不同种降压药物对维持性血液透析患者左心室重塑和功能的影响

Effects of Various Kinds of Hypotensors on Left Ventricular Remodeling and Function in Maintenance Hemodialysis Patients

关键词:  降压药  血液透析  左心室重塑

Key words:  hypotensive drug  hemodialysis  left ventricular remodeling

摘要:

目的 探讨不同种降压药对维持性血液透析患者(MHD)对左心室重塑和功能的影响。方法 选择MHD患者87例随机分为4组，分别为长效钙离子阻滞剂组(CCB，苯磺酸氨氯地平)20例、CCB+β受体阻滞剂组(CCB+β-RB，倍他乐克)22例、CCB+血管紧张素阻滞剂组(CCB+ACEI，洛汀新)23例、CCB+联合血管紧张素II受体阻滞剂组(CCB+ARB，伊贝沙坦)22例分别口服12个月，并应用超声心动图测量0，6，12个月，左房收缩期内径(LADS)、左心室舒张末内径(LVEDD)、左心室收缩末内径(LVEDS)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、左心室射血分数(EF)、短轴缩短率(FS)，计算左心室心肌重量(LVM)及其指数(LVMI)。结果 12个月时，CCB+β-RB组、CCB+ACEI组、CCB+ARB组的LVM、LVMI较实验开始时(0个月)有显著性降低(P<0.05或P<0.01)且CCB+ACEI组、CCB+ARB组的LVM、LVMI比CCB+β-RB组有显著性降低(P<0.05)，并且CCB+ACEI组、CCB+ARB组6个月时已经有统计学差异(P<0.01)；CCB+ACEI组、CCB+ARB组的LVEDD、LVDS、IVST、LPVWT较实验开始时有显著性降低(P<0.05或P<0.01)，EF和FS较实验开始时有升高趋势，但无统计学意义(P>0.05)。实验开始时CCB+ACEI组、CCB+ARB组的LVH发生率分别为86.95%和86.36%，12个月结束时为56.52%和54.54%，有统计学差异(P<0.05)。结论 苯磺酸氨氯地平对左心室重塑无效果，联合ACEI或ARB比联合β-RB更有效的改善MHD患者左心室重塑。

Abstract:

OBJECTIVE To observe the effect of various kinds of hypotensors on left ventricular remodeling and function in maintenance hemodialysis (MHD) patients. METHODS Eighty-seven MHD patients were randomly divided into four groups: CCB group (amlodipine, n=20), CCB combination with β-receptor blocker group (CCB+β-RB group, n=22), CCB combination with angiotensin-converting enzyme inhibitor group (CCB+ACEI group, n=23) and CCB combination with angiotensin receptor blockers group (CCB+ARB group, n=22). They were treated for 12 months. The left atrial end-systolic diameter (LAD), left ventricular end-diastolic (LVEDD), end-systolic dimensions (LVEDS), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT) and ejection fraction (EF) were evaluated, then calculating left ventricular mass index (LVM) and left ventricular mass index(LVMI) with ultrasonic cardiography at 0, 6, 12 month. RESULTS At 12 month, compared with the pre-treatment, LVM and LVMI in CCB+β-RB group, CCB+ACEI group and CCB+ARB group were decreased significantly. Moreever, LVM and LVMI in CCB+ACEI group and CCB+ARB group were less than those in CCB+β-RB group. Compared with the pre-treatment, LVEDD, LVDS, VST and LPVWT in CCB+ACEI group and CCB+ARB group were decreased significantly. CONCLUSION Amlodipine combination with ACEI and ARB was more effective to inhibit left ventricular remodeling than that combination with β-RB in MHD patients.