摘要目的比较早期和长期卡托普利治疗老年(65～75岁)和年轻(≤64岁)急性心肌梗死(心梗)患者作用差异. 方法 822例首次心梗72小时内入院患者中,根据是否早期及随访期持续卡托普利治疗,分为年轻治疗组209例、老年治疗组269例,年轻对照组131例、老年对照组213例.用Kaplan-Meier法计算各组的生存率,同时用多因素分析测定影响治疗组生存率的因素(包括年龄). 结果卡托普利治疗组患者的生存率与年龄相关(P<0.001);其中住院期死亡年轻治疗组8例,年轻对照组10例(3.83% vs.7.63%,P>0.05);老年治疗组25例,老年对照组52例(9.29% vs. 24.41%,RR=0.37,95%CI: 0.29～0.48;P<0.0001).随访期卡托普利治疗组的生存率与年龄不相关(P>0.05);老年和年轻治疗组死亡和心性事件均低于相应对照组(P<0.01).结论卡托普利治疗对急性心梗早期作用有年龄差异,对老年患者有明显的有益作用;而长期应用改善预后作用无年龄差异.

abstractsAbstract:Objective To analyse the relationship between age and treatment with captopril after acute myocardial infarction (AMI).Methods In a randomized trial, 822 patients with a first AMI received conventional medical treatment, including intravenous thrombolytic therapy and oral aspirin or metoprolol, and then were randomly allocated to captopril [dosage from the first 6.25?mg to 25?mg/t.i.d, 209 younger patients (≤64 years), 269 elderly patients (65-75 years)] or conventional treatment only (131 younger patients, 213 elderly). Survival in the four groups was calculated with the Kaplan-Meier method. Multivariate analysis was performed to understand the degree that multi-variables (including age) affect survival in patients taking captopril in the hospital or during long term follow-up.Results The survival of patients who took captopril correlated significantly with age (P<0.001). The survival of the elderly patients on captopril treatment did increase (P<0.0001), but not of the younger ones (P>0.05) during hospitalization. During follow-up, the survival of patients who took captopril correlated insignificantly with age (P>0.05), but both the elderly and the younger patients have good survival rates (all P<0.01) and lower cardiac events (all P<0.01) when they took captopril.Conclusions Captopril exerts a weak effect on the younger patients but a beneficial effect on the elderly patients during hospitalization after AMI. However, there is no difference between the younger and the elderly in the prognosis, both having good survival and lower cardiac events when they take captopril long term during follow-up.