培哚普利和坎地沙坦倍增剂量治疗老年退行性心脏瓣膜病心力衰竭疗效观察

目的评估培哚普利和坎地沙坦倍增剂量对老年退行性心脏瓣膜病心力衰竭的疗效。方法 218例老年退行性心脏瓣膜病心力衰竭患者随机分为3组:培哚普利组(4mg/d治疗2周后改用8mg/d)、坎地沙坦组(4mg/d治疗2周后改用8mg/d)、对照组(常规抗心力衰竭治疗,不用血管紧张素转换酶抑制剂),治疗24周,观察患者治疗前后坐位血压、血清高敏C反应蛋白(hsCRP)、脑钠肽、左室质量指数(LVMI)的变化,并记录治疗期间的不良反应。结果培哚普利组治疗后LVMI、血清脑钠肽、hsCRP均明显下降(P0.05);坎地沙坦组血清LVMI、脑钠肽亦出现下降,但无统计学意义,而血清hsCRP则显著降低(P0.05);3组抗心力衰竭治疗的有效率分别为:培哚普利组84.9%,坎地沙坦组69.3%,对照组52.0%,3组间差异有统计学意义(P0.05)。培哚普利组不良反应发生率最高(15.1%),其中咳嗽副反应发生率为6.5%,而双下肢水肿发生率对照组明显高于治疗组(P0.05)。结论培哚普利和坎地沙坦倍增剂量治疗均能减轻左室肥厚,对于老年退行性心脏瓣膜病心力衰竭患者耐受性较好。

Double dosage of perindopril and candesartan for treatment of elderly heart failure patients with degenerative valvular disease

Objective To evaluate the therapeutic effects of double dosage of perindopril and candesartan in the elderly heart failure （HF） patients with degenerative valvular disease.Methods A total of 218 elderly HF patients with degenerative valvular disease were divided into three groups： perindopril group,candesartan group,and control group.In perindopril group,the patients received 2-week perindopril treatment at daily dosage of 4mg,then the dosage changed to 8mg.In candesartan group,the treatment regimen was similar to that in perindopril group,except that perindopril was replaced by candesartan.In control group,the patients received routine treatment.After 24-week treatment,the adverse reactions,serum high sensitivity C-reactive protein （hsCRP）,brain natriuretic peptide （BNP）,and left ventricular mass index （LVMI） were determined.Results The serum hsCRP,BNP and LVMI decreased significantly in perindopril group （P0.05）.In candesartan group,the serum LVMI and BNP decreased,but with no significance （P0.05）,while serum hsCRP decreased significantly （P0.05）.The effectiveness rate was 84.9%,69.3%,and 52% in perindopril,candesartan,and control groups,respectively,with significant difference among 3 groups （P0.05）.The adverse reaction was most obvious in perindopril group （15.1%）,among which,coughing incidence accounted for 6.5%.The Lower limb edema was the most obvious in control group （6%,P0.05）.Conclusion Both perindopril and candesartan can alleviate left ventricular hypertrophy and afford good tolerance to the elderly HF patients with degenerative valvular disease.