卡维地洛和美托洛尔对高血压性心脏病患者心肌质量的影响

Effects of Carvediolol and Uetoprold on the Quality of Myocardium in Patients with Hypertensive Heart Disease

目的观察β受体阻滞剂卡维地洛和美托洛尔对高血压性心脏病患者左室心肌质量的影响。方法将2005年6月-2007年6月收治的260例原发性高血压性心脏病患者,随机分为A、B两组,每组130例。均停用其他降压药物1周后,A组服用卡维地洛,B组服用美托洛尔。两组第1周均服用12.5 mg,2次/d;无明显心动过缓或血压明显下降者,第2周改服25 mg,2次/d,必要时均加用硝苯地平控释片以血压降低至正常范围,心率≥55次/min为宜,每2周加量,最大剂量为50 mg,2次/d。疗程6个月。观察指标:分别于用药前后测定患者左室舒张末内径(LVDd)、左室射血分数(LVEF)、室间隔厚度(LVST)及左室后壁厚度(PWT)。计算左室心肌质量(LVMW)、左室心肌质量指数(LVWI)。结果 A、B两组在试验前后分别作自身对比,LVDd减小,LVST及PWT变薄,LVEF增高,LVWI降低差异有统计学意义(P<0.01);A、B两组在试验后对比,差异无统计学意义(P>0.05)。结论卡维地洛、美托洛尔应用于高血压心脏病患者,可有效降低血压和减慢心率,减少心肌耗氧量,降低左室负荷及神经激素的活动,减轻左室肥厚,减低心肌质量。

Objective To observe the effects of β-receptor blockers on left ventricular myocardial mass in patients with hypertensive heart disease.Methods A total of 260 patients with primary hypertensive heart disease treated between June 2005 and June 2007 were enrolled in our study,and they were randomly divided into two groups,with 130 in each group.One week after other antihypertensive drugs were discontinued,group A began to take small dose of carvedilol,while group B took small dose of metoprolol tablets.In the first week,the dosage was 12.5 mg,bid.For patients without too slow heartbeat or significant blood pressure decrease,the dosage was changed to 25mg,bid in the second week,and when necessary,nifedipine controlled release tablets were added to decrease blood pressure to normal range.The heart rate should not be less than 55 times/min.Every two weeks,we increased the dose,and the maximum dose was 50 mg,bid.The course of treatment was 6 months.Before and after treatment,we measured left ventricular end diastolic diameter（LVDd）,left ventricular ejection fraction（LVEF）,interventricular septal thickness（LVST） and left ventricular posterior wall thickness（PWT） of the patients.We performed the calculation of myocardial mass of left ventricle（LVW）,and according to height and weight,we calculated the body surface area（BSA）,and left ventricular mass index（LVWI）.Results The two groups were compared before and after the experiment respectively.The LVDd decreased,LVST and left ventricular PWT became thin.LVEF increased.LVWI decreased from（133.58 ± 8.69）g/m2 to（109.22 ± 23.51）g/m2 after the treatment,and the difference was statistically significant（P0.01）.Group A patients had shorter LVDd,lower LVST and left ventricular PWT,and higher LVEF than patients in group B.LVWI decreased,but the difference was not significant.Conclusions β-receptor blockers in hypertension patients with heart disease can effectively reduce blood pressure,heart rate,myocardial oxygen consumption,left ventricular load,neurohormonal activity,and left ventricular hypertrophy,and myocardial mass.Carvedilol as a new comprehensive adrenaline receptor blocker seems to have more advantages than metoprolol,but there is no statistical evidence at present.