比索洛尔对老年充血性心力衰竭体液激素的影响

EFFect of bisoprolol on neurohormonal activation in elderly patients with congestive heart failure

目的 探讨比索洛尔对老年充血性心衰患者循环体液激素的影响。方法 选择在常规强心、利尿及血管紧张素转换酶抑制剂等治疗 2月以上 ,左室射血分数 <0 .49,近二周临床病情相对稳定的慢性充血性心衰患者 2 0例。在原治疗的基础上加用比索洛尔治疗 6月 ,通过放射免疫法测定循环体液激素水平。1 8例心功能正常者作为对照组。结果 心衰患者具有较高的循环体液激素水平 ,与对照组相比 ,Ang 、 RA、 ALD、 ANP、 ET-1、 TNF-α均升高 (均 P<0 .0 1 )。比索洛尔治疗后比治疗前明显降低 (均 P<0 .0 1 ) ,左室射血分数治疗后明显提高 (P<0 .0 1 )。结论 充血性心衰病人即使已使用 ACEI治疗 ,仍然存在着神经体液异常。比索洛尔可有效调节多种体液激素和改善心脏功能。临床上 ,对病情相对稳定的充血性心衰患者应在 ACEI基础上合用 β受体阻滞剂。

Objective To evaluate the effects of bisoprolol on plasma neurohormonal activation in patients with CHF.Methods In addition to the traditional treatments(glucoside,diuretic,captopril or enapril),20 elderly patients with CHF were treated with bisoprolol for 6 month.The main inclusivn criteria for entry into the study are:after the traditional treatment for 2 months,dyspnoea on exertion with or without edema and fatigue,left ventricular ejection fraction(LVEF)<0.49 on echocardiography and New York Heart Association(NYHA)class Ⅱ to Ⅳ,clinically stable during the preceding 2 weeks.The patients in this study included 16 male and 4 female.The mean age was 73.80±4.91 years.The alteration of the plasma levels of renin(RA),angiotensin(Ang Ⅱ),alderone(ALD),atrial natriuretic peptide(ANP),endothelin-1(ET-1)and tumor necrosis factor-α(TNF-α)were observed in all subjects by radioimmunoassay respectively,including 18 healthy control subjects and 20 patients with CHF before and after therapy with bisoprolol.Results Even though they had been initially given to background treatments,the plasma levels of RA,Ang Ⅱ,ALD,ANP,ET-1 and TNF-α were significantly higher in CHF group than those in the control group (all p<0.01).After bisoprolol treatment for 3 months,The plasma levels of those neurohormonal parameters were significantly decreased(all p<0.01 respectively).It was more lower after treatment for 6 months than that of after treatment for 3 months (except Ang Ⅱ,p<0.05,respectively).LVEF increased from 0.345±0.095 to 0.399±0.105 and 0.449±0.091(all p<0.01).Conclusions Bisoprolol in the long-term treatment of patients with CHF can decrease the plasma levelsof RA,AngⅡ,ALD,ET-1,TNF-α and ANP.It is suggested that bisoprolol should be used on the basis of the traditional treatment for the elderly patients with CHF,if they are stable.