血管紧张素转换酶抑制剂和血管紧张素受体拮抗剂对扩张型心肌病内皮功能的影响

摘要

目的：探讨血管紧张素转换酶抑制剂（angiotension converting enzyme inhibitor，ACEI）达爽和血管紧张素受体拮抗剂（angiotension receptor blocker，ARB）安博维对扩张型心肌病患者内皮功能的影响。方法：采用超声肱动脉内径测量法，对20例正常人和24例扩张型心肌病患者服用达爽或安博维治疗前后肱动脉内径在反应性充血后和含服硝酸甘油后的百分变化率进行比较，分析ACE-I和ARB对扩张型心肌病内皮功能的影响。结果：治疗前扩张型心肌病患者肱动脉内径在反应性充血前后变化较小，但与对照组比较差异均有统计学意义（P<0.01）；而经达爽或安博维治疗后肱动脉内径反应性充血后变化率明显高于治疗前，比较差异均有统计学意义（P<0.05）；而经达爽或安博维治疗的效果比较差异无统计学意义（P>0.05）。结论：ACE-I和ARB均可改善扩张型心肌病的内皮功能，两者在治疗效果上差异不明显。%Objective:To evaluate the effects of angiotension converting enzyme inhibitor(ACEI) imidapril or angiotension receptor blocker (ARB)irbesartan on the endothelial function in patients with idiopathic dilated cardiomyopathy by transthoracic echocardiography.Method:Twenty-four patients with idiopathic dilated cardiomyopathy and 20 healthy subjects were included in this study. Brachial artery endothelium dependent dilation function [flow-mediated dilation(FMD)] and nitroglycerin-induced percent changes in the brachial artery diameter were measured by two-dimensional ultrasound before and after the treatment of imidapril or irbesartan and the effect of ACE-I and ARB on endothelial function in dicated cordiomyopathy were analyzed. Result:The treatment of dilated cardiomyopathy patients in the brachial artery diameter had smaller changes before and after the reactive hyperemia,but with the control group had significant difference(P<0.01).The change rate of brachial artery diameter reaction after treatment of imidapril or irbesartan were significantly higher than those before treatment,the differences were statistically significant(P<0.05).But the therapeutic effect of imidapril or irbesartan had no statistically significant difference(P>0.05).Conclusion:ACE-I and ARB can improve the endothelial function in patients with dilated cardiomyopathy,the treatment effect is not obvious difference.