美托洛尔治疗扩张型心肌病及高血压对左心室重构的影响  

Efficacy of metoprolol on left ventricular remodeling and influence of blood pressure in patients with dilated cardiomyopathy

作　　者：曾小林[1] 杨天伦[1] 

机构地区：[1]中南大学湘雅医院心内科,长沙410008

出　　处：《岭南心血管病杂志》2008年第3期181-183,共3页South China Journal of Cardiovascular Diseases

摘　　要：目的观察扩张型心肌病患者对β受体阻断药的耐受性及治疗后左心室重构与高血压的关系。方法扩张型心肌病26例,高血压组12例,血压正常组14例。在常规治疗基础上开始口服美托洛尔6.25 mg/d,逐渐加大剂量直至目标剂量250 mg/d或最大耐受量,然后维持此剂量并随访1年。所有患者均于治疗前及治疗后1年采用超声心动图检测其左心室舒张末期内径(left ventricular end-diastolicdimension,LVEDd)、左心房舒张末期内径(left atrial end-diastolic dimension,LAEDd)及左心室射血分数(left ventricular ejection fraction,LVEF)。结果高血压组患者对美托洛尔的平均耐受量明显高于血压正常组患者(P﹤0.05);治疗前,两组患者LVEDd、LAEDd及LVEF组间差异无统计学意义(P﹥0.05);美托洛尔治疗1年后,两组患者LVEDd、LAED的及LVEF均有明显改善,但高血压组LVEDd明显小于血压正常组患者,而LVEF明显高于血压正常组(P﹤0.05)。结论伴发高血压的扩张型心肌病患者对美托洛尔的耐受性较好,治疗后改善左心室重构更显著。Objectives To investigate the tolerance of metoprolol and changes of left ventricular remodeling after treatment of hypertension in patients with dilated cardiomyopathy （DCM）. Methods A total of 26 patients with DCM was enrolled in the study. Among them, there were 12 patients accompanied with hypertension （HP group）, and 14 patients with normal blood pressure （No-HP group）. All patients were treated with metoprolol at a starting dosage of 6.25 mg/d. The dosage was gradually increased to the target dosage of 250 mg/d or to the maximum tolerant dosage on the basis of routine treatment. Then, the treatment at this high dosage was maintained for 1 year follow up. The left ventricular end-diastolic dimension （LVEDd） and left atrial enddiastolic dimension （LAEDd） and left ventricular ejection fraction （LVEF） were determined using echocardiography before and after treatment for 1 year. Results The tolerance for metoprolol was found to be significantly higher in the HP group than in the No-HP group （P 〈 0.05 ） ; There were no significantly difference in LVEDd, LAEDd and LVEF between the two groups before treatment （P 〉0.05）; after 1 year＇s treatment, although LVEDd, LAEDd and LVEF had better changes in the two groups, LVEDd was significantly lower and LVEF was significantly higher in the HP group than in the No-HP group （P 〈0.05 ）. Conclusions Patients of DCM with hypertension have a higher tolerance of beta-adrenergic receptor antagonist and have a better change of left ventricular remodeling after treatment than the DCM patients without hypertension.

关 键 词：心肌病 扩张型 美托洛尔 耐受性 心力衰竭 高血压 

分 类 号：R542.2[医药卫生—心血管疾病]