美托洛尔对慢性心力衰竭患者心室重构及心功能的影响

Effects of metoprolol therapy on left ventricular remodeling and function in patients with chronic heart failure

目的观察美托洛尔对慢性心力衰竭（CHF）患者心功能、心室重构及预后的影响。方法选取广东省梅州市人民医院住院CHF患者180例，按入院的先后顺序分为观察组和对照组，各90例。患者均接受基础治疗（洋地黄、利尿剂、血管紧张素转换酶抑制剂）。观察组加用美托洛尔[6．25mg／次，2次／d口服，每1～2周调剂量1次，直至达靶剂量（50mg，2次／d）或最大耐受量]，随访6个月后观察治疗的有效率、左心室射血分数（LVEF）、左心室收缩末期内径（LVESD）、左心室舒张末期内径（LVEDD）、静息心率、血浆脑钠肽前体（NT-proBNP）、6min步行距离（6MWT）的变化。结果与对照组比较，观察组的临床显效率和总有效率均较高，LVEF上升，6MWT提高，静息心率下降[80．0％（72／90）比48．9％（44／90）、95．5％（86／90）比80．0％（72／90）、（55±6）％比（50±6）％、（523±18）m比（421±18）m、（66±5）次／min比（79±6）次／min]，差异均有统计学意义（均P〈0．01），而治疗后LVESD和LVEDD缩小、NT—proBNP水平下降，较对照组明显改善，差异有统计学意义[（45．1±0．2）mm比（50．1±0．3）]mm、（34．6±2．2）mm比（38．3±2．1）mm、（888±50）ng／L比（899±60）ng／L]（P〈0．05）。结论在以血管紧张素转换酶抑制剂治疗基础上使用美托洛尔治疗慢性收缩性心力衰竭能明显改善患者左心重构及左心功能。

Objective To evaluate the effects of metoprolol on the heart function improvement, remodeling process and prognosis in chronic heart failure patients. Methods Totally 180 patients with chronic heart failure were divided into control group（90 patients）and observation group（90 patients）. The control group was given basic treatment with digoxin, diuretics, angioteusin converting enzyme inhibitor （ ACEI ）. The observation group was given metoprolol in addition to basic treatment [ 6.25 mg/l time, 2 times/d orally every 1-2 weeks adjustable dose 1 times, until it reaehed the target dose （50 mg, 2 times/d） or the maximum tolerance dose1. Heart function, left ventricular ejection fraction（LVEF） , left ventricular diastolic dimension（LVEDD） , left ventricular endsystolic dimension（LVESD）, resting heart rate （RHR）, plasma amino- terminal pro-brain natriuretic peptide （NT-proBNP） level and 6-minute walk test（6MWT） in chronic heart failure patients were observed before and after six months treatment. Results After treatment, the LVEF and 6MWT were obviously improved; RHR in observation group was decreased [80.0% （72/90） vs 48.9% （44/90） ,95.5% （86/90） vs 80.0% （72/90）, （55 ±6） % vs （50 ±6） %, （523 ±18 ） mvs （421 ±18 ） m, （ 66 ±5 ） times a minute vs （ 79 ±6 ） times a minute ] （ P 〈 0.01 ）. LVEDD, LVESD and NT-proBNP level were also decreased at 6 months compared with those in observation group [（45.1 ±0.2）mm vs （50.1 ±0.3）mm, （34, 6 ±2.2）mm vs （38.3 ±2. 1）mm, （888 ±50）ng/L vs （899 ± 60）ng/L] （P 〈 0.05 ）. Conclusions In additional to the conventional therapy with angiotensin converting enzyme inhibitors, metoprolol can improve left ventricular performance and remodeling in patients with chronic heart failure.