美托洛尔联合赖诺普利对心力衰竭患者心功能及血清学指标的影响

Influence of metoprolol combined lisinopril on cardiac function and serological markers in patients with heart failure

目的:探讨美托洛尔联合赖诺普利对慢性心力衰竭(CHF)患者心功能及血清学指标的影响。方法:2014年5月~2016年5月我院收治的120例CHF患者,被随机均分为赖诺普利组和联合治疗组(接受美托洛尔联合赖诺普利治疗),均治疗6个月。比较两组患者治疗后的临床疗效、治疗前后心功能指标、C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)、N末端B型利钠肽前体(NT-proBNP)、胱抑素C(CysC)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)水平及不良反应发生率。结果:与治疗前比较,治疗6个月后两组左室舒张末期内径(LVEDd)、左室收缩末期内径(LVESd)、CRP、TNF-α、NT-proBNP、CysC和NGAL水平显著降低,左室射血分数(LVEF)显著升高(P均=0.001);与赖诺普利组比较,治疗6个月后联合治疗组的总有效率(73.33%比90.00%)显著升高(P=0.018);LVEF[(44.91±2.45)%比(48.82±3.55%]显著升高(P=0.001),LVEDd[(50.34±3.11)mm比(45.92±3.04)mm]、LVESd[(41.34±3.33)mm比(35.53±2.34)mm]、CRP[(14.47±2.77)ng/L比(10.32±3.01ng/L]、TNF-α[(157.78±43.21)ng/L比(110.22±29.01)ng/L]、NT-proBNP[(932.43±46.45)pg/ml比(464.21±39.78)pg/ml]、CysC[(1.34±0.36)mg/L比(0.97±0.22)mg/L]、NGAL[(117.69±16.51)μg/L比(75.58±10.22)μg/L]显著降低(P均=0.001)。两组患者均未观察到药物相关的不良反应。结论:美托洛尔联合赖诺普利较单独赖诺普利更有效改善CHF患者心功能,抑制机体炎症反应,减轻机体损伤,改善心脏重构,值得推广。

Objective： To explore influence of metoprolol combined lisinopril on cardiac function and serological mark- ers in patients with chronic heart failure （CHF）. Methods： A total of 120 CHF patients treated in our hospital from May 2014 to May 2016 were enrolled. They were randomly and equally divided into lisinopril group and combined treatment group （received metoprolol combined lisinopril）, both groups were treated for six months. Therapeutic effect, incidence rate of adverse reactions, levels of cardiac function indexes, C reactive protein （CRP）, tumor nec- rosis factor a （TNF-a）, N terminal pro B type natriuretic peptide （NT-proBNP）, cystatin C （CysC） and neutrophil gelatinase associated lipocalin （NGAL） before and after treatment were compared between two groups. Results： Compared with before treatment, after six-month treatment, there were significant reductions in left ventricular end-diastolic dimension （LVEDd）, left ventricular end-systolic dimension （LVESd）, levels of CRP, TNF-a, NT- proBNP, CysC and NGAL, and significant rise in left ventricular ejection fraction （LVEF） in both groups, P = 0. 001 all. Compared with lisinopril group after six-month treatment, there were significant rise in total effective rate （73.33% vs. 90.00%）, P=0.018, and LVEF [（44. 91± 2. 45）% vs. （48.82±3.55）%1, P=0.001; and sig- nificant reductions in LVEDd [-（50.34 ± 3.11）mm vs. （45.92 ± 3.04）mm3, LVESd [（41.34 ± 3.33）mm vs. （35.53 ± 2.34）mm3, levels of CRP F （14.47 ± 2.77）ng/L vs. （10.32 ± 3.01） ng/L3, TNF-a [-（157.78 ± 43.21）ng/L vs.（110.22 ± 29.01）ng/L], NT-proBNP [-（932.43 ± 46.45） pg/ml vs. （464.21 ± 39.78） pg/ml], CysC E（1.34 ± 0.36） mg/L vs. （0.97 ± 0.22）mg/L] and NGAL [-（117.69 ± 16.51） μg/L vs. （75.58 ± 10.22） μg/L] in combined treat- ment group, P = 0. 001 all. No adverse drug reaction was found in two groups. Conclusion： Compared with alone lisi- nopril, metoprolol combined lisinopril can effectively improve cardiac function, inhibit inflammation, relieve body injury, improve cardiac structure and effectively improve prognosis more in CHF patients, which is worth extending.