替米沙坦与雷米普利联用对慢性心力衰竭患者肾素-血管紧张素-醛固酮系统及心室重塑的影响

目的 观察小剂量替米沙坦与雷米普利联用对慢性心力衰竭(CHF)患者心功能及血浆肾素-血管紧张素Ⅱ-醛固酮系统(BASS)、脑钠素(BNP)的影响.方法 100例慢性心力衰竭患者随机分为A、B、C 3组,在常规治疗的基础上,A组:33例,替米沙坦80mg/d;B组:33例,雷米普利5mg/d;C组:34例,替米沙坦40mg/d+雷米普利2.5mg/d;疗程6个月.治疗前后分别超声测定左室舒张末内径(LVEDD)、左室射血分数(LVEF),测定血浆肾素活性(Ben)、血管紧张素Ⅱ(Ang Ⅱ)、醛固酮(Ald)及BNP水平.结果 3组患者治疗6个月后,LVEDD、LVEF均有明显改善,与治疗前相比差异有统计学意义(P<0.01);治疗后LVEDD、LVEF变化值C组较A、B组有统计学差异(P<0.01).各组治疗后Ren升高,与治疗前相比有统计学差异(P<0.01),Angll含量A组较治疗前明显增加(P<0.01),B组较治疗前明显降低(P<0.01),C组治疗前后无统计学差异(P>0.05).各组治疗后Ald、BNP水平均明显降低,与治疗前相比有统计学差异(P<0.01);治疗前后Ald、BNP下降幅度C组较A、B组有统计学差异(P<0.01).结论 小剂量联合应用替米沙坦和雷米普利比单药应用在慢性心力衰竭治疗中获益更大.

Effects of Combined Telmisartan and Ramlpril on Heart Function and Renin-angiotensin-aldosterone System and Ventricle Remodeling in Patients with Chronic Congestive Heart Failure

Objective To study the effects of combined telmisartan and ramiprll on heart function and renin - angiotensin - aldoste-tone system and ventricle remodeling and brain natriuretie peptide in patients with chronic heart failure (CHF). Methods 100 patientswith chronic heart failure were randomly divided into three groups: telmisartan group (A group, treated with telmisartan 80mg once daily, n =33), ramipril group (B group treated with ramipril 5mg once daily, n =33) and telmisartan plus ramipril group (treated with telmis-artan 40mg plus ramipril 2.5mg once daily, n = 34). Left ventricular end - diastolic dimensions (LVEDD) and left ventricular ejection fraction (LVEF) were assessed, and plasma renin activity (Ren) , angiotensinIl (Angll), aldosterone (Aid) and brain natriuretic pep-tide (BNP) were measured before and after therphy. Results After 6 months of treatment, LVEDD and LVEF were improved in all groups(P < 0.01). All changs were significant in C group than those in A group or B group(P < 0.01). The concentration of Ren were in-creased in all groups(P <0.01). The concentration of Angll was increased in A group and decreased in B group(P <0.01)while there was no difference at pre or post treatment in C group (P > 0.01). The concentration of Ald and BNP was decreased in all groups (P < 0.01). Ald and BNP were decreased more significantly in C group than those in A group or B group. Conclusion Combination of low dose of telmisartan and ramipril therapy has more benificial clinical features than telmisartan or ramipril alone in patients with CHF.