卡维地洛与美托洛尔对维持性血液透析患者的临床疗效和心功能的影响

Effects of carvedilol and metoprolol on the clinical efficacy and cardiac function of maintenance hemodialysis patients

目的:探讨卡维地洛与美托洛尔对维持性血液透析患者的临床疗效和心功能的影响.方法:选择2019年1月至2020年2月在重庆市黔江中心医院接受维持性血液透析治疗伴有左心室肥厚的患者162例进行研究.采用随机数字表将患者分为两组,每组各81例,对照组和观察组分别在常规治疗基础上加以美托洛尔和卡维地洛治疗.比较两组患者心功能指标、氧化应激反应、炎症因子、糖脂代谢水平及不良反应.结果:治疗后两组患者LVEDD、LVPWT、IVST和MDA水平均明显下降,但观察组下降幅度更大(P<0.05).治疗后两组患者SOD、GSH-Px水平均明显升高,但观察组升高幅度更大(P<0.05).治疗后两组患者炎症因子hs-CRP、IL-6及IL-1β水平和糖脂代谢指标空腹血糖、总胆固醇及甘油三酯水平均明显下降,但观察组下降幅度更大(P<0.05).对照组共出现5例(6.17%)不良反应,与观察组的6例(7.40%),比较差异无统计学意义(P>0.05).结论:卡维地洛与美托洛尔相比可有效改善维持性血液透析左心室肥厚患者心功能,缓解氧化应激反应及炎症反应,改善糖脂代谢且不增加不良反应发生率.

Objective:To investigate the effects of carvedilol and metoprolol on the clinical efficacy and cardiac function of maintenance hemodialysis patients.Methods:162 patients with left ventricular hypertrophy receiving maintenance hemodialysis in Qianjiang Central Hospital of Chongqing City from January 2019 to February 2020 were selected.A random number table was used to divide the patients into 2 groups,with 81 cases in each group.The control and observation group were treated with metoprolol or carvedilol apart from conventional treatment,respectively.The cardiac function indices,oxidative stress response,inflammatory factors,glucose and lipid metabolism and adverse reactions of the two groups were compared.Results:After treatment,the levels of LVEDD,LVPWT,IVST and MDA in the two groups decreased significantly,but the decrease in the observation group was greater(P<0.05).Meanwhile,the SOD and GSH-Px levels of the two groups increased significantly,but the increase in the observation group was greater(P<0.05);the levels of inflammatory factor such as hs-CRP,IL-6,IL-1βand glucose&lipid metabolism indexes such as fasting blood glucose,total cholesterol,and triglyceride levels in the two groups of patients decreased significantly,but the decrease in the observation group was even greater(P<0.05).There were 5 cases(6.17%)of adverse reactions in the control group,and 6 cases(7.40%)in the observation group,of which the difference was not statistically significant(P>0.05).Conclusion:Compared with metoprolol,carvedilol can effectively improve the heart function of patients with left ventricular hypertrophy on maintenance hemodialysis,relieve oxidative stress and inflammation,improve glucose and lipid metabolism without increasing the incidence of adverse reactions.