·经验交流·

培哚普利联合坎地沙坦治疗慢性心力衰竭及对氧化指标的影响

赵印印

摘要：目的探讨培哚普利联合坎地沙坦治疗慢性心力衰竭的临床疗效和对氧化应激指标的影响。方法选取2010年9月—2014年3月收治的慢性心力衰竭患者112例。随机均分为对照组和治疗组，对照组进行常规治疗；治疗组使用培哚普利联合坎地沙坦进行治疗。观察两组患者的总体疗效、心功能、左心室形态、活动能力、氧化指标、药物安全性。结果治疗后治疗组显效率(37.50%)和总有效率(82.14%)，均明显高于对照组(P<0.05)；与对照组比较，治疗组患者左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)、室间隔厚度(IVST)、左室后壁厚度(LVPWT)均显著减小，左室射血分数(LVEF)及6 min步行距离显著增加，差异均具有统计学意义(P<0.01)；与对照组比较，血浆中丙二醛(MDA) 含量明显下降，超氧化物歧化酶(SOD)、过氧化氢酶(CAT)、谷胱甘肽过氧化物酶(GSH-Px)活性明显上调，差异均具有统计学意义(P<0.05)；治疗组与对照组药物治疗安全性比较，差异无统计学意义(P>0.05)。结论培哚普利联合坎地沙坦治疗慢性心力衰竭效果显著，可改善患者心功能，减轻氧化应激损伤。

关键词：慢性心力衰竭；培哚普利；坎地沙坦；氧化应激

中图分类号：R541R289

收稿日期：(2014-08-13)

Effects of Perindopril and Candesartan on the Oxidative Stress in Chronic Heart Failure

Zhao Yinyin

Deparment of Vasculocardiology，County Hospital of Binxian， Xianyang 713500， China

Abstract：ObjectiveTo investigate the clinical effect and oxidative stress of perindopril and candesartan for treatment of chronic heart failure(CHF).MethodsOne hundred and twelve patients with CHF were randomly divided into two groups：Control group treated with conventional treatment，and experimental group treated with perindopril and candesartan.The total effective rates， heart function， morphology of left ventricular， activity of living， oxidative activity and drug safety were compared.ResultsThe total effective rate was 82.14% in experimental group，which was significantly higher than that in control group (P<0.05).The left ventricular end systolic dimension (LVESD)， left ventricular end diastolic dimension ( LVEDD)， interventricular septum thickness (IVST) and left ventricular posterior wall thickness (LVPWT) were lower in experimental group compared with control group (P<0.01)， the left ventricular ejection fraction (LVEF) and walking distance of 6 min were higher in experimental group compared with the control group (P<0.01).Compared with control group，the concentration of malondialdehyde (MDA) decreased significantly， and the oxidative activity of superoxide dismutase (SOD)， catalase (CAT) and glutathione peroxidase (GSh-Px) increased significantly in experimental group (P<0.05).There was no statistical difference in drug safety between two groups (P>0.05).ConclusionPerindopril and candesartan for the treatment of CHF has a significant clinical effect.It can improve the cardiac function， relieve oxidative stress injury in patients with CHF.

Key words：chronic heart failure；perindopril；candesartan；oxidative stress

流行病学研究显示，35岁～74岁城乡居民慢性心力衰竭(CHF)患病率为0.9%，并预计CHF发病将呈明显上升趋势[1]。CHF主要发病机制有细胞因子调节紊乱、心肌细胞肥厚、神经内分泌的激活和过代偿等[2]，其中心室重构与神经内分泌激活是心功能进展性恶化的基础，是CHF的重要生物学特征[3]。肾素-血管紧张素-醛固酮系统(RAAS)的过度激活在CHF发生发展中扮演重要角色，血管紧张素Ⅱ受体拮抗剂(ARB)和血管紧张素转换酶抑制剂(ACEI)是阻断RAAS的重要药物，广泛应用于临床治疗CHF。培哚普利(ACEI)和坎地沙坦(ARB)两类药物联合治疗CHF疗效肯定，且经济安全[4，5]，但尚未见到相关的联合应用对CHF患者氧化应激指标影响的临床报道。本研究拟探讨培哚普利和坎地沙坦在CHF治疗中的联合应用效果及对氧化指标的影响，为CHF临床药物治疗提供更多参考信息。……