美托洛尔治疗充血性心力衰竭的临床研究

Clinical study on therapy for congestive heart failure with metoprolol

目的：探讨美托洛尔（ｍｅｔｏｐｒｏｌｏｌ）治疗充血性心力衰竭（ＣＨＦ）的有效性和可行性。方法：采用随机对照方法，观察经强心、利尿和血管紧张素转换酶抑制剂（ＡＣＥＩ）治疗仍有ＣＨＦ症状的扩张型心肌病患者加用美托洛尔治疗前后循环内分泌因子和心功能状态的变化。结果：①治疗３个月时，美托洛尔组心胸比和心脏面积与对照组相比均明显缩小（分别Ｐ＜００１）；②治疗３个月时，美托洛尔组左室射血分数（ＬＶＥＦ）较对照组显著增高（３７３５±６２８ｖｓ３３２５±６４６，Ｐ＜００１）；③所有患者血浆内皮素（ＥＴ）和去甲肾上腺素（ＮＥ）水平均与ＬＶＥＦ呈负相关（均Ｐ＜０００１）；④显效组患者年龄偏小，心率偏快，血浆ＮＥ，ＥＴ水平较高，和其他组相比有显著差异。结论：美托洛尔治疗ＣＨＦ有效，尤其年龄偏小、心率偏快、血浆ＮＥ和ＥＴ水平较高的扩张型心肌病亚组。

Objective: To explore the efficacy and possibility of the treatment with metoprolol for congestive heart failure(CHF).Methods: We evaluated,using a randomized and controlled method ,the effects of metoprolol on circular endocrine factors and cardiac function in patients with CHF due to dilated cardiomyopathy who continued to have symptoms despite conventional therapy with digoxin,diuretics,and angiotensin converting enzyme inhibitors (ACEI).Results: ① The cardiothoracic ratio and cardiac area of X-rays film in metoprolol group were significantly minimized at 3 month therapy in comparison with that in control group (respectively, P <0.01).② The left ventricular ejection fraction (LVEF)in metoprolol group was higher than that in control group at 3 month therapy (37.35±6.28 vs 33.25±6.46, P <0.01) ③ There was a negative linear correlation in all patients between the levels of plasma norepinephrine (NF) or endothelin (ET)and LVEF (respectively, P <0.001).The age was younger,the heart rate was faster and the levels of plasma NE,ET were higher in the patients with the obvious effective group than those in the other groups.Conclusion: It is effective to treat with metoprolol for CHF in patients with dilated cardiomyopathy,especially in whose the age is younger,the heart rate is faster,and the levels of plasma NE and ET are higher. K