不同剂量缬沙坦治疗冠心病临床疗效的对比研究

摘要

目的 比较不同剂量缬沙坦治疗冠心病的临床疗效.方法 选取2014年3月—2016年3月佛山市第二人民医院收治的冠心病患者84例,采用随机数字表法分为对照组、低剂量组、高剂量组,每组28例.对照组患者予以常规药物治疗,低剂量组患者在常规药物治疗基础上予以低剂量缬沙坦治疗,高剂量组患者在常规药物治疗基础上予以高剂量缬沙坦治疗;3组患者均连续治疗6个月.比较3组患者治疗前后左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)、左房室瓣舒张早期血流峰值速度/左房室辩舒张晚期血流峰值速度(E/A比值)及治疗前、治疗1个月、治疗3个月、治疗6个月超敏C反应蛋白(hs-CRP)水平、白介素6(IL-6)水平、肱动脉内皮依赖性舒张功能(FMD),并观察3组患者治疗期间不良反应发生情况.结果 治疗前3组患者LVEDD、LVEF、E/A比值比较,差异无统计学意义(P＞0.05);治疗后低剂量组、高剂量组患者LVEDD短于对照组,LVEF、E/A比值高于对照组(P＜0.05);治疗后高剂量组患者LVEDD短于低剂量组,LVEF高于低剂量组(P＜0.05).时间与方法在hs-CRP、IL-6水平上存在交互作用(P＜0.05);时间在hs-CRP、IL-6水平上主效应显著(P＜0.05);方法在hs-CRP、IL-6水平上主效应显著(P＜0.05);治疗1、3、6个月,低剂量组、高剂量组患者hs-CRP、IL-6水平低于对照组,高剂量组患者hs-CRP、IL-6水平低于低剂量组(P＜0.05).时间与方法在FMD上存在交互作用(P＜0.05);时间在FMD上主效应显著(P＜0.05);方法在FMD上主效应显著(P＜0.05);治疗1、3、6个月,低剂量组、高剂量组患者FMD优于对照组,高剂量组患者FMD优于低剂量组(P＜0.05).3组患者治疗期间不良反应发生率比较,差异无统计学意义(P＞0.05).结论 高剂量缬沙坦治疗冠心病的临床疗效优于低剂量缬沙坦,可更有效地改善患者心功能及血管内皮功能,减轻炎性反应,且安全性较高.%Objective To compare the clinical effect on coronary heart disease in different doses of valsartan.Methods A total of 84 patients with coronary heart disease were selected in the Second People's Hospital of Foshan from March 2014 to March 2016,and they were divided into control group,low-dose group and high-dose group according to randomnumber table,each of 28 cases.Patients of the three groups received conventional medical treatment,meanwhile patients of low-dose group received low-dose valsartan,while patients of high-dose group received high-dose valsartan;all of the three groups continuously treated for 6 months.LVEDD,LVEF,early blood peak velocity of left atrioventricular valve/end blood peak velocity of left atrioventricular valve (E/A ratio) before and after treatment,hs-CRP,IL-6 and FMD before treatment,after 1 month,3 months and 6 months of treatment were compared among the three groups,and incidence of adverse reactions was observed during the treatment.Results No statistically significant differences of LVEDD,LVEF or E/A ratio was found among the three groups before treatment (P ＞ 0.05);after treatment,LVEDD of low-dose group and high-dose group was statistically significantly shorter than that of control group,respectively,LVEF and E/A ratio of low-dose group and high-dose group were statistically significantly higher than those of control group (P ＜ 0.05);LVEDD of high-dose group was statistically significantly shorter than that of low-dose group,while LVEF of high-dose group was statistically significantly higher than that of low-dose group (P ＜ 0.05).There was interaction between time and method in hs-CRP and IL-6 (P ＜ 0.05);main effects of time and method were significant in hs-CRP and IL-6 (P ＜ 0.05);after 1 month,3 months and 6 months,hs-CRP and IL-6 of low-dose group and high-dose group were statistically significantly lower than those of control group,meanwhile hs-CRP and IL-6 of high-dose group were statistically significantly lower than those of low-dose group (P ＜ 0.05).There was interaction between time and method in FMD (P ＜ 0.05);main effects of time and method were significant in FMD (P ＜ 0.05);after 1 month,3 months and 6 months,FMD of low-dose group and high-dose group was statistically significandy better than that of control group,respectively,meanwhile FMD of high-dose group was statistically significantly better than that of low-dose group (P ＜ 0.05).No statistically significant differences of incidence of adverse reactions was found among the three groups during the treatment (P ＞ 0.05).Conclusion High-dose valsartan has better clinical effect than low-dose valsartan in treating coronary heart disease,can more effectively improve the cardiac function and vascular endothelial function,relieve the inflammatory reaction,and is relatively safe.