不同剂量厄贝沙坦治疗冠心病临床疗效及其对超敏C反应蛋白和颈动脉斑块影响的对比研究

摘要

目的：比较不同剂量厄贝沙坦治疗冠心病的临床疗效及其对超敏 C 反应蛋白（hs-CRP）和颈动脉斑块的影响。方法选取2011年4月—2015年7月邛崃市医疗中心医院收治的冠心病患者123例，采用随机数字表法分为A、B、C 组，每组41例。A 组患者予以小剂量厄贝沙坦治疗（75 mg/ d），B 组患者予以较高剂量厄贝沙坦治疗（150 mg/ d），C 组患者予以高剂量厄贝沙坦治疗（225 mg/ d）；3组患者均连续治疗10周。比较3组患者临床疗效，治疗前后脑钠肽（BNP）、肌酐（Cr）、hs-CRP水平及颈动脉斑块相关指标〔颈动脉内膜中层厚度（IMT）、斑块面积、斑块厚度、斑块数量〕、心功能指标〔左心室射血分数（ LVEF）、左心室短轴缩短分数（ FS）、左心室舒张末期内径（LVDd）〕、不良反应发生情况。结果3组患者临床疗效比较，差异无统计学意义（P >0.05）。治疗前3组患者 BNP、Cr、hs-CRP水平比较，差异无统计学意义（P >0.05）；治疗后 B、C 组患者 BNP、hs-CRP水平低于 A 组，Cr 水平高于A 组（P <0.05）。治疗前3组患者 IMT、斑块面积、斑块厚度、斑块数量比较，差异无统计学意义（P >0.05）；治疗后 B、C 组患者 IMT、斑块面积、斑块厚度小于 A 组，斑块数量少于 A 组（P <0.05）。治疗前3组患者 LVEF、FS、LVDd 比较，差异无统计学意义（P >0.05）；治疗后 B、C 组患者 LVEF、FS 高于 A 组，LVDd 小于 A 组（P <0.05）。C 组患者肌痛发生率高于 A、B 组（P <0.05）。结论不同剂量厄贝沙坦治疗冠心病的临床疗效相当，高剂量厄贝沙坦（225 mg/ d）可更有效地降低患者hs-CRP水平，减轻颈动脉斑块病变严重程度，改善患者心功能，但安全性较低。%Objective To compare the clinical effect and impact on hs-CRP and carotid plaque in patients with coronary heart disease in different doses of irbesartan. Methods A total of 123 patients with coronary heart disease were selected in the Medical Central Hospital of Qionglai from April 2011 to July 2015,and they were divided into A group,B group and C group according to random number table,each of 41 cases. Patients of A group were given small dose of irbesartan(75 mg/ d), patients of B group were given median dose of irbesartan(150 mg/ d),while patients of C group were given large dose of irbesartan(225 mg/ d);all of the three groups continuously treated for 10 weeks. Clinical effect,BNP,Cr,hs-CRP,carotid plaque related index( including carotid IMT,plaque area,thickness and number of plaque) and index of cardiac function (including LVEF,FS and LVDd)before and after treatment,and incidence of adverse reactions were compared among the three groups. Results No statistically significant differences of clinical effect was found among the three groups( P > 0. 05). No statistically significant differences of BNP,Cr or hs-CRP was found among the three groups before treatment(P > 0. 05);after treatment,BNP and hs-CRP of B group and C group were statistically significantly lower than those of A group,while Cr of B group and C group was statistically significantly higher than that of A group,respectively(P < 0. 05). No statistically significant differences of carotid IMT,plaque area,thickness or number of plaque was found among the three groups before treatment(P >0. 05);after treatment,carotid IMT,plaque area and thickness of plaque of B group and C group were statistically significantly smaller than those of A group,and number of plaque of B group and C group was statistically significantly less than that of A group,respectively(P < 0. 05). No statistically significant differences of LVEF,FS or LVDd was found among the three groups before treatment(P > 0. 05);after treatment,LVEF and FS of B group and C group were statistically significantly higher than those of A group,and LVDd of B group and C group was statistically significantly shorter than that of A group,respectively(P< 0. 05 ). The incidence of myalgia of C group was statistically significantly higher than that of A group and B group, respectively(P < 0. 05). Conclusion Different doses of irbesartan have similar clinical effect in treating patients with coronary heart disease,but large dose of irbesartan(225 mg/ d) can more effectively reduce the hs-CRP level,relive the severity of carotid plaque,improve the cardiac function,but the safety is relatively low.