比索洛尔对充血性心力衰竭患者心功能及神经内分泌因子的影响

Effect of bisoprolol on heart function and neuroendocrine factors in patients with congestive heart failure

目的探讨比索洛尔对充血性心力衰竭患者心功能和神经内分泌因子的影响。方法选择孝感市中心医院2011年1月至2014年1月收治的充血性心力衰竭患者72例,按照随机数字表法分为试验组和对照组各36例。两组患者均常规给予强心、利尿等药物治疗,试验组在常规治疗基础上每日清晨服用比索洛尔1.25 mg,对照组在常规治疗基础上每日清晨服用同等剂量安慰剂,疗程1年。分别于治疗前和疗程结束后检测心功能指标和血浆神经内分泌因子浓度。结果治疗后,试验组患者心率、收缩压、舒张压、左心房内径(left atrial diameter,LAD)、左心室舒张末期内径(left ventricular end diastolic dimension,LVEDd)和左心室收缩末期内径(left ventricular end-systolic dimension,LVESd)指标明显下降,射血分数(ejection fraction,EF)和心排血量(cardiac output,CO)明显升高,与治疗前比较,差异均有统计学意义(P<0.05)。对照组收缩压和舒张压下降明显,EF和CO明显升高,与治疗前比较差异有统计学意义(P<0.05);其他指标与治疗前比较,差异无统计学意义(P>0.05)。治疗后,试验组血浆血管紧张素Ⅱ、心钠素(atrial natriuretic peptide,ANP)、脑钠肽(brain na-triuretic peptide,BNP)、内皮素(endothelin,ET)和去甲肾上腺素(norepinephrine,NE)浓度均显著降低,与治疗前比较差异有统计学意义(P<0.05)。对照组治疗后血浆各神经内分泌因子浓度与治疗前比较,差异无统计学意义(P>0.05)。心率与血浆血管紧张素II、ANP、BNP、ET和NE的浓度均呈显著正相关。结论比索洛尔能明显改善充血性心力衰竭患者的心功能和血浆神经内分泌因子水平,可以有效控制和逆转心室重构,达到治心力衰竭的目的。

Objectives To investigate the effects of bisoprolol on heart function and neuroendocrine factors in patientswith congestive heart failure.Methods Totally 72 patients with congestive heart failure in Central Hospital of XiaoganCity from January 2011 to January 2014 were randomly divided into treatment group and control group with 36 cases ineach group.Two groups of patients were routinely given the strong heart and diuresis drugs treatment.Patients intreatment group daily took bisoprolol 1.25 mg in the morning based on the conventional treatment,and patients incontrol group took equal doses of placebo,with a course of 1 year.Heart function indicators and plasma concentrationsof neuroendocrine factors were detected before and after treatment.Results After treatment,heart rate（HR）,systolicblood pressure（SBP）,diastolic blood pressure（DBP）,left atrial diameter（LAD）,left ventricular end diastolicdimension（LVEDd）and left ventricular end-systolic dimension（LVESd）significantly decreased（P〈0.05）,andejection fraction（EF）and cardiac output（CO）significantly raised in treatment group（P〈0.05）.SBP and DBPdecreased significantly（P〈0.05）,CO and EF significantly raised in control group（P〈0.05）,and other indicatorswere not significantly different compared with those before treatment（P〉0.05）.After treatment,plasma concentrationsof atrial natriuretic peptide（ANP）,brain natriuretic peptide（BNP）,endothelin（ET）,norepinephrine（NE）andangiotensinⅡ（Ang Ⅱ）significantly decreased in experimental group when compared with those of before treatment（P〈0.05）,and they had no significant differences between before and after treatment in control group（P〈0.05）.HR significantly positively correlated with plasma concentrations of Ang II,BNP,ANP,ET and NE.Conclusions Bisoprolol can significantly improve cardiac function and plasma concentrations of neuroendocrine cytokines inpatients with congestive heart failure.It can effectively control and reverse ventricular remodeling,and achieve thepurpose of treating heart failure.