卡维地洛与比索洛尔对心力衰竭患者心功能及心型脂肪结合蛋白、脑钠肽的影响  

Effect of Carvedilol and Bisoprolol on the Changes of Heart Type Fatty Acid Binding Protein and Brain Natriuretic Peptide in Patients with Congestive Heart Failure

作　　者：张海涛[1] 邵辉[2] 王兴宏[3] 董秋立[1] 王忠明[1] 

机构地区：[1]华北石油管理局总医院心内科,河北任丘062552 [2]华北石油管理局总医院科教科,河北任丘062552 [3]华北石油管理局总医院介入科,河北任丘062552

出　　处：《中国药房》2015年第32期4532-4534,共3页China Pharmacy

基　　金：华北油田矿区医疗卫生临床医学相关研究(No.2015-HB-G11-01)

摘　　要：目的:观察卡维地洛与比索洛尔对老年心力衰竭(CHF)患者心功能及心型脂肪结合蛋白(H-FABP)、脑钠肽(BNP)水平的影响。方法:选取CHF患者110例,按随机数字表法分为卡维地洛组和比索洛尔组,各55例。卡维地洛组患者给予卡维地洛3.125 mg,bid,每2周剂量加倍,直至达目标靶剂量25 mg或耐受最大剂量;比索洛尔组患者给予比索洛尔1.25 mg,qd,每2周剂量加倍,直至达目标靶剂量10 mg或耐受最大剂量。两组患者疗程均为6个月。观察两组患者治疗后临床有效率,应用心脏超声测量治疗前后左心室舒张末内径(LVEDD)、左室射血分数(LVEF)、收缩压(SBP)和舒张压(DBP)变化;结合放射免疫方法测定血浆中BNP和H-FABP浓度变化。结果:治疗后,卡维地洛组患者临床总有效率(96.4%)高于比索洛尔组(89.2%),差异有统计学意义(P<0.05);两组患者治疗后LVEDD、LVEF、BNP、H-FABP、SBP和DBP较治疗前均有明显降低,且卡维地洛组显著低于比索洛尔组,差异均有统计学意义(P<0.01或P<0.05)。结论:卡维地洛与比索洛尔均能明显改善患者心功能,卡维地洛疗效更为显著,同时H-FABP治疗前后的明显下降提示H-FABP也可以作为判断心力衰竭治疗效果的另一个可靠的指标。OBJECTIVE： To observe the changes of heart type fatty binding protein （H-FABP） and brain natriuretic peptide （BNP） when carvedilol and bisoprolol in the treatment of elderly patients with chronic heart failure （CHF）. METHODS： 110 CHF patients were randomly assigned into carvedilol group and bisoprolol group （n=55）. Carvedilol group was given carvedilol 3.125 mg, bid, doubling dose every 2 weeks to reach target dose 25mg or maximum tolerant dose; bisoprolol group was given bisoprolol 1.25 rag, qd, doubling dose every 2 weeks to reach target dose 10 mg or maximum tolerant dose. Treatment course lasted for 6 months. Clinical effective rate of 2 groups were observed after treatment. Echocardiography was used to measure the changes of LVEDD, LVEF, SBP and DBP before and after treatment. The plasma concentration of BNP and H-FABP were measured by radio- immunoassay. RESULTS： After treatment, total effective rate of carvedilol group （96.4%） was higher than that of bisoprolol group （89.2%）, with statistical significance （P〈0.05）. Compared with before treatment, the levels of LVEDD, LVEF, BNP, H-FABP, SBP and DBP in 2 groups were all decreased significantly after treatment, with statistical significance （P〈0.01 or P〈0.05）. CON- CLUSIONS： Both carvedilol and bisoprolol can significantly improve cardiac function, but carvedilol efficacy is more significant. At the same time, significant decrease of H-FABP before and after treatment indicate that H-FABP can be used as a reliable index of heart failure treatment effect.

关 键 词：心力衰竭 心型脂肪结合蛋白 脑钠肽 超声检查 卡维地洛 比索洛尔 

分 类 号：R541.6[医药卫生—心血管疾病]