比索洛尔对原发性高血压患者左心室重构及血浆脑钠肽的影响

Effects of Bisoprolol on Essential Hypertension on Left Ventricular Remodeling and Plasma Brain Natriuretic Peptide Levels

目的:观察比索洛尔对原发性高血压(EH)患者左心室重构(LVR)及血浆脑钠肽(BNP)的影响。方法:选择47例EH患者,在常规治疗基础上给予富马酸比索洛尔片治疗,连续治疗24周。观察治疗前、后血压变化,治疗前、后应用彩色多普勒超声诊断仪测定室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、左心室舒张末期内径(LVEDd)、左心室收缩末期内径(LVEDs)和左心室射血分数(EF),计算左心室质量指数(LVMI)和左心室室壁相对厚度(RWT);采用微粒子酶免疫分析法测定血浆BNP水平。并设同期健康体检者30例为正常对照组。结果:EH伴左心室肥厚(LVH)患者的RWT、LVMI和血浆BNP水平显著高于正常对照组(P<0.01),EF显著低于正常对照组(P<0.01);血浆BNP水平与LVEDd、LVEDs、LVMI呈显著正相关(P<0.01),与EF呈显著负相关(P<0.01)。比索洛尔治疗后患者血压显著下降(P<0.01),临床总有效率为80.9%;LVR指标显著改善(P<0.05或P<0.01),血浆BNP水平显著降低(P<0.01)。未见严重不良反应发生。结论:比索洛尔降压疗效确切、耐受性好,能逆转左心室重构,改善心脏功能,对EH患者血浆BNP水平具有一定影响。

OBJECTIVE： To observe the effects of bisoprolol on left ventricular remodeling （LVR） and plasma brain natriuretic peptide （BNP） levels in essential hypertension patients. METHODS： Based on routine treatment, 47 patients with primary hyperten- sion were given Bisoprolol fumarate tablets for 24 consecutive weeks. The changes of blood pressure were observed before and after treatment. The color Doppler ultrasonic diagnostic apparatus was adopted for determination of thickness of interventrieular septum （IVST） , left ventricular posterior wall thickness （LVPWT） , left ventricular end diastolic diameter （LVEDd） , left ventricular end-diastolic diameter （LVEDs） and left ventricular ejection fraction （EF）, left ventricular mass index （LVMI） and left ventricular wall thickness （RWT） before and after treatment; microparticle enzyme analysis method was used for the determination of BNP lev- els in plasma, with 30 healthy cases as control in the same period. RESULTS： RWT, LVMI and plasma BNP levels in patients with EH complicating with left ventricular hypertrophy （LVH） were significantly higher than in normal control group （P〈0.01）, while EF was significantly lower than in normal control group （P〈0.01） ; the plasma level of BNP were positively correlated to LVEDd, LVEDs, LVMI （P〈0.01）, and negative correlated to EF （P〈0.01）. After treatment of bisoprolol, blood pressure of EH patients decreased significantly （P〈0.01）, and total clinical efficiency was 80.9%; ventricular remodeling index improved signifi- cantly （P〈0.05 or P〈0.01）, and plasma levels of BNP were significantly reduced （P〈0.01）. No severe ADR was found. CON- CLUSION： Bisoprolol shows sound antihypertensive efficacy and tolerability, reverse left ventricular remodeling and improve heart function in patients with EH. It has certain effect on plasma BNP secretion in EH patient.