美托洛尔对慢性心力衰竭患者脑钠肽水平及心功能的影响  

The Effects of Metoprolol on Blood Level of Brain Natriuretic Peptide and Cardiac Function in Patients with Chronic Heart Failure

作　　者：贾百全[1] 孙同文[2] 彭跃华[1] 张自富[1] 

机构地区：[1]河南焦作矿务局中央医院心内科,454000 [2]河南郑州大学第一附属医院心内科,450052

出　　处：《中国误诊学杂志》2005年第18期3404-3406,共3页Chinese Journal of Misdiagnostics

摘　　要：目的:探讨美托洛尔对慢性心力衰竭 (CHF) 患者脑钠肽 (BNP) 水平和心功能的影响.方法:已接受常规治疗,纽约心脏病协会(NYHA)分级标准心功能Ⅱ～Ⅲ级的CHF患者90例,随机分为两组:治疗组(50例),对照组(40例).治疗组在常规治疗基础上加用美托洛尔,从小剂量(6.25 mg,2次/d)逐渐加至靶剂量(50 mg,2次/d),治疗6个月.对比分析治疗前后两组患者的血浆BNP水平、NYHA分级、心率、血压、超声心动图等指标.结果:治疗组较对照组左室舒张末期内径[(63±7)mm vs (59±5) mm)]、左室收缩末期内径[(53±8) vs (47±4) mm)]和左室质量指数[(160±24)g/m2 vs (135±18) g/m2)]显著下降(均P<0.05),左室射血分数(LVEF)显著升高[(38±11)% vs (47±9)%](P<0.05),血浆BNP[(121±54)ng/L vs (70±9)ng/L)]显著降低(P<0.05);另外,美托洛尔治疗前后患者血浆BNP降低值与左室舒张末期内径(r=0.80)、左室收缩末期内径(r=0.79)和左室质量指数(r=0.71) 减少呈正相关 (均P<0.01),而与LVEF的增加呈负相关(r=-0.86,P<0.01).结论:美托洛尔能抑制CHF患者神经内分泌的过度激活,阻断CHF的发展进程,改善心功能,血浆BNP可作为评价β受体阻滞剂治疗CHF疗效的监测指标之一.Objective：To investigate the effects of metoprolol on changes in plasma brain natriuretic peptide （BNP） level and cardiac function in patients with chronic heart failure （CHF）. Methods：A total of 90 patients with CHF, who had already received conventional therapy, were randomly divided into two groups： the Metoprolol group （n= 507 and the conventional group（n=40）. Patients in the Metoprolol group were given Metoprolol titrated to the target dosage （from 6.25 mg b. i, d. to 50 mg b. i. d. ）. Plasma BNP levels.NYHA functional class, heart rate, blood pressure, and echocardiographic indices were evaluated before and after 6 months＇ therapy. Results ： After 6-month therapy, Metoprolol could significantly decrease left ventricular end-diastolic and -systolic dimensions [LVEDd： （63± 7） mm vs （59±5） mm,LVESd：（53±8） vs （47±4）mm）], and left ventricular mass index [LVMI,（160±24） vs （135±18） g/ m^2] ,all P〈0.05,increase left ventricular ejection fraction [LVEF ： （38± 11）% vs （47± 9） % ,P〈0.05）], and attenuate BNP [（121±54）ng/L vs （70±9）ng/L,P〈0.01）,compared with the patients in the conventional group. Meanwhile, changes in BNP level were positively correlated with the decrease in LVEDd （r=0. 80）, LVESd （r=0.79）,and LVMI （r： 0, 71） （all P〈0. 01）, and negatively correlated with the increase in LVEF （r =-0.86, P〈 0.01 ）. Conclusions Metoprolol may suppress neurohormonal activation,inhibit the process of CHF,and improve cardiac function in CHF patient. Plasma BNP level may serve as a therapeutic indicator for beta-blocker treatment in CHF patients,

关 键 词：心力衰竭 充血性/病理生理学 美托洛尔/治疗应用 利钠肽 脑/血液 

分 类 号：R541.610.23[医药卫生—心血管疾病]