卡维地洛对慢性心衰患者血浆脑钠肽水平及左心功能的影响

Effect of carvedilol on plasma BNP and left ventricular systolic function of patients with CHF

目的:观察卡维地洛对慢性心力衰竭(CHF)患者血浆脑钠肽(BNP)及左心室收缩功能的变化。方法:CHF患者87例,分卡维地洛治疗组(B组)44例和常规治疗组(A组)43例。随访6个月,评估两组治疗前、治疗后1个月、3个月及6个月患者心功能指标和血浆BNP浓度。结果:治疗后1个月两组血浆BNP水平较治疗前下降(P<0.05),3个月时下降更明显。3个月组间比较有显著性差异(P<0.05);两组患者治疗1个月后左心室舒张末内径(LVEDD)、左心室舒张末容积(LVEDV)、左心室收缩末容积(LVSDV)及左心室射血分数(LVEF)与治疗前比较均无统计学差异(P>0.05);6个月时的上述指标与治疗前比较均有显著性差异(P<0.05)。两组患者血浆BNP水平与同期测定的左心室舒张末内径呈正相关(r=0.51,P<0.01),与LVEF呈负相关(r=-0.43,P<0.01)。结论:卡维地洛能有效地改善CHF患者的心功能;CHF患者BNP水平的变化早于心脏超声指标的变化;血浆BNP水平可以作为治疗心力衰竭的一个可靠观察指标。

Objective： To investigate the clinical effect of carvedilol on the plasma brain natriuretic peptide and left ventricular systolic function of the patients with chronic heart failure （CHF）. Methods：87 cases were divided into 2 groups. In group A including 43 patients, diuretic, angiotensin converting enzyme inhibitor, vasodilator with or without digitalis were used, and group B including 44 patients were treated with carvedilol after preliminary remission in addition to the above routine treatment. After 6-month follow-ups were done, the partial cardiac function indexes, cardiac structure and plasma brain natriuretic peptide （BNP） concentration were evaluated according to the data before the treatment, after 1, 3 and 6 months of treatment. Results： After 1 month treatment, the BNP level was lower than that before treatment （P〈0.05）, and the decrease was more apparently after 3 months of treatment, moreover, it showed a significant difference （P〈0.05） between the 2 groups. No statistical difference was detected between the data before and after 1 month treatment in the two groups cases in the index of left ventricular end-diastolic diameter （LVEDD）, left ventricular end-diastolic volume （LVEDV）, left ventricular end-diastolic volume （LVEDV） and left ventricular ejection fraction （LVEF） （P〉0.05）,while the data after 6 month treatment showed significant difference （P〈0.05）. The plasma BNP concentration of 2 groups exhibited a positive correlation with LVEDD （r=0.51, P〈0.01） and a negative correlation with LVEF （r=-0.43, P〈0.01）. Conclusion：Carvedilol has the effect of improving the cardiac function of patients with CHF. The change of BNP level is earlier than echocardiography index. So BNP level can be used as a reliable index for the treatment of chronic heart failure.