選取2010年10月至2012年4月航天中心醫院門診及住院的高血壓繼髮左心室舒張功能不全患者249例,採用隨機數字錶法分為觀察組(121例)和對照組(128例).對照組給予ARB聯閤β1受體阻滯劑方案,觀察組在對照組的基礎上加用醛固酮拮抗劑.2組患者均治療24箇月.分析2組血壓、左心室功能、腦鈉肽等的變化.結果 入組前和治療24箇月後,觀察組患者血清腦鈉肽分彆為(204±34)、(128±25) ng/L,對照組分彆為(200 ±33)、(156±27) ng/L.2組患者治療後血清腦鈉肽均較本組治療前明顯降低,治療前後差異均有統計學意義(P＜0.05);觀察組治療後血清腦鈉肽明顯低于對照組治療後,組問差異有統計學意義(P＜0.05).觀察組和對照組患者治療後血壓較本組治療前明顯下降,左心室射血分數、二尖瓣舒張早期最大血流速度/舒張晚期最大血流速度比值較本組治療前明顯提高,治療前後差異均有統計學意義[收縮壓:(139±16) mmHg(l mmHg=0.133 kPa)比(163±25) mmHg,(137±17) mmHg比(162±25) mmHg;舒張壓:(89±14) mmHg比(98±19) mmHg,(89 ± 13) mmHg比(98±20) mmHg;左心室射血分數:(58±5)％比(53±4)％,(52±5)％比(46±5)％;二尖瓣舒張早期最大血流速度/舒張晚期最大血流速度比值:(1.34±0.68)比(0.68±0.23),(1.06±0.55)比(0.71±0.21),均P＜0.05].觀察組治療後血壓下降、左心室射血分數及二尖瓣舒張早期最大血流速度/舒張晚期最大血流速度比值的改善明顯優于對照組,組間差異有統計學意義(P＜0.05).觀察組和對照組纍計髮生心力衰竭例數分彆為21例和44例,對照組治療期間髮生心力衰竭風險明顯高于觀察組(風險比=0.41,95％置信區間:0.25 ～ 0.66,P＜0.01).結論 ARB聯閤β1受體阻滯劑方案與ARB、β1受體阻滯劑聯閤醛固酮拮抗劑方案對高血壓繼髮左心室舒張功能不全患者均有一定臨床療效,但ARB、β1受體阻滯劑聯閤醛固酮拮抗劑方案可明顯降低治療期間心力衰竭髮生風險.
목적 탐토혈관긴장소Ⅱ수체길항제(ARB)연합β1수체조체제방안여ARB、β1수체조체제연합철고동길항제방안재공제고혈압계발좌심실서장공능불전환자혈압급심력쇠갈풍험방면적차이.방법 선취2010년10월지2012년4월항천중심의원문진급주원적고혈압계발좌심실서장공능불전환자249례,채용수궤수자표법분위관찰조(121례)화대조조(128례).대조조급여ARB연합β1수체조체제방안,관찰조재대조조적기출상가용철고동길항제.2조환자균치료24개월.분석2조혈압、좌심실공능、뇌납태등적변화.결과 입조전화치료24개월후,관찰조환자혈청뇌납태분별위(204±34)、(128±25) ng/L,대조조분별위(200 ±33)、(156±27) ng/L.2조환자치료후혈청뇌납태균교본조치료전명현강저,치료전후차이균유통계학의의(P＜0.05);관찰조치료후혈청뇌납태명현저우대조조치료후,조문차이유통계학의의(P＜0.05).관찰조화대조조환자치료후혈압교본조치료전명현하강,좌심실사혈분수、이첨판서장조기최대혈류속도/서장만기최대혈류속도비치교본조치료전명현제고,치료전후차이균유통계학의의[수축압:(139±16) mmHg(l mmHg=0.133 kPa)비(163±25) mmHg,(137±17) mmHg비(162±25) mmHg;서장압:(89±14) mmHg비(98±19) mmHg,(89 ± 13) mmHg비(98±20) mmHg;좌심실사혈분수:(58±5)％비(53±4)％,(52±5)％비(46±5)％;이첨판서장조기최대혈류속도/서장만기최대혈류속도비치:(1.34±0.68)비(0.68±0.23),(1.06±0.55)비(0.71±0.21),균P＜0.05].관찰조치료후혈압하강、좌심실사혈분수급이첨판서장조기최대혈류속도/서장만기최대혈류속도비치적개선명현우우대조조,조간차이유통계학의의(P＜0.05).관찰조화대조조루계발생심력쇠갈례수분별위21례화44례,대조조치료기간발생심력쇠갈풍험명현고우관찰조(풍험비=0.41,95％치신구간:0.25 ～ 0.66,P＜0.01).결론 ARB연합β1수체조체제방안여ARB、β1수체조체제연합철고동길항제방안대고혈압계발좌심실서장공능불전환자균유일정림상료효,단ARB、β1수체조체제연합철고동길항제방안가명현강저치료기간심력쇠갈발생풍험.
Objective To evaluate the clinical curative effect and safety of angiotensin Ⅱ receptor antagonist(ARB),β1 receptor blockers combined with aldosterone antagonists (three drug regimen) and ARB,β1 receptor blockers(two drug regimen) in the treatment of patients with hypertension secondary to left ventricular diastolic dysfunction.Methods Totally 249 cases of hypertension secondary to left ventricular diastolic dysfunction were recruited from October 2010 to April 2012 and were divided into the observation group(121 cases) and control group(128 cases).Patients in the control group were given ARB + β1 receptor blockers (two drug regimen) and patients in the observation group were given ARB + β1 receptor blockers + aldosterone antagonists(three drug regimen).All of the patients were treated and followed up for 24-month.Changes of 2 groups of blood pressure,left ventricular function,brain natriuretic peptide(BNP) were analyzed.Results The serum BNP of 2 groups after treatment was lower than that before treatment [the observation group:(128 ± 25)ng/L vs (204 ± 34)ng/L,the control group:(156 ± 27) ng/L vs (200 ± 33) ng/L,P ＜ 0.05],but serum BNP was much lower in the observation group than that in control group after treatment(P ＜ 0.05).The blood pressure of 2 groups after treatment was lower than that before treatment; left ventricular ejection fraction and mitral early diastolic velocity/late diastole blood flow velocity were higher than those before treatment [systolic pressure:(139 ± 16) mmHg (1 mmHg =0.133 kPa)vs (163±25)mmHg,(137±17)mmHgvs (162±25)mmHg; diastolic pressure:(89±14)mmHg vs (98 ± 19) mmHg,(89 ± 13) mmHg vs (98 ± 20) mmHg ; left ventricular ejection fraction:(58 ± 5) ％ vs (53 ± 4) ％,(52 ± 5) ％ vs (46 ± 5) ％ ; mitral early diastolic velocity/late diastole blood flow velocity:(1.34 ± 0.68) vs (0.68 ± 0.23),(1.06 ± 0.55) vs (0.71 ± 0.21),all P ＜ 0.05].The blood pressure was significantly decreased; left ventricular ejection fraction and mitral early diastolic velocity/late diastole blood flow velocity were significantly improved in both groups(P ＜ 0.05).Twenty-one and forty-four cases of heart failure were observed in the observation and control group and demonstrated the higher risk in control group(hazard ratio =0.41,95％ confidence interval:0.25-0.66,P ＜ 0.01).Conclusion These drug regimes have the clinical efficacy in the treatment of hypertension secondary to left ventricular diastolic dysfunction,but the three drug regiment can significantly decrease the risk of developing heart failure.
