不同剂量比索洛尔对心力衰竭患者神经内分泌及炎症细胞因子的影响

Effects of Neurohumoral Activity and Cytokines From Differen Dose of Bisoprolol in Chronic Systolic heart Failure

目的 :评价不同剂量比索洛尔对慢性收缩性心力衰竭 (心衰 )患者神经内分泌活性、细胞因子、心功能和心脏事件的影响。 方法 :12 0例慢性心功能不全患者 ,在常规治疗心衰的前提下 ,随机分为小剂量比索洛尔组 [平均 (3 5± 1 2 )mg]和大剂量比索洛尔组 [平均 (8 5± 1 2 )mg] ,每组 60例 ,观察其对去甲肾上腺素、血浆肾素活性、血管紧张素Ⅱ、醛固酮、内皮素、白细胞介素 6、肿瘤坏死因子 α、心钠素、脑钠素、心功能及心脏事件的影响。 结果 :两组治疗后与治疗前比心率均有显著下降 (P均 <0 0 5 )。大剂量比索洛尔组左心室射血分数、心排出量、短轴缩短率、左心室舒张末期内径、左心室收缩末期内径、纽约心功能分级及神经内分泌水平治疗后与治疗前相比有显著改善 (P均 <0 0 5 )。而小剂量比索洛尔组治疗前后上述参数均无显著变化 (P均 <0 0 5 )。随访二年 ,大剂量比索洛尔组 1例心源性死亡 ,因心衰恶化再入院 12例 ,而小剂量比索洛尔组 6例心源性死亡 ,因心衰恶化再入院 2 4例 ,死亡和再入院复合终点两组间均达极显著差异 (P均 <0 0 0 1)。 结论 :与小剂量比索洛尔相比 ,大剂量比索洛尔对神经内分泌及细胞因子抑制更大 ,心功能改善更好 ,心脏事件显著减少。

Objec ive: o inves iga e he effec s of differen dose of bisoprolol on neurohormonal ac ivi y,cy okines,cardiac func ion,cardiac dea h in chronic sys olic hear failure pa ien s Me hods: One hundred and wen y chronic hear failure pa ien s were randomly divided in o large dose group (average 8 5± 1 2 mg) and small dose group (average 3 5±1 2 mg) he changes of norepinephrine (NE) ,angio ensionⅡ (AngⅡ) ,aldos erone (Ald) ,endo helin (E ) ,in erleukin 6 BF (IL 6) , umour necrosis fac or α ( NF α) Q ,plasm rennin ac ivi y (PRA) ,cardiona rin (ANP) ,brain na riure ic pep ide (BNP) ,cardiac func ion,cardiac dea h were observed Resul s:Af er rea men , he hear ra e were decreased in wo groups, p <0 05,LVEF,CO,FS,NYHA were increased,LVEDs,LVEDd were decreased and he level of norepinephrine,angio ensionⅡ,aldos erone,endo helin,in erleukin 6, umour necrosis fac or α,plasm rennin ac ivi y,cardiona rin,brain na riure ic pep ide were decreased in large dose group, p <0 05 In small dose group,no significan changes were found of above indexs Af er wo years of follow up,in large dose group,one pa ien died of cardiac dea h (hear func ion deprava ion) , welve pa ien s rehospi alized because of hear func ion deprava ion;in small dose group,six pa ien s died of cardiac dea h ( hree of sudden dea h, hree of hear func ion deprava ion) , wen y four pa ien s rehospi alized because of hear func ion deprava ion, here was differen be ween wo groups, p WTB <0 001 Conclusions: Compared wi h low dose group,large dose of bisiprolol can resul in more reduc ion of BNP,more improved cardiac func ion and less cardiac even s WTH