Wolfel E E
Division of Cardiology, University of Colorado Health Sciences Center, Denver 80262, USA.
Pharmacotherapy. 1998 Nov-Dec;18(6):1323-34.
In addition to effects on survival, hemodynamics, and exercise capacity, quality of life has become an important outcome of therapy for chronic heart failure. A large clinical trial of the angiotensin-converting enzyme (ACE) inhibitor enalapril reports that certain domains of health-related quality of life (HRQL) have a long-term impact on survival in patients with reduced left ventricular systolic function, regardless of symptoms of heart failure at diagnosis. Results of large-scale clinical trials that measured the impact of several different ACE inhibitors on quality of life in these patients suggest benefits of the drugs, but data are confounded by a definite placebo effect. Studies are further confounded by high noncompletion rates for sicker patients, particularly beyond 1 year. Because measurement tools varied and different quality of life domains were evaluated, direct comparison of studies is problematic. Typically, HRQL measurements in patients receiving ACE inhibitors showed small improvement or did not differ significantly from those in placebo-treated patients with long-term follow-up, although short-term trials (< 6 mo) showed some benefit. Moreover, multicenter trials such as SOLVD, V-HeFT II, and ramipril studies indicated that ACE inhibitors do not compromise and may actually improve certain components of quality of life in a large number of patients with chronic heart failure secondary to reduced left ventricular systolic function while having favorable effects on survival, exercise capacity, hemodynamics, or symptoms.
除了对生存率、血流动力学和运动能力有影响外，生活质量已成为慢性心力衰竭治疗的一项重要结果。一项关于血管紧张素转换酶（ACE）抑制剂依那普利的大型临床试验报告称，与健康相关的生活质量（HRQL）的某些领域对左心室收缩功能降低的患者的生存率有长期影响，无论诊断时是否有心力衰竭症状。在这些患者中测量几种不同ACE抑制剂对生活质量影响的大规模临床试验结果表明了这些药物的益处，但数据因明确的安慰剂效应而混淆。病情较重的患者的高失访率进一步混淆了研究结果，尤其是超过1年的情况。由于测量工具不同且评估的生活质量领域不同，研究之间的直接比较存在问题。通常，接受ACE抑制剂治疗的患者的HRQL测量显示改善较小，或与接受安慰剂治疗的患者在长期随访中的测量结果无显著差异，尽管短期试验（<6个月）显示有一些益处。此外，诸如SOLVD、V-HeFT II和雷米普利研究等多中心试验表明，ACE抑制剂不会损害，实际上可能会改善大量因左心室收缩功能降低继发慢性心力衰竭患者的某些生活质量组成部分，同时对生存率、运动能力、血流动力学或症状有有利影响。
