厄贝沙坦与美托洛尔对急性心肌梗死患者心室重构及心率变异性影响的比较

Effect on ventricular remodeling and heart rate variability in patients with acute myocardial infarction: a comparison between irbesartan and metoprolol

目的观察厄贝沙坦与美托洛尔对急性心肌梗死患者心室重构及心率变异性影响的比较。方法将89例急性心肌梗死患者随机分为美托洛尔组(52例)与厄贝沙坦组(37例)。2组在常规治疗基础上分别加用厄贝沙坦与美托洛尔,并随访至半年。记录2组治疗前后常规诊疗指标[血压、心率、超敏C反应蛋白(hs-CRP)、脑钠肽(BNP)],心室重构指标[超声参数(ESVI,EDVI,LVEF)、基质金属蛋白酶2(MMP-2)],心率变异性(SDNN,SDANN,LF,HF,LF/HF)以及不良心血管事件。结果治疗后,2组均降低血清hs-CRP、BNP浓度(P<0.01),但美托洛尔组心率降低更为明显(P<0.01);2组LVEF均明显升高,血清MMP-2水平显著降低(P<0.05),厄贝沙坦组尤为明显(P<0.05);2组均改善了心率变异性,但美托洛尔对SDNN、SDANN的改善作用较厄贝沙坦更为明显(P<0.05);半年内2组患者心血管事件发生率未见差异性(P>0.05)。结论厄贝沙坦对急性心肌梗死的治疗不劣于美托洛尔;厄贝沙坦可能能更好地改善心室重构,而美托洛尔对心率变异性的改善作用更强。

[ Objective] To compare the effect between irbesartan and metoprolol on ventricular remodeling and heartrate variability （ HRV） in patients with acute myocardial infarction （AMI） . [Methods] 89 patients with AMI were randomly divided into irbesartan group （52 cases） and metoprolol group （37 cases）. The groups were respectively given irbesartan and metoprolol on the basis of traditional treatment ,and the patients were followed up for 6 months. The indexes before and after treatment were recorded , including conventional indexes [blood pressure , heart rate , high sensitive C reactive protein （hs-CRP） , and brain natriuretic peptide （ BNP） ] , ventricular remodeling indexes [ ESVI , EDVI , LVEF , and matrix metalloproteinase 2 （MMP-2, 9） ] , HRV indexes （ SDNN , SDANN , LF , HF and LF IHF） , and adverse cardiovascular events. [Results] After treatment , the levels of serum hsCRP and BNP decreased in both two groups （P 〈 0.01） , while the heart rate decreased more significantly in metoprolol group （P 〈 0.01 ）. LVEF increased significantly and serum MMP-2 level decreased significantly in both two groups （P 〈 0.05） , especially in irbesartan group （P 〈 0.05）. HRV indexes were improved in both groups , and the improvement of SDNN and SDANN in metoprolol group was more significant than that in irbesartan group （P 〈 0.05）. There was no significant difference in incidence rate of cardiovascular events in six months between two groups （P 〉 0. 05 ） . [ Conclusion] The effect of irbesartan on AMI is not inferior to metoprolol. Irbesartan might have a better effect on the ventricular remodeling , and metoprolol has better improvement effect on HRV.