美托洛尔对充血性心力衰竭患者神经内分泌活性及心功能的影响  

The effect of metoprolol on neuroendocrine activities and cardiac function in patients with congestive heart failure

作　　者：姚冬梅[1] 刘坤申[1] 万国华[1] 彭应心[1] 李延辉[1] 冯珏[2] 卢亚敏[2] 

机构地区：[1]河北省人民医院心内科 [2]河北省人民医院同位素科

出　　处：《临床心血管病杂志》2003年第6期327-329,共3页Journal of Clinical Cardiology

摘　　要：目的 :观察美托洛尔对应用血管紧张素转换酶抑制剂 (ACEI)等基础治疗的充血性心力衰竭 (CHF)患者神经内分泌激活及心功能的影响 ,探讨其治疗CHF的机制。方法 :入选的 95例CHF患者均接受基础治疗(洋地黄、利尿剂、ACEI)。并随机分为治疗组和对照组 ,治疗组加用美托洛尔 ,随访至 6个月时治疗组为 5 7例 ;对照组 2 6例。并分别于治疗前和治疗后 1、3、6个月测定血浆肾素活性 (PRA)、血管紧张素Ⅱ (AngⅡ )和去甲肾上腺素 (NE)水平。结果 :治疗组应用美托洛尔后PRA、NE明显下降 ,同治疗前相比二者均P <0 .0 1;而对照组PRA、AngⅡ、NE与基线相比均明显升高 (P <0 .0 1,P <0 .0 1,P <0 .0 5 )。美托洛尔组同对照组相比 ,对神经内分泌的抑制加强 ,同时伴有左室射血分数 (LVEF)的升高。结论 :单纯ACEI等基础治疗仍存在PRA、AngⅡ和NE等神经内分泌的激活 ,美托洛尔可抑制神经内分泌的激活 。Objective:To study changes of PRA, AngⅡ and NE during metoprolol therapy in patients with congestive heart failure(CHF).Methods:All patients received baseline therapy(digitalis, diuretic and ACEI) were randomly assigned to control group and treatment group. Plasma levels of norepinephrine (NE), plasma renin activity(PRA), angiotensinⅡ(AngⅡ) were measured before and 1 month,3 months, 6 months after initiation of metoprolol treatment.Results:Metoprolol group had a lower activation of neuroendocrine, especially in PRA and NE , compared with pretreatment, both had significant differences (P< 0.01,P< 0.01). In the meantime, left ventrvicular ejection fraction(LVEF) was elevated. While the levels of PRA, AngⅡ, NE had dramatic elevation (P< 0.01,P< 0.01,P< 0.05) in the control group.Conclusion:There still exists activation of neuroendocrine during ACEI medication in CHF patients, and it can be suppressed by adiministration of metoprolol and in the meantime, LVEF was elevated.

关 键 词：心力衰竭 充血性 支甲肾上腺素 肾素-血管紧张素系统 美托洛尔 

分 类 号：R541.6[医药卫生—心血管疾病]