卡维地洛对慢性心力衰竭患者神经内分泌和血流动力学的影响

Effect of carvedilol on neuroendocrine and hemodynamics in patients with chronic heart failure

目的 比较卡维地洛 (Carvedilol)与美托洛尔 (Metoprolol)对慢性心力衰竭 (CHF)患者神经内分泌激素和血流动力学的影响。方法 80例 CHF患者 ,随机分为卡维地洛组和美托洛尔组。观察治疗前后脑钠素 (BNP)、去甲肾上腺素 (NE)和左室射血分数 (LVEF)、平均肺动脉压(MPAP)、肺楔压 (PCWP)的变化。结果 卡维地洛组较美托洛尔组显著降低 BNP、NE、MPAP和 PCWP(P<0 .0 5) ,较美托洛尔组明显提高 L VEF(P<0 .0 5)。结论 卡维地洛抗交感活性作用强于美托洛尔 ,能显著降低 BNP、NE水平 。

Objective To compare the effect of carvedilol with metoprolol neuroendocrine and hemodynamics in patients with chronic heart failure (CHF). Methods Eighty patients with CHF were diveded into the carvedilol group and the metoprolol group randomly. Carvedilol 5mg and metoprolol 6.25mg were given, respectively, twice a day. After one week, their dosages were increased. Carvedilol and metoprolol were gradually increased to their target dosage (25mg), twice a day. The treatment course was one year. Brain natriuretic peptide (BNP), atrial natriuretic peptide (ANP), noradrenaline (NE), arginine vesopression (AVP), plasma rennin activity (PRA), angiotensin (AngⅡ) and left ventricular ejection fraction (LVEF), cardiac index (CI), mean pulmonary artery pressure (MPAP), pulmonary capillary (PCWP), mean blood pressure (MBP), mean right atrial pressure (MRAP), pulmonary vascular resistance (PVR) as well as maximal aerobic power (VO 2max) were observed before and after the treatment. Results Both carvedilol and metoprolol could decrease the levels of ANP, BNP, NE, PRA and AngⅡ in plasma, and could increase the levels of LVEF and CI, lower the levels of MPVP and PCWP, but carvedilol had greater influence on the levels of NE, LVEF, MPVP and PCWP than metoprolol ( P< 0.05). Conclusions The effect of carvedilol on the sympatholytic activities is greater than that of metoprolol, It can significantly decrease the levels of BNP and NE. The improvement of heamodynamics is better than that of metoprolol.