美托洛尔缓释片对慢性心力衰竭患者炎性因子及心功能的影响

Effect of metoprolol sustained release tablet on inflammatory factor and cardiac function in patients with chronic heart failure

目的观察慢性心力衰竭(CHF)患者应用美托洛尔缓释片后对炎性因子及心功能的影响。方法选取2015年1—12月上海市浦东医院心血管内科收治CHF患者120例为研究对象,按随机数字表法分为观察组及对照组各60例。患者均予常规治疗,观察组另予琥珀酸美托洛尔缓释片积极控制心率,以静息心率降至55~60次/min为目标心率指导药物治疗。检测2组治疗前、治疗1个月后静息心率、炎性因子水平[包括C反应蛋白(CRP)、白介素-1β(IL-1β)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)等],治疗前、治疗12个月后左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左心室射血分数(LVEF)的变化以及血浆脑钠肽(BNP)水平。结果治疗1个月后,观察组患者静息心率及炎性因子(CRP、IL-1β、IL-6、TNF-α)水平显著低于治疗前(P<0.05),且治疗后观察组均显著低于对照组(t=2.07、2.26、1.99、2.03、2.14,P均<0.05),治疗12个月后,观察组患者静息心率显著低于对照组(t=4.22,P<0.01),超声心动图参数(LVEDD、LVESD)及血浆BNP水平显著低于对照组,LVEF显著高于对照组(t=2.32、2.43、2.21、2.12,P均<0.05)。结论美托洛尔缓释片积极控制心率可降低CHF患者炎性因子水平,改善心功能。

Objectives To investigate the influence of intensive heart rate control on inflammatory factor and cardiac function in patients with chronic heart failure.Methods From January 2015 to December 2015,a total of 120 CHF patients in New York Heart Association （NYHA） functional classes II to IV were enrolled and randomized divided into treatment group （n=60） and control group （n=60）.All the patients were in stable situation after conventional drug treatment.The patients in treatment group underwent intensive heart rate control for target HR （55-60 bpm） through adjusting the dose of metoprolol sustained release tablets.The resting heart rate was measured at the beginning,1 month and 12 months after treatment.The concentration of C reaction protein （CRP）,interleukin 1β（IL-1β）,interleukin 6 （IL-6）,tumor necrosis factorα（TNF-α） were detected before and after 1 month treatment.The concentration of brain natriuretic peptide （BNP）,left ventricular ejection fraction （LVEF）,left ventricular end diastolic diameter （LVEDD）,left ventricular end systolic dimension （LVESD） was measured before and 12 months after treatment.Results After 1 month treatment,the resting heart rate and inflammatory factors （CRP,IL-1β,IL-6,TNF-α） levels of the patients in the treatment group decreased significantly compared with that of control group （t=2.07,t=2.26,t=1.99,t=2.03,t=2.14,P〈0.05）.After 12 months treatment,the resting heart rate of the patients in the treatment group decreased significantly compared with that of control group （t=4.22,P〈0.01）,the echocardiography parameters （LVEDD,LVESD） and the concentration of BNP of the patients in the treatment group decreased significantly （t=2.32,t=2.43,t=2.21,t=2.12,P〈0.05）,LVEF of treatment group increased significantly （P〈0.05）.Conclusion Metoprolol sustained release tablets can significantly decrease inflammatory factors （CRP,IL-1β,IL-6,TNF-α） levels and improve cardiac function in patients with chronic heart failure.