心率控制对慢性心力衰竭患者炎症因子及心功能的影响

Influence of intensive heart rate control on inflammatory factor and cardiac function in patients with chronic heart failure

目的观察慢性心衰(CHF)患者入院后予以积极控制心率后对炎症因子及心功能的影响。方法选择2015年1-12月在上海市浦东医院心血管内科住院纽约心脏学会(NYHA)心功能分级Ⅱ~Ⅳ级的120例CHF患者,随机分配至治疗组及对照组,所有患者在常规治疗基础上,治疗组予以琥珀酸美托洛尔缓释片积极控制心率,以患者静息心率降至55~60次/min为目标心率指导药物治疗。检测两组治疗前、治疗6个月后静息心率,炎症因子水平,左室舒张末期内径(LVEDD),左室收缩末期内径(LVESD),左心室射血分数的变化以及血浆BNP水平。结果治疗6个月后,治疗组患者静息心率显著低于对照组(P<0.001),治疗组患者炎症因子(CRP、IL-1β、IL-6、TNF-α)水平显著低于对照组(P<0.05),LVEDD、LVESD及血浆BNP水平显著低于对照组,LVEF显著高于对照组(P<0.05)。结论积极控制心率可降低CHF患者炎症因子水平,改善心功能。

Objective 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 into treatment group （n = 60） and control group （n = 60）. All the patients were in stable situation af- ter conventional drug treatment. The patients in treatment group underwent intensive heart rate control for target HR （55 - 60 beats/min） through adjusting the dose of metoprolol sustained-release tablets. The concentration of C-reac- tion protein （ CRP）, interleukin- 1β （ IL- 1β ）, intedeukin-6 （ IL-6 ） and tumor necrosis factor ct （ TNF-α ） were de- tected before and after 6-month treatment. The resting heart rate and the concentration of brain natriuretic peptide （BNP）, left ventricular ejection fracetion （LVEF）, left ventricular end diastolic diameter （LVEDD） and left ven- tricular end systolic dimension （LVEDD） were measured at the start and 6-months after treatment. Results After 6-month treatment, the resting heart rate of the patients in the treatment group decreased significantly compared with that of the control group （P 〈 0.001 ）. Inflammatory factors （CRP, IL-1β, IL-6 and TNF-α） levels decreased significantly compared with that of control group （P 〈 0.05）. The echocardiography parameters （LVEDD and LVESD） and the concentration of BNP of the patients in the treatment group decreased significantly （P 〈 0.05 ）, LVEF of treatment group increased significantly （P 〈 0.05 ）. Conclusion Intensive heart rate control in patients with chronic heart failure can significantly reduce Inflammatory factor levels and improve the cardiac function.