洛汀新科室会幻灯集.ppt

* 446例高危患者随机分配到安慰剂组，雷米普利2.5mg/ d或雷米普利10/天组，随访4年，结果左室舒张终末期容量，在安慰剂组为增加4.2ml，雷米普利2.5mg降低0.4ml，雷米普利10mg降低5.9ml；左室收缩终末期容量，在安慰剂组为增加5.3ml，雷米普利2.5mg增加2.9ml，雷米普利10mg降低1.9ml，且与雷米普利2.5mg相比， P＝0.01，这说明保护剂量ACEI较低剂量更明显降低左室容量 * b型钠尿肽（b－typenatriureticpeptide，BNP），又称脑钠素或脑钠肽，因其有排钠利尿、内皮非依赖性的血管平滑肌作用而具有降压、抗心肌纤维化、影响神经内分泌系统等功效。近来发现BNP在各种心血管疾病，尤其是心室功能不全、急性心肌梗死（ami）、高血压等疾病的诊断、治疗及预后等方面有重要意义，已引起临床工作者的高度重视。 血浆BNP水平的增高已被视为心衰严重程度和慢性心衰患者死亡率的一个独立的预后指标。 发表在2009年Arq Bras Cardiol 杂志上的《ACE inhibitors and plasma B-type natriuretic peptide levels in elderly patients with heart failure》研究中，使用喹那普利10mg、20mg、30mg、40mg，观察8个月后，结果基线、喹那普利10mg、20mg、30mg、40mg组的BNP水平分别为， 603.3 pg/ml、 402.5 pg/ml、 293.6 pg/ml、224.3 pg/ml、196.3pg/ml，这提示保护剂量的ACEI能有效降低老年左心衰患者体内BNP水平。 A total of 30 patients (76.1 ± 5.3 years; 15 women), in NYHA functional class II-III HF, with left ventricular EF < 40% (33.5 ± 4.5%), on diuretics (30), digoxin (24) and nitrates (13) were included. The patients were assessed at baseline and every two months, with escalating doses of quinapril of 10, 20, 30 and 40 mg. * We randomly assigned 3164 patients with New York Heart Association class II to IV heart failure and an ejection fraction #30% to double-blind treatment with either low doses (2.5 to 5.0 mg daily, n51596) or high doses (32.5 to 35 mg daily, n51568) of the ACE inhibitor, lisinopril, for 39 to 58 months, while background therapy for heart failure was continued. When compared with the low-dose group, patients in the high-dose group had a nonsignificant 8% lower risk of death (P50.128) but a significant 12% lower risk of death or hospitalization for any reason (P50.002) and 24% fewer hospitalizations for heart failure (P50.002). Dizziness and renal insufficiency was observed more frequently in the high-dose group, but the 2 groups were similar in the number of patients requiring discontinuation of the study medication. * 所以保护剂量ACEI对心血管系统可能的保护机制详细如下，ACEI延缓心血管高危患者动脉粥样硬化显示出剂量依赖趋势，逆转左心室肥厚、改善左室容量存在明显剂量依赖；ACEI降低老年左心衰患者BNP存在剂量依赖；保护剂量ACEI明显改善冠