厄贝沙坦对高血压并发充血性心力衰竭凝血-纤溶系统的影响

目的观察血管紧张肽Ⅱ受体阻滞药厄贝沙坦对高血压并发充血性发心力衰竭(CHF)患者凝血-纤溶系统及心功能的影响。方法77例高血压并心力衰竭患者随机分为厄贝沙坦组(n=39):口服厄贝沙坦150mg,1次/d,连用4周;卡托普利组(n=38):口服卡托普利25mg,3次/d,连用4周,用药前后采用一期法检测血浆凝血酶原时间(PT),采用凝血酶法检测血浆纤维蛋白原(FIB),采用发色底物法检测血浆组织型纤溶酶原激活物(t-PA)、纤溶酶原激活抑制物-1(PAI-1),行超声心动图计算左室射血分数(LVEF)和E/A比值,评定心功能变化。结果治疗4周后两组血压明显降低(P<0.01),降压幅度比较差异无统计学意义(P>0.05);治疗后两组FIB、PAI-1显著降低(P<0.01),t-PA显著增高(P<0.01),治疗后两组比较差异有统计学意义(P<0.05);治疗后两组LVEF、E/A比值均明显升高(P<0.05),厄贝沙坦组较卡托普利组改善更明显(P<0.05)。结论厄贝沙坦可改善高血压合并CHF患者受损的凝血-纤溶系统,逆转高血压、心力衰竭所致的血栓前状态(PTS)和动脉粥样硬化(AS)。并且改善心脏收缩功能和舒张功能,缓解心力衰竭症状,疗效优于卡托普利。

Influence of irbesartan on coagulation-fibrinolysis system and heart function in the patients with hypertension and congestive heart failure

Objective To observe the influence of irbesartan on the patients with hypertension and congestive heart failure(CHF).Methods 77 patients were divided randomly into irbesartan group(n=39)which were given irbesartan 150mg,qd for 4 weeks;and captopril group(n=38)which were given captopril 25mg,tid for 4 weeks.Prothrombin time(PT),fibrinogen(FIB),tissue-type plasminogen activator(t-PA),plasminogen activator inhibitor(PAI)-1 in plasma were determined before and after the treatment.Ejection fraction(EF),E/A ratio were measured by ultrasonic cardiogram.Results The blood pressure,FIB,PAI-1 decreased significantly(P<0.01),t-PA increased significantly(P<0.01)4 weeks after the treatment.There were significant differences between two groups(P<0.05).The heart function were improved obviously in two groups after the treatment,LVEF,E/A ratio increased in two groups after the treatment(P<0.05).The irbesartan group was better than the captopril group.Conclusion Irbesartan could improve impaired coagulation-fibrinolysis system in the patients with hypertension and CHF,change prethrombotic state(PTS)and atherosclerosis and improve systolic and diastolic function in heart.