β受体阻滞剂对慢性心力衰竭患者血浆钠尿肽、心功能和心室重构的影响

The influences of beta-blockers on plasma of natriuretic peptides,the left ventricular function and remolding in patients with chronic heart failure

目的 探讨美多洛尔和卡维地洛对慢性心力衰竭 (CHF)患者心脏神经内分泌、心功能及心室重构的影响。方法 CHF患者 33例 ,分别予常规治疗 (基础组 ,12例 )或加用美多洛尔 (美多洛尔组 ,10例 )、卡维地洛 (卡维地洛组 ,11例 )治疗 3个月。治疗前后用同位素放免法和放免法测定血浆心房钠尿肽、脑钠尿肽 (ANP、BNP)水平 ,心脏彩色多普勒超声诊断仪测量左室结构和心功能 ;观察治疗前后各组钠尿肽水平、心功能、心室重构的变化及组间差异。结果 (1) 3组血浆ANP、BNP水平都显著下降 (P均 <0 0 5或 0 0 1) ;组间下降程度ANP水平无显著差异 (F =0 0 6 ,P >0 0 5 ) ,BNP水平有显著差异 (F =4 97,P <0 0 5 ) ,两 β受体阻滞剂组均明显大于基础组 (P均 <0 0 5 ) ,但两组间无显著差异 (P >0 0 5 )。 (2 )两 β受体阻滞剂组治疗后NYHA心功能分级均改善 (P<0 0 5 ) ,肺动脉收缩压下降 (P均 <0 0 5 ) ,其中治疗前左室射血分数 <35 %者 (8例 ) ,治疗后明显上升 (P <0 0 5 )。 (3) 3组治疗后心脏结构指标无显著变化 (P >0 0 5 )。结论 CHF患者在常规治疗基础上加用 β受体阻滞剂治疗 3个月 ,可显著改善心功能 ,但未观察到对心室重构指标的明显影响及两

Objective This study was performed to investigate the effects of metoprolol and carvedilol on cardiac neuroendocrine system,the left ventricular function and remolding in patients with chronic heart failure(CHF).Methods 33 CHF patients were randomly assigned to receive metoprolol or carvedilol or control in addition to standard therapy for a total of 3 months.Plasma levels of atrial and brain natriuretic peptides (ANP,BNP)were measured by radioimmunoassay and immunoradiometric assay in these patients before and after treatment.Doppler echocardiography was performed to evaluate left ventricular function and structure.Effcets of beta-blocker were assessed by changes of plasma levels of natriuretic peptides,left ventricular function and structure before and after treatment.Results (1)After 3 months optimized treatment,ANP and BNP plasma levels both decreased in all three groups,with no between-group difference of ANP changes,whereas there was significant difference of BNP changes between patients who received beta-blockers and those without.(2)In patients receiving beta-blockers,there was an improvement of NYHA class,a reduction of pulmonary artery systolic pressure,and an increase of LVEF in 8 patients with LVEF<35% before treatment,but there was no significant difference between metoprolol and carvedilol groups in a short period.In the control group,there were no significant changes in NYHA class,LVEF and pulmonary artery systolic pressure.(3)No obvious changes of left ventricular structure had been observed over 3 months treatment. Conclusion Patients treated with beta-blockers in addition to the standard therapy for CHF show beneficial effects on left ventricular function.But according to echocardiography assessment,beta-blocker treatment produces no significant effect on ventricular remodeling within 3 months.There were also no apparent differences in clinical results between metoprolol and carvedilol.