| 刘浩林,汪 钦,邱荣鹤,廉 坤,谭志军,何鸣镝,魏佳昶,谢华宁,何 争.超大剂量ARB治疗不同年龄扩张型心肌病合并心力衰竭患者的临床疗效和安全性研究*[J].,2019,19(1):74-78 |
| 超大剂量ARB治疗不同年龄扩张型心肌病合并心力衰竭患者的临床疗效和安全性研究* |
| A Retrospective Study on Supramaximal-dose ARB in the treatment of Dilated Cardiomyopathy Patients Complicated with Heart Failure with Different Ages* |
| 投稿时间：2018-03-25 修订日期：2018-04-21 |
| DOI：10.13241/j.cnki.pmb.2019.01.015 |
| 中文关键词: 扩张型心肌病 心力衰竭 不同年龄段 超大剂量 ARB |
| 英文关键词: Dilated cardiomyopathy Heart failure Different age groups Supramaximal dose ARB |
| 基金项目:国家自然科学基金青年基金项目（81500272）；陕西省科学技术研究发展计划项目（2016SF-034） |
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| 中文摘要: |
| 摘要 目的：探讨超大剂量ARB治疗不同年龄扩张型心肌病(dilated cardiomyopathy，DCM)合并心力衰竭患者的临床疗效和安全性。方法：选择2012年9月-2015年6月西京医院心内科收治的117例DCM合并心衰的住院患者并将其随机分为60岁及以上年龄超大剂量(32例，老年超大剂量组)及常规剂量(34例，老年常规剂量组)ARB治疗组；30岁及以下年龄超大剂量(24例，青年超大剂量组)和常规剂量(27例，青年常规剂量组)ARB治疗组。超大剂量组长期接受ARB(缬沙坦，320-720 mg bid)治疗，常规剂量组长期接受ARB(缬沙坦80-240 mg bid)治疗。进行临床随访，比较各组患者全因死亡率、心衰再入院率及左室射血分数(LVEF)值等。结果：超大剂量组与常规剂量组、老年超大剂量组与老年常规剂量组年龄、性别、BMI、心率、收缩压、舒张压、心功能、高血压人数及比例、LVEF值等临床基线资料比较差异均无统计学意义(P>0.05)；青年常规剂量舒张压显著高于青年超大剂量组(P＜0.05)，但两组其它基线资料均无统计学差异。经过平均28.18±9.38月的治疗和随访，超大剂量组全因死亡率、心衰再住院率显著低于常规剂量组(P＜0.05)；老年超大剂量组全因死亡率、心衰再住院率显著低于老年常规剂量组(P＜0.05)；青年超大剂量组心衰再住院率显著低于青年常规剂量组(P＜0.05)，但全因死亡率无统计学差异。各组患者治疗后LVEF值均较治疗前有明显提高，且超大剂量组、老年超大剂量组、青年超大剂量组的LVEF值均显著高于其常规剂量组(P＜0.05)。超大剂量组和常规剂量组都发生了低血压、肝功损害、肾功损害等不良反应，但两组各项不良反应发生率比较无统计学差异。结论：超大剂量ARB治疗DCM合并心衰患者比常规剂量治疗能更大程度上降低死亡率和心衰再住院率，改善心功能也更加明显；但超大剂量ARB治疗青年DCM合并心衰患者仅能进一步降低心衰再住院率，不能降低全因死亡率；在院内严密监护下，超大剂量ARB治疗扩心病合并心衰安全可行。 |
| 英文摘要: |
| ABSTRACT Objective: To discuss the clinical efficacy and safety of supramaximal dose of ARB in the treatment of different ages of patients with dilated cardiomyopathy(DCM) complicated with heart failure. Methods: 117 cases of DCM patients treated in Xi Jing hospital from September 2012 to June 2015 were selected and randomized into the supramaximal-dose group and the normal-dose group, each group were subdivided into ≥60 years old and ≤30 years old groups. Patients in the supramaximal-dose group were treated with valsartan(320-720 mg bid) while patients in the normal-dose group were given valsartan (80-240 mg bid). These patients were followed-up and the rate of all cause death and hospitalization due to heart failure as well as the LVEF were compared between different groups. Results: There was no significant difference between the supramaximal-dose group and the normal-dose group, or the old supramaximal-dose group and the old normal-dose group in the clinical baseline data such as age, gender, BMI, heart rate, systolic/diastolic pressure, cardiac function, percentage of hypertension, LVEF, and Pro-BNP levels. Although the average diastolic pressure of young normal-dose group was significantly higher than that of the young supramaximal-dose group(P<0.05), there was no significant difference between the two groups in other baseline data mentioned above. After a period of treatment as long as 28.18±9.38 months on average, the all cause death rate and hospitalization rate of supramaximal-dose group and old supramaximal-dose group were significantly lower than those of the normal-dose group respectively(p＜0.05). The young supramaximal-dose group failed to achieve significant difference in the all cause death rate compared with the young normal-dose group although its hospitalization risk was much lower(P＜0.05). All the groups show an obvious improvement of LVEF after the treatment. The LVEF of supramaximal-dose, old supramaximal-dose, young supramaximal-dose group were significantly higher than their normal-dose groups(p＜0.05). When it comes to the safety, main adverse effects such as hypotension, impaired liver and renal function were found both in the supramaximal-dose group and the normal-dose group. However, there was no difference between the two groups in these items. Conclusion: Compared with normal-dose ARB, long-term supramaximal-dose ARB could significantly reduce the risk of all cause death and hospitalization as well as improve the cardiac function in the treatment of DCM patients with heart failure, which is the same as the result of supramaximal-dose of ARB treatment in the old DCM patients with heart failure. As for the young DCM patients with heart failure, supramaximal-dose of ARB treatment couldn't reduce the hospitalization rate but failed to show any benefit in reducing the risk of all cause death. Importantly, supramaximal-dose of ARB was safe and feasible under the in-hospital supervision and proper management in the treatment of DCM patients with heart failure. |
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