卡维地洛与美托洛尔治疗慢性心力衰竭疗效比较

Comparison on clinical effect of carvediol and meroprolol in treatment of chronic heart failure

目的:对比第三代β-受体阻滞剂卡维地洛与第二代β-受体阻滞剂美托洛尔对慢性充血性心力衰竭(CHF)的长期临床疗效,为临床治疗药物的选择提供依据。方法:81例患者随机分为卡维地洛组(n=43)和美托洛尔组(n=38),治疗6个月,监测2组治疗前后心率(fH)、血压、NYHA心功能分级、左心室内径(dLVED、dLVES)、射血分数(LVEF)及短轴缩短率(FS)、6min步行试验(6MWT)距离和QT离散度(QTd)的变化。结果:卡维地洛组有3例患者因临床情况恶化而停药,8例患者未达目标剂量;美托洛尔组2例患者因临床情况恶化而停药,5例患者未达目标剂量。美托洛尔组心率的减慢明显优于卡维地洛组(P<0.01),卡维地洛组收缩压和舒张压的下降比美托洛尔组明显(P<0.05),卡维地洛组NYHA心功能分级和LVEF、FS、dLVED与dLVES的改善优于美托洛尔组(P<0.05),美托洛尔组6MWT距离的增加比卡维地洛组明显(P<0.05),卡维地洛组QTd的减小比美托洛尔组明显(P<0.05)。结论:美托洛尔与卡维地洛的长期临床疗效有明显差异,卡维地洛降压、增加心肌收缩力、改善心功能、逆转心肌重构作用更强,并具有抗心律失常作用;而美托洛尔减慢心率、提高运动耐量的作用比卡维地洛明显。提示可根据患者的不同特征和需要进行有选择的应用。

Aim： To compare the long term clinical effect of two kinds of β-blockers on chronic heart failure. Methods： A total of 81 patients with chronic heart failure（CHF） were allocated into two groups at random：earvediol group （n = 43） and meroprolol group （ n = 38）. The changes of heart rate （HR） , blood pressure, NYHA class , dLVED, dLVES, LVEF, FS, 6MWT distance and QTd were observed after 6 months treatment. Results：In carvediol group, 3 patients were withdrawal from the treatment because of worsened conditions and 8 patients quit the trial since treating dosage below the desived level, which were 2 and 5 patients in meroprolol group. The reduction of HR in meroprolol group was more obvious than that in carvediol group （P 〈 0.01 ）. The decline of systolic blood pressure and diastolic blood pressure in carvediol group were more obvious than those in meroprolol group （P 〈0.05 ） and improvement of NYHA class, LVEF, FS, dLVED and dLVES in carvediol group were more significant than meroprolol group （ P 〈 0.05 ）. There was a significant increase of 6MWT in meroprolol group than carvediol group （P 〈 0.05 ）. The reduction of QTd in carvediol group was more obvious than that in meroprolol group （ P 〈 0.05 ）. Conclusion ： There is a significant difference of long term clinic effect between meroprolol and earvediol. In reducing blood pressure, remodeling of cardiac muscle and improving contractive power of cardiac muscle and cardiac function, carvediol is more effective than meroprolol. However, meroprolol is more effective than carvediol in slowing HR and improving exercise tolerance. Meroprolol and carvediol should be used according to different clinical requirements.