托伐普坦治疗心肌梗死后左心室功能不全的疗效观察

李文峰; 张丹丹; 刘佳; 夏纪田; 林玉璧; 李自成

doi:10.13201/j.issn.1001-1439.2014.07.013

托伐普坦治疗心肌梗死后左心室功能不全的疗效观察

- 1 暨南大学附属第一医院心内科 (广州, 510630);
- 2 暨南大学医学院人解与组胚教研室;
- 3 广东省第二人民医院呼吸科

详细信息

通讯作者: 李自成,E-mail:1099293158@qq.com

中图分类号: R541.6

收稿日期: 2014-01-13

Effect of tolvaptan on left ventricular dysfunction after myocardial infarction

- 1 Department of Cardiology, the First Hospital of Ji'nan University, Guangzhou, 510630, China;
- 2 Anatomy and Embryology Staff Room, Medical College, Ji'nan University;
- 3 Department of Respiration, the Second People's Hospital in Guangdong Province

More Information

Corresponding author: LI Zicheng, E-mail: 1099293158@qq.com

Received Date: 13 January 2014

摘要

摘要: 目的:研究托伐普坦对心肌梗死后左心室功能不全的疗效, 初步探讨其作用机制。方法:随机选取心肌梗死后10周的患者共120例, 和健康体检人员30例, 分别为心梗组和健康对照组, 将心梗组随机分为4个亚组, 即安慰剂组、呋塞米治疗组、托伐普坦治疗组和呋塞米+托伐普坦治疗组。所有参与者均行体格检查及超声心动图检查, 并抽取静脉血以测定相关生化指标。结果:给药4周后, 与安慰剂组相比, 托伐普坦治疗组和托伐普坦+呋塞米治疗组的血利钠肽 (BNP) 均显著降低 (P＜0.05), 左室舒张末期内径和收缩末期内径均显著降低 (P＜0.05), 左室射血分数明显改善 (P＜0.05)。与安慰剂组相比, 对照组的心室重量/体重比值均明显降低 (P＜0.05), 托伐普坦组和托伐普坦+呋塞米治疗组亦显著降低 (P＜0.05)。但与安慰剂组相比, 呋塞米治疗组的上述指标无明显统计学差异 (P＞0.05)。结论:托伐普坦可改善心肌梗死后左心功能不全, 并有抑制心肌重构的作用。
- 托伐普坦 /
- 左心室功能不全 /
- 心肌梗死 /
- 心肌重构
Abstract: Objective: To study the effects of tolvaptan on left ventricular dysfunction after myocardial infarctionand explore the potential mechanisms.Method: There are 120 patients 10weeks after myocardial infarction and 30 healthy subjects were included in this study.Patients with MI were divided into four subgroups, including placebo group, furosemide group, tolvaptan group, furosemide and tolvaptan group.All the participants underwent physical and echocardiographic examinations.Meanwhile, fasting blood was collected to determine the biochemical parameters.Result: Four weeks after medication,, compared with placebo group, the levels of BNP in plasma were significantly reduced in tolvaptan group (P＜0.05) and furosemide and tolvaptan group (P＜0.05).Similarl, yLVEDd and LVESd were significantly reduced in tolvaptan group (P＜0.05) and furosemide and tolvaptan group (P＜0.05), while LVEF was significantly increased and LVM/WT was significantly reduced in tolvaptan group (P＜0.05) and furosemide and tolvaptan group (P＜0.05).However, compared with the placebo group, there is no significant change of all the above parameters.Conclusion: Tolvaptan may improve left ventricular dysfunction and myocardial remodeling after myocardial infarction.
- tolvaptan /
- left ventricular dysfunction /
- myocardial infarction /
- myocardial remodeling

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参考文献(15)

[1]	GRING C N, FRANCIS G S.A hard look at angiotensin receptor blockers in heart failure[J].J Am Coll Cardiol, 2004, 44:1841-1846.
[2]	MA T K, KAM K K, YAN B P, et al.Renin-angiotensin-aldosterone system blockade for cardiovascular diseases:current status[J].Br J Pharmacol, 2010, 160:1273-1292.
[3]	HILLEGE H L, GIRBES A R, DE KAM P J, et al.Renal function, neurohormonal activation, and survival in patients with chronic heart failure[J].Circulation, 2000, 102:203-210.
[4]	COSTELLO-BOERRIGTER L C, BOERRIGTER G, CATALIOTTI A, et al.Renal and anti-aldosterone actions of vasopressin-2receptor antagonism and B-type natriuretic peptide in experimental heart failure[J].Circ Heart Fail, 2010, 3:412-419.
[5]	GOLDSMITH S R, GHEORGHIADE M.Vasopressin antagonism in heart failure[J].J Am Coll Cardiol, 2005, 46:1785-1791.
[6]	COSTELLO-BOERRIGTER L C, BOERRIGTER G, BURNETT J C Jr.Pharmacology of va-sopressin antagonists[J].Heart Fail Rev, 2009, 14:75-82.
[7]	GHEORGHIADE M, GATTIS W A, BARBAGELATA A, et al.Rationale and study design for a multicenter, randomized, double-blind, placebo-controlled study of the effects of tolvaptan on the acute and chronic outcomes of patients hospitalized with worsening congestive heart failure[J].Am Heart J, 2003, 145:S51-S54.
[8]	DEVEREUX R B, PICKERING T G, ALDERMAN M H, et al.Left ventricular hypertrophy in hypertension.Prevalence and relationship to pathophysiologic variables[J].Hypertension, 1987, 9 (2 Pt 2):II53-60.
[9]	UDELSON J E, MCGREW F A, FLORES E, et al.Multicenter, randomized, double-blind, placebocontrolled study on the effect of oral tolvaptan on left ventricular dilation and function in patients with heart failure and systolic dysfunction[J].J Am Coll Cardiol, 2007, 49:2151-2159.
[10]	GHEORGHIADE M, KONSTAM M A, BURNETT J C Jr, et al.Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan (EVEREST) Investigators.Short-term clinical effects of tolvaptan, an oral vasopressin antagonist, in patients hospitalized for heart failure:the EVEREST Clinical Status Trials[J].JAMA, 2007, 297:1332-1343.
[11]	PANG P S, KONSTAM M A, KRASA H B, et al.Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) Investigators.Effects of tolvaptan on dyspnoea relief from the EVEREST trials[J].Eur Heart J, 2009, 30:2233-2240.
[12]	UDELSON J E, ORLANDI C, OUYANG J, et al.Acute hemodynamic effects of tolvaptan, a vasopressin V2 receptor blocker, in patients with symptomatic heart failure and systolic dysfunction:an international, multicenter, randomized, placebo-controlled trial[J].J Am Coll Cardiol, 2008, 52:1540-1545.
[13]	LI X, CHAN T O, MYERS V, et al.Controlled and cardiac-restricted overexpression of the arginine vasopressin V1A receptor causes reversible left ventricular dysfunction through Gaq-mediated cell signaling[J].Circulation, 2011, 124:572-581.
[14]	WALKER B R, CHILDS M E, ADAMS E M.Direct cardiac effects of vasopressin:role of V1-and V2-vasopressinergic receptors[J].Am J Physiol, 1988, 255 (2 Pt 2):H261-H265.
[15]	MOROOKA H, IWANAGA Y, TAMAKI Y, et al.Chronic administration of oral vasopressin type 2receptor antagonist tolvaptan exerts both myocardial and renal protective effects in rats with hypertensive heart failure[J].Circ Heart Fail, 2012, 5:484-492.