伊伐布雷定联合美托洛尔对行冠状动脉介入治疗的缺血性心肌病患者心率变异性及神经内分泌因子的影响  

Effects of ivabradine combined with metoprolol on heart rate variability and neuroendocrine factors in patients with ischemic cardiomyopathy undergoing percutaneous coronary intervention

作　　者：韩俊伟[1] 周敏 温红萍[1] 栗菲雪 宋建波[1] Han Junwei;Zhou Min;Wen Hongping;Li Feixue;Song Jianbo(Department of Pharmacy,Shanxi Provincial People′s Hospital,Taiyuan 030012)

机构地区：[1]山西省人民医院药学部,太原030012

出　　处：《中华心力衰竭和心肌病杂志（中英文）》2021年第4期229-233,共5页Chinese Journal of Heart Failure and Cardiomyopathy

基　　金：吴阶平医学基金会-临床科研专项资助基金(320.6750.2021-08-11)。

摘　　要：目的探讨伊伐布雷定联合美托洛尔对于行经皮冠状动脉介入治疗(PCI)的缺血性心肌病(ICM)患者心率变异性(HRV)及神经内分泌因子的影响。方法选取2019年6月至2021年6月期间于山西省人民医院住院行PCI术的ICM患者,采用随机数字表方法分为对照组及观察组。对照组在常规药物治疗基础上给予美托洛尔治疗,观察组在常规药物治疗基础上给予美托洛尔联合伊伐布雷定治疗。两组患者均治疗3个月,比较患者治疗前后HRV指标,包括24 h窦性心律R-R间期标准差(SDNN)、24 h连续5 min正常R-R间期均值标准差(SDANN)和24 h相邻正常R-R间期差值均方根(RMSSD),以及神经内分泌因子,包括N末端B型利钠肽原(NT-proBNP)、血管紧张素Ⅱ(AngⅡ)和醛固酮(ALD)水平的变化,记录患者治疗后3个月主要不良心脏事件(MACE),包括恶性心律失常、心源性死亡及因心衰加重再住院。结果共入选了158例ICM患者,对照组和观察组各79例,两组患者基线特征比较,差异无统计学意义(P均>0.05)。治疗3个月后,两组患者的SDNN、SDANN及RMSSD水平均较治疗前升高,差异有统计学意义(P均<0.05),且观察组的SDNN、SDANN及RMSSD水平高于对照组,组间差异有统计学意义(P均<0.05)。治疗3个月后,两组患者的NT-proBNP、AngⅡ及ALD水平均较治疗前降低,差异有统计学意义(P均<0.05);且观察组NT-proBNP、AngⅡ及ALD水平低于对照组,组间差异有统计学意义(P均<0.05)。治疗3个月后,观察组MACEs发生4例(5.06%),对照组MACEs发生7例(8.86%),两组间差异无统计学意义(P>0.05)。结论伊伐布雷定联合美托洛尔可以改善行PCI术的ICM患者的HRV指标,降低神经内分泌因子水平,降低MACEs发生率,而且安全性良好。Objective To investigate the effect of ivabradine combined with metoprolol on heart rate variability(HRV)and neuroendocrine factors in patients with ischemic cardiomyopathy(ICM)undergoing percutaneous coronary intervention(PCI).Methods ICM patients underwent PCI in Shanxi Provincial People′s Hospital from June 2019 to June 2021 were enrolled and divided into the control group and the observation group by random number table method.On the basis of conventional drug therapy,patients in the control group were treated with metoprolol and those in the observation group were treated with ivabradine combined with metoprolol for 3 months.HRV indicators including 24h sinus rhythm RR interval standard deviation(SDNN),24h continuous 5-min normal RR interval mean standard deviation(SDANN)and 24h adjacent normal RR interval differences root mean square(RMSSD),neuroendocrine factors,including N-terminal pro-B type natriuretic peptide(NT-proBNP),angiotensin II(Ang II)and aldosterone(ALD),and the main adverse cardiac event(MACE),including malignant arrhythmia,cardiogenic death and rehospitalization due to exacerbation of heart failure between these two groups were compared before and after treatment for 3 months.Results A total of 158 ICM patients were enrolled,including 79 cases in the control group and other 79 cases in the observation group.After treatment for 3 months,the levels of SDNN,SDANN and RMSSD in both groups both increased significantly(all P<0.05),with significantly higher levels in the observation group compared with those in the control group(all P<0.05).Moreover,the levels of NT-proBNP,Ang II and ALD in both groups decreased significantly after treatment for 3 months(all P<0.05),with lower levels in the observation group in comparison with those in the control group(all P<0.05).Furthermore,after treatment for 3 months,MACEs occurred in 4 cases(5.06%)in the observation group and 7 cases(8.86%)in the control group with no significant difference between these 2 groups(P>0.05).Conclusion In patients with ICM under

关 键 词：缺血性心肌病 伊伐布雷定 美托洛尔 心率变异性 神经内分泌 

分 类 号：R541.4[医药卫生—心血管疾病]