比索洛尔治疗糖尿病并发缺血性心肌病短期和长期疗效观察

SHORT-TERM AND LONG-TERM CURATIVE EFFECT OF BOSU IN PATIENTS WITH DIABETES AND ISCHEMIC CARDIOMYOPATHY

目的探讨比索洛尔治疗糖尿病并发缺血性心肌病的短期和长期疗效。方法选择84例2型糖尿病并发缺血性心肌病继发的收缩功能降低性心脏病患者,随机分成二组:一组(对照组)常规治疗(ACEI+利尿剂+地高辛);二组(观察组)在常规治疗基础上加用比索洛尔治疗,对比观察其短期和长期疗效。结果①短期疗效:观察组用药15d,与对照组相比,峰值最大心率血压乘积(mmHg×心跳次数/min)(RPP)分别为(23 730±7 595)mmHg和(21 520±6 835)mmHg×心跳次数/min(P<0.01),射血分数分别为(47±7)%和(41±9)%(P<0.001)。②长期疗效:治疗18个月后观察组患者的射血分数(45±8)%明显高于对照组(36±8)%(P<0.001)。观察组有22例NYHA心功能分级降低1级,5例降低2级,而对照组8例NYHA心功能分级降低1级。③二组治疗前,治疗15d及18个月后血糖、HbA1c及总胆固醇、甘油三酯、HDL-胆固醇和LDL-胆固醇均无显著变化。结论糖尿病并发缺血性心肌病后收缩功能障碍性心脏病的患者用比索洛尔治疗可以持久性改善患者的心脏功能和左心室功能,且不影响脂质和血糖代谢,比索洛尔可作为糖尿病并发缺血性心肌病的长期理想用药。

Objective To study the short- term and long- term curative effect of Bosu（bisoprolol） in patients with diabetets and ischemic cardiomyopathy： Methods 84 patients with type 2 diabetes mellitus and ischemic cardiomyopathy followed by congestive heart failure were divided randomly into 2 groups, one group was regularly treated with ACEI, digoxin, and diuretic as usual, the other was treated with bisoprolol in addition to the above regular treatment. Shortterm and long- term curative effect were compared between the two groups. Results （1） Short- term effect： after 15 days treatment, , the Max RPP was （23,730 ＋ 7595）mmHg × HR/min in Bosu treatment group, （21,520 ± 6835）mmHg× HR/min（P 〈 0.01）in control group; the EF were （47±7）% and （41.＋9）% in the two groups, respectively（P 〈 0. 001）. （2）Long-term effect ..after 18 months treatment, EF（45 ±8）% in Bosu treatment group was significantly different with（36 ± 8） % in the control group （P 〈 0. 001）. In Bosu group, the NYHA class of 22 patients was reduced by 1 class, and of 5 patients was reduced by 2 classes; In the control group, only 8 patients＇ NYHA class reduced by 1 class. （3） In the two groups, PG, HbA1c,TC,TG, HDL- Ch,LDL- Ch were not significantly different between before treatment,15 - day posttreatment and 18 - month posttreatment. Conclusion Bosu may improve cardiac function of patients with diabetes and ischemic cardiomyopathy, furthermore, it has no effect on fat and glucose metabolism. Therefore,Bosu is the ideal long- term drugs for the patients with diabetes and ischemic cardiomyopathy.