扩张型心肌病合并心衰患者长期联用多重阻滞剂对心室重构及QT离散度的影响

目的：探讨扩张型心肌病（DCM）心衰患者长期联用多重阻滞剂对心室重构及QT离散度（QTd）的影响。方法：129例DCM心衰患者随机分为A、B、C、D四组,A组（美托洛尔＋依那普利）33例,依那普利从起始2.5mg,2次/d,渐增至10mg,2次/d;美托洛尔从起始每日6.25mg,1次/d,渐增至25mg,2次/d;B组（美托洛尔＋依那普利＋螺内酯）34例,螺内酯20mg/d;C组（美托洛尔＋依那普利＋厄贝沙坦）32例,厄贝沙坦从起始每日37.5mg,1次/d,渐增至150mg,1次/d;D组（美托洛尔＋依那普利＋厄贝沙坦＋螺内酯）30例,药物剂量和方法同前。治疗疗程均为18个月。治疗前后分别检测心脏腔室内径和QTd。结果：A、B、C、D组治疗18月后左心室舒张末期内径（LVEDD）（mm）分别为56.67±2.4、53.4±3.6、54.1±3.4、52.3±3.6;右室舒张末期内径（RVEDD）（mm）分别为37.3±3.5、34.5±3.6、35.2±3.2、31.7±6.3;左心房内径（LAD）（mm）分别为45.8±6.3、42.7±6.6、41.6±7.3、37.3±6.4;QTd分别为57.3±13.2、51.7±14.7、44.8±16.2、38.4±17.1;QTcd分别为71.5±16.5、63.7±17.4、65.3±15.2、54.8±18.5;各指标与本组治疗前比较差异均有统计学意义（P〈0.05）,且D组分别较A、B、C组各指标差异有统计学意义（P〈0.05）,而B、C组比较则无统计学意义（P〉0.05）。结论：依那普利、美托洛尔、厄贝沙坦、螺内酯共同产生的的多重阻滞对DCM心衰患者心室重构和QTd的影响明显优于依那普利合用美托洛尔或在此基础上加用厄贝沙坦或螺内酯。

Long-term Effect of Multi-blocking on Cardiac Remodeling and QT Dispersion in Patients with Dilate Cardiomyopathy

Objective： To study the effects of multi-blocking on cardiac remodeling and QT dispersion（ QTd） in patients with dilate cardiomyopathy. Method： All 129 patients were randomly divided into group A,B,C,D. In group A（ n = 33）,the patients were treated with enazepril and metoprlol after receiving routine treatment,enazepril was begun with 2.5mg for once,twice a day,then the dosage was increased to10mg for once,twice a day. Metoprlol was begun with 6.25mg for once,twice a day,then the dosage was increased to 25mg for once,twice a day. In group B（ n = 34）,the patients were treated with Ienazepril,metoprlol and spironolactone,the dosage of Spironolactone was 20mg for once,once a day. In the group C（ n =32）,the patients were treated with enazepril,metoprlol and ibesartan. ibesartan was begun with 37.5mg for once,once a day,then the dosage was increased to 150mg for once,once a day. In the group D（ n = 30）,the patients were treated with ibesartan,metoprlol,enazepril and spironolactone,The same was drug dosage and treatment ways than before. The cardiac cavity and ventricular diameter and QT dispersion were measured before treatment and 12 months after treatment. Result： After 18 months treatment,end-diastolic diameter of left ventricle（ LVEDD）,end-diastolic diameter of right ventricle（ RVEDD）,left atrium diameter（ LAD）,QTd and corrected QT dispersion（ QTcd） were obviously decreased than before in the same group（ P〈0.05）. Compared with each other in four groups,in group D,the changes mentioned above were significantly different than A,B and C groups,and there were significantly different between group B and C and group A（ P〈0.05）,but compared with group B and group C,there was no different（ P〈0.05）. Conclusion： Multi-blocking produced by combining with ibesartan,metoprlol,enazepril and spironolactone can more effectively inhibit cardiac remodeling and decrease than by combining with enazepril and metoprlol for cardiomyopathy patients with dilate.