基于N-脑利钠肽前体的美托洛尔治疗心衰的临床研究

Clinical Research of Metoprolol for Treatment of Heart Failure Based on Concentration of N-Terminal pro B-Type Natriuretic Peptide

目的建立β受体阻滞剂美托洛尔治疗心力衰竭的量效关系,并考察影响疗效的主要因素。方法收集心力衰竭患者病历106例,美托洛尔维持剂量分别为12.5、25、50、71.5和100 mg/d。通过线性模型拟合美托洛尔剂量与N-脑利钠肽前体(N-proBNP)和心率变化值间的关系,并经多元数据分析考察年龄、性别、心率基线值、N-proBNP基线值和左室射血分数基线值对疗效影响。结果服用美托洛尔后N-proBNP和心率均明显下降(P<0.05),但N-proBNP的下降与剂量未见显著性相关,但心率下降值与剂量呈正相关,经多元数据分析发现N-proBNP基线值对美托洛尔疗效有显著影响。结论结合N-proBNP基线值,可以根据患者心率下降情况调整美托洛尔剂量为临床治疗提供参考。

OBJECTIVE To build the dose-effect relationship of the beta-blocker metoprolol in patients with heart failure,and investigate the main factors which influence the drug effect. METHODS One hundred and six cases of the patients with heart failure were collected. The maintenance doses of metoprolol were 12. 5,25,50,71. 25 and 100 mg / d,respectively. Linear models were established between dose of metoprolol and the change of the N-pro BNP and heart rate. The main factors,such as gender,age and the baselines of heart rate,N-proBNP and left ventricular ejection fraction were investigated by multi-variables analysis. RESULTS The values of N-pro BNP and heart rate decreased significantly（ P〈0.05） after the administration of metoprolol. But the drop of N-pro BNP did not show a significant linear relationship with metoprolol doses,while the decrease of heart rate showed a positive linear relationship with doses. The baseline of N-proBNP significantly affected the drug effect of metoprolol after multi-variables analysis. CONCLUSION With the baseline of N-proBNP,the dose of metoprolol was adjusted based on the heart rate,which would give some reference to the clinical therapy.