比索洛尔和美托洛尔对慢性心力衰竭患者心脏功能及血浆脑钠肽水平的影响

Effect of Bisoprolol and Metoprolol on Cardiac Function and Plasma BNP Levels of Patients with Chronic Heart Failure

目的探讨比索洛尔和美托洛尔两种选择性β1受体阻断剂对慢性心力衰竭(CHF)患者心脏功能及血浆脑钠肽水平的影响。方法选择2014年1月至2015年6月在首都医科大学附属北京潞河医院心内科接受治疗的140例CHF患者。采用随机数字表法将患者分为美托洛尔组和比索洛尔组,每组70例。美托洛尔组患者在常规治疗的基础上加用美托洛尔,起始剂量为每次6.25 mg,每日2次,根据患者的耐受情况及病情发展逐渐增加药量;比索洛尔组患者在常规治疗的基础上加用比索洛尔,起始剂量为每次1.25 mg,每日1次,根据患者的耐受情况及病情发展逐渐增加药量。两组患者均持续服药3个月。比较两组患者的疗效,治疗前后心功能指标、脑钠肽和N端脑钠肽前体(NT-proB NP)水平以及6 min步行试验距离(6 min WD)。结果治疗后,比索洛尔组的总有效率为95.71%(67/70),高于美托洛尔组患者的84.29%(59/70),差异有统计学意义(P<0.05),两组患者的疗效比较,差异有统计学意义(Z=2.173,P=0.030)。治疗后,两组患者的左心室射血分数(LVEF)明显升高,左心室收缩末期内径(LVESV)和左心室舒张末期内径(LVEDV)较治疗前明显下降,且比索洛尔组患者的LVEF高于美托洛尔组、LVESV以及LVEDV均低于美托洛尔组患者[(38.0±4.4)%比(34.7±1.2)%、(49.1±3.1)mL比(52.9±6.2)mL、(62.2±6.4)mL比(65.1±8.8)mL],差异有统计学意义(P<0.05)。治疗后,两组患者脑钠肽和NT-proBNP的水平较治疗前明显降低,6 min WD较治疗前长,且比索洛尔组患者的6 min WD长于美托洛尔组,脑钠肽和NT-proB NP水平低于美托洛尔组[(381±69)m比(346±63)m,(453±22)μg/L比(793±22)μg/L和(614±72)ng/L比(938±83)ng/L],差异有统计学意义(P<0.05)。结论与美托洛尔相比,比索洛尔治疗CHF的临床疗效更好,其可显著改善心功能指标,降低脑钠肽和NT-proB NP水平,增加6 min WD。

Objective To study the effect of bisoprolol and metoprolol on cardiac function and plasma brain natriuretic peptide（BNP） levels of chronic heart failure（CHF） patients. Methods Total of 140 CHF patients treated in Beijing Luhe Hospital from Jan. 2014 to Jun. 2015 was included in the study. They were divided into metoprolol group and bisoprolol group according to random number table method ,70 cases each. The metoprolol group was given metoprolol on the basis of conventional therapy, the starting dose was 6.25 mg each time, twice a day, according to the situation of the patient＇s tolerance and progression, gradually increasing the doses. Bisoprolol group was given bisoprolol on the basis of conventional therapy, 1.25 mg each time, once per day, according to the situation of the patient＇s tolerance and illness development, gradu- ally increasing dosage. Both groups were continuously treated for three months. The curative effect, cardiac function index, BNP and NT-proBNP levels and 6 minutes walking distance（6 min WD） of the two groups were compared. Results The total efficacy of the bisoprolol group was 95.71% （ 67/70 ）, of the metoprolol group was 84. 29% （59/70）, the difference had statistical significance （P 〈 0.05 ）, the curative effect of the bisoprolol group was better than the metoprolol group （ Z = 2. 173, P = 0. 030 ）. The left ventricular ejection fraction（INEF） of both groups after treatment was increased, left ventricular end systolic diameter （LVESV） ,left ventricular end diastolic diameter（LVEDV） levels of the two groups were decreased significantly after troatment, the LVEF, LVESV and LVEDV leveisof the bisoprolol were lower than metoprolol group[ （38.0±4.4）% vs （34.7 ±1.2）%,（49. 1 ±3.1） mLvs （52.9±6.2） mL,（62.2±6.4） mLvs （65.1 ± 8.8） mL],the differences had statistical significance （P 〈 0.05 ）. After treatment, the BNP and NT-proBNP levels of the two groups declined obviously, 6 min WD was longer,and 6 min WD of the bisoprolol group was higher than the metoprolol group , BNP and NT-proBNP levels were lower than the metoprolol group [（381±69） mvs （346±63） m,（453 ±22） μg/L vs （793±22） μg/L,（614±72） ng/L vs （938 ± 83 ） ng/L ] , the differences had statistical significance （ P 〈 0.05 ）. Conclusion Compared with metoprolol, the curative effect of bisoprolol is better, which can significantly improve the heart function and BNP levels,as well as prolong the 6 min WD.