{"id":18101,"date":"2019-12-19T05:38:45","date_gmt":"2019-12-18T21:38:45","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=18101"},"modified":"2019-12-24T05:46:22","modified_gmt":"2019-12-23T21:46:22","slug":"lancet%e5%9c%a8%e7%ba%bf%e5%8f%91%e8%a1%a8%ef%bc%9a%e5%8e%84%e8%b4%9d%e6%b2%99%e5%9d%a6%e6%b2%bb%e7%96%97%e9%a9%ac%e5%87%a1%e7%bb%bc%e5%90%88%e5%be%81%ef%bc%9a%e5%8f%8c%e7%9b%b2%e5%ae%89%e6%85%b0","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=18101","title":{"rendered":"[Lancet\u5728\u7ebf\u53d1\u8868]\uff1a\u5384\u8d1d\u6c99\u5766\u6cbb\u7597\u9a6c\u51e1\u7efc\u5408\u5f81\uff1a\u53cc\u76f2\u5b89\u6170\u5242\u5bf9\u7167\u968f\u673a\u8bd5\u9a8c"},"content":{"rendered":"\n

Irbesartan in Marfan syndrome (AIMS): a double-blind, placebo-controlled randomised trial<\/h1>\n\n\n\n

Michael Mullen, Xu Yu Jin, Anne Child, et al<\/h3>\n\n\n\n

Lancet Published: December 10, 2019 DOI:https:\/\/doi.org\/10.1016\/S0140-6736(19)32518-8<\/a><\/h3>\n\n\n\n

Background \u80cc\u666f<\/h3>\n\n\n\n

Irbesartan, a long acting selective angiotensin-1 receptor inhibitor, in Marfan syndrome might reduce aortic dilatation, which is associated with dissection and rupture. We aimed to determine the effects of irbesartan on the rate of aortic dilatation in children and adults with Marfan syndrome.<\/p>\n\n\n\n

\u5384\u8d1d\u6c99\u5766\u662f\u4e00\u79cd\u957f\u6548\u7684\u9009\u62e9\u6027\u8840\u7ba1\u7d27\u5f20\u7d20-1\u53d7\u4f53\u963b\u6ede\u5242\uff0c\u53ef\u80fd\u51cf\u5c11\u9a6c\u51e1\u7efc\u5408\u5f81\u60a3\u8005\u7684\u4e3b\u52a8\u8109\u6269\u5f20\uff08\u4e3b\u52a8\u8109\u6269\u5f20\u4e0e\u5939\u5c42\u53ca\u7834\u88c2\u76f8\u5173\uff09\u3002\u6211\u4eec\u65e8\u5728\u786e\u5b9a\u5384\u8d1d\u6c99\u5766\u5bf9\u9a6c\u51e1\u7efc\u5408\u5f81\u7684\u513f\u7ae5\u53ca\u6210\u4eba\u4e3b\u52a8\u8109\u6269\u5f20\u7684\u5f71\u54cd\u3002<\/p>\n\n\n\n

Methods \u65b9\u6cd5<\/h3>\n\n\n\n

We did a placebo-controlled, double-blind randomised trial at 22 centres in the UK. Individuals aged 6\u201340 years with clinically confirmed Marfan syndrome were eligible for inclusion. Study participants were all given 75 mg open label irbesartan once daily, then randomly assigned to 150 mg of irbesartan (increased to 300 mg as tolerated) or matching placebo. Aortic diameter was measured by echocardiography at baseline and then annually. All images were analysed by a core laboratory blinded to treatment allocation. The primary endpoint was the rate of aortic root dilatation. This trial is registered with ISRCTN, number ISRCTN90011794.<\/p>\n\n\n\n

\u6211\u4eec\u5728\u82f1\u56fd22\u4e2a\u4e2d\u5fc3\u8fdb\u884c\u4e86\u4e00\u9879\u5b89\u6170\u5242\u5bf9\u7167\u3001\u53cc\u76f2\u968f\u673a\u4e34\u5e8a\u8bd5\u9a8c\u3002\u4e34\u5e8a\u786e\u8bca\u9a6c\u51e1\u7efc\u5408\u5f81\u76846-40\u5c81\u60a3\u8005\u5165\u9009\u3002\u6240\u6709\u60a3\u8005\u5747\u4f7f\u7528\u6bcf\u65e5\u4e00\u6b2175 mg\u5f00\u653e\u6807\u7b7e\u5384\u8d1d\u6c99\u5766\uff0c\u7136\u540e\u968f\u673a\u5206\u4e3a\u5384\u8d1d\u6c99\u5766150 mg\uff08\u82e5\u8010\u53d7\u53ef\u52a0\u91cf\u81f3300 mg\uff09\u6216\u5b89\u6170\u5242\u3002\u5728\u57fa\u7ebf\u53ca\u6b64\u540e\u6bcf\u5e74\u901a\u8fc7\u5fc3\u810f\u8d85\u58f0\u68c0\u67e5\u6d4b\u91cf\u4e3b\u52a8\u8109\u76f4\u5f84\u3002\u6240\u6709\u5f71\u50cf\u5747\u7531\u5bf9\u8bd5\u9a8c\u5206\u7ec4\u8bbe\u76f2\u7684\u4e2d\u5fc3\u5b9e\u9a8c\u5ba4\u8fdb\u884c\u5206\u6790\u3002\u4e3b\u8981\u9884\u540e\u7ec8\u70b9\u4e3a\u4e3b\u52a8\u8109\u6839\u90e8\u6269\u5f20\u7387\u3002\u8bd5\u9a8c\u5728 ISRCTN \u6ce8\u518c\uff0c\u6ce8\u518c\u53f7ISRCTN90011794\u3002<\/p>\n\n\n\n

Findings \u7ed3\u679c<\/h3>\n\n\n\n

Between March 14, 2012, and May 1, 2015, 192 participants were recruited and randomly assigned to irbesartan (n=104) or placebo (n=88), and all were followed for up to 5 years. Median age at recruitment was 18 years (IQR 12\u201328), 99 (52%) were female, mean blood pressure was 110\/65 mm Hg (SDs 16 and 12), and 108 (56%) were taking \u03b2 blockers. Mean baseline aortic root diameter was 34\u00b74 mm in the irbesartan group (SD 5\u00b78) and placebo group (5\u00b75). The mean rate of aortic root dilatation was 0\u00b753 mm per year (95% CI 0\u00b739 to 0\u00b767) in the irbesartan group compared with 0\u00b774 mm per year (0\u00b760 to 0\u00b789) in the placebo group, with a difference in means of \u22120\u00b722 mm per year (\u22120\u00b741 to \u22120\u00b702, p=0\u00b7030). The rate of change in aortic Z score was also reduced by irbesartan (difference in means \u22120\u00b710 per year, 95% CI \u22120\u00b719 to \u22120\u00b701, p=0\u00b7035). Irbesartan was well tolerated with no observed differences in rates of serious adverse events.<\/p>\n\n\n\n

2012\u5e743\u670814\u65e5\u81f32015\u5e743\u67081\u65e5\u671f\u95f4\uff0c\u5171\u7eb3\u5165192\u540d\u60a3\u8005\uff0c\u968f\u673a\u5206\u4e3a\u5384\u8d1d\u6c99\u5766\u7ec4(n=104)\u6216\u5b89\u6170\u5242\u7ec4(n=88)\uff0c\u6240\u6709\u60a3\u8005\u5747\u968f\u8bbf\u6700\u957f\u81f35\u5e74\u3002\u5165\u9009\u65f6\u4e2d\u4f4d\u5e74\u9f8418 \u5c81(IQR 12\u201328)\uff0c99\u540d (52%) \u60a3\u8005\u4e3a\u5973\u6027\uff0c\u5e73\u5747\u8840\u538b\u4e3a 110\/65 mm Hg (SDs 16 \u548c 12)\uff0c108\u540d (56%) \u60a3\u8005\u4f7f\u7528 \u03b2 \u53d7\u4f53\u963b\u6ede\u5242\u3002\u5384\u8d1d\u6c99\u5766\u7ec4\u57fa\u7ebf\u4e3b\u52a8\u8109\u6839\u90e8\u5e73\u5747\u76f4\u5f84\u4e3a 34\u00b74 mm (SD 5\u00b78)\uff0c\u5b89\u6170\u5242\u7ec4 34\u00b74 mm (5\u00b75)\u3002\u5384\u8d1d\u6c99\u5766\u7ec4\u4e3b\u52a8\u8109\u6839\u90e8\u6269\u5f20\u7387\u5e73\u5747\u4e3a\u6bcf\u5e74 0\u00b753 mm (95% CI 0\u00b739 to 0\u00b767)\uff0c\u5b89\u6170\u5242\u7ec4\u4e3a 0\u00b774 mm (0\u00b760 to 0\u00b789)\uff0c\u5747\u503c\u5dee\u5f02\u4e3a\u6bcf\u5e74 \u22120\u00b722 mm (\u22120\u00b741 to \u22120\u00b702, p=0\u00b7030)\u3002\u5384\u8d1d\u6c99\u5766\u8fd8\u80fd\u591f\u964d\u4f4e\u4e3b\u52a8\u8109Z\u8bc4\u5206\u6539\u53d8\u7387 (\u5747\u503c\u5dee\u5f02\u6bcf\u5e74 \u22120\u00b710, 95% CI \u22120\u00b719 to \u22120\u00b701, p=0\u00b7035)\u3002\u5384\u8d1d\u6c99\u5766\u8010\u53d7\u6027\u826f\u597d\uff0c\u6ca1\u6709\u89c2\u5bdf\u5230\u4e25\u91cd\u4e0d\u826f\u4e8b\u4ef6\u53d1\u751f\u7387\u5b58\u5728\u663e\u8457\u5dee\u5f02\u3002<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

Interpretation \u7ed3\u8bba<\/h3>\n\n\n\n

Irbesartan is associated with a reduction in the rate of aortic dilatation in children and young adults with Marfan syndrome and could reduce the incidence of aortic complications.<\/p>\n\n\n\n

\u5384\u8d1d\u6c99\u5766\u964d\u4f4e\u9a6c\u51e1\u7efc\u5408\u5f81\u513f\u7ae5\u53ca\u9752\u5e74\u7684\u4e3b\u52a8\u8109\u6269\u5f20\u7387\uff0c\u53ef\u4ee5\u964d\u4f4e\u4e3b\u52a8\u8109\u5e76\u53d1\u75c7\u7684\u53d1\u751f\u7387\u3002<\/p>\n\n\n\n

Funding \u8d44\u52a9<\/h3>\n\n\n\n

British Heart Foundation, the UK Marfan Trust, the UK Marfan Association.<\/p>\n","protected":false},"excerpt":{"rendered":"

Irbesartan in Marfan syndrome (AIMS): a double-blind, p […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18101"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=18101"}],"version-history":[{"count":3,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18101\/revisions"}],"predecessor-version":[{"id":18104,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18101\/revisions\/18104"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=18101"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=18101"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=18101"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}