van Veldhuisen D J, de Graeff P A, Remme W J, Lie K I
Department of Cardiology/Thoraxcenter, University Hospital Groningen, The Netherlands.
J Am Coll Cardiol. 1996 Oct;28(4):813-9. doi: 10.1016/s0735-1097(96)00247-1.
Digoxin has been a controversial drug since its introduction >200 years ago. Although its efficacy in patients with heart failure and atrial fibrillation is clear, its value in patients with heart failure and sinus rhythm has often been questioned. In the 1980s, reports of some large-scale trials indicated that digoxin, with or without vasodilators or angiotensin-converting enzyme inhibitors, reduced signs and symptoms of congestive heart failure and improved exercise tolerance. This beneficial influence was mainly found in patients with more advanced heart failure and dilated ventricles, whereas the effect in those with mild disease appeared to be less pronounced. In the last few years, new data have shown that digoxin may also have clinical value in mild heart failure, either when used in combination with other drugs or when administered alone. As neurohumoral activation has increasingly been recognized to be a contributing factor in the disease progression of chronic heart failure, the modulating effects of digoxin on neurohumoral and autonomic status have received more attention. Also, there is evidence that relatively low doses of digoxin may be at least as effective as higher doses and have a lower incidence of side effects. Further, the recognition that the use of digoxin too early after myocardial infarction may be harmful and the development of other drugs, in particular angiotensin-converting enzyme inhibitors, have obviously changed the place of digoxin in the treatment of chronic heart failure. The large-scale survival trial by the Digitalis Investigators Group (DIG), whose preliminary results have recently been presented, has shown that although digoxin has a neutral effect on total mortality during long-term treatment, it reduces the number of hospital admissions and deaths due to worsening heart failure. The potentially new features of the old drug digoxin are discussed in this review.
自200多年前被引入以来，地高辛一直是一种存在争议的药物。尽管其对心力衰竭和心房颤动患者的疗效是明确的，但其对心力衰竭和窦性心律患者的价值却常常受到质疑。在20世纪80年代，一些大规模试验的报告表明，无论是否联用血管扩张剂或血管紧张素转换酶抑制剂，地高辛都能减轻充血性心力衰竭的体征和症状，并提高运动耐量。这种有益影响主要见于心力衰竭更严重且心室扩大的患者，而对轻度疾病患者的效果似乎不那么明显。在过去几年中，新的数据表明，地高辛在轻度心力衰竭中也可能具有临床价值，无论是与其他药物联用还是单独使用。由于神经体液激活越来越被认为是慢性心力衰竭疾病进展的一个促成因素，地高辛对神经体液和自主神经状态的调节作用受到了更多关注。此外，有证据表明，相对低剂量的地高辛可能至少与高剂量一样有效，且副作用发生率更低。此外，认识到心肌梗死后过早使用地高辛可能有害以及其他药物尤其是血管紧张素转换酶抑制剂的研发，显然改变了地高辛在慢性心力衰竭治疗中的地位。地高辛研究组（DIG）进行的大规模生存试验，其初步结果最近已公布，表明尽管地高辛在长期治疗期间对总死亡率有中性影响，但它减少了因心力衰竭恶化导致的住院和死亡人数。本文综述了老药地高辛潜在的新特性。
