小剂量厄贝沙坦、依那普利联用治疗扩张型心肌病的临床观察

目的探讨小剂量厄贝沙坦、依那普利联用治疗扩张型心肌病（Dilatecadiom yopathy,DCM）的临床疗效和安全性。方法 96例DCM患者在利尿剂、β受体阻滞剂,洋地黄治疗基础上,随机分为3组：A组（依那普利组）,依那普利20mg/d;B组（厄贝沙坦组）,厄贝沙坦150mg/d;C组（小剂量联用组）,依那普利10mg/d,厄贝沙坦75mg/d。治疗前后分别检测左右室舒张末期内径（LVEDD、RVEDD）、左室射血分数（LVEF）、6min步行试验（6-MWT）、血压、血钾及血肌酐水平。结果通过治疗前后,对A组、B组和C组在左室舒张末期内径、右室舒张末期内径、左室射血分数、6min步行距离上述4项指标进行比较,均较治疗前差异有显著意义（P〈0.05）,且C组更明显,而A组与B组比较,差异无显著意义（P〉0.05）;而治疗前后,A、B、C3组在收缩压、舒张压、血肌酐、血钾等指标方面差异无显著意义（P〉0.05）。结论小剂量厄贝沙坦、依那普利联用治疗DCM可明显地改善心功能,逆转心室重构,疗效优于单用常规剂量治疗,并且安全性好。

Clinical observation on the low dose of ienazepril combined with ibasartan to treat dilate cadiomyopathy

Objective To study the clinical therapeutic effect and safety of low dose of Ienazepril combined with Ibesartan in the treatment of dilate cadiomyopathy （DCM）.Methods Total of 96 patients with DCM and receiving treatment of diuretic and β-receptor blocks or diqitalis were randomly divided into A,B and C three groups.A group （Ienazepril group,Ienazepril 20 mg·day-1）,B group （Ibesartan group,Ibesartan 150 mg·day-1）,C group （low-dose combination group,Ienazepril 10 mg·day-1 and Ibesartan 75 mg·day-1）.The end-diastolic diameter of left or right ventricle （LVEDD/RVEDD）,left ventricular ejection fraction （LVEF）,the blood pressure （BP）,six-minutes-walk trial （6-MWT）,and the levels of kalium（K＋） and cretinine（Cr） in plasma,were measured before and after treatment.Results Before and after 12 months treatment,compared with the end-diastolic diameter of left ventricular （LVEDD）,the end-diastolic diameter of right ventricle （RVEDD）,the left ventricular ejection fraction （LVEF） and six-minutes-walk trial（6 min）,the changes were significantly different than before in three groups A,B and C（P0.05）,but in C group,the changes mentioned above were significantly.Compared with the levels of the systolic blood pressure（SBP）,the diastolic blood pressure（DBP）,cretinine in plasma,the levels of kalium in plasma,there was no statistics variance before or after treatment in each group （P0.05）.Conclusion The effect of low-dose Ienazepril and Ibesartan combination on DCM is better than alone routine dose Ienazepril or Ibesartan treatment in improving level of heart function and remodeling of left ventricle,and it is safe.