卡维地洛与美托洛尔对血液透析患者心肌梗死及心功能影响的对比研究

Comparison of the effects of carvedilol and metoprolol on myocardial infarction and cardiac function in hemodialysis patients

目的对比卡维地洛与美托洛尔对维持性血液透析患者急性心肌梗死发病情况及心功能的影响,为临床用药提供参考。方法选取2019年12月10日至2020年12月31日在某院接受维持性血液透析患者180例,随机分为卡维地洛组60例、美托洛尔组60例和对照组60例,卡维地洛组给予维持血液透析+卡维地洛口服,美托洛尔组给予维持血液透析+琥珀酸美托洛尔缓释片口服,对照组仅维持血液透析,维持治疗12个月,观察3组间急性心肌梗死发生率,比较各组间心肌损伤标志物氨基末端脑钠肽前体(NT-proBNP)、高敏肌钙蛋白T(hs-cTNT)、肌红蛋白(Mb)、血清肌酸激酶同工酶(CK-MB)和左室射血分数(LVEF)的差异。结果卡维地洛组与美托洛尔组急性心肌梗死发生率均明显低于对照组,差异具有统计学意义(P<0.05);NT-proBNP水平明显低于对照组,LVEF值明显高于对照组,差异具有统计学意义(P<0.05),hs-cTNT、Mb、CK-MB与对照组无显著差异(P>0.05);与美托洛尔组相比,卡维地洛组急性心肌梗死发生率略低,但差异无统计学意义(P>0.05),美托洛尔组与卡维地洛组间NT-proBNP、hs-cTNT、Mb、CK-MB、LVEF值无明显差异。结论卡维地洛和美托洛尔均可降低维持性血液透析患者急性心肌梗死发生率,改善心功能,但2组间比较无明显差别。

Objective To compare the effects of carvedilol and metoprolol on myocardial infarction and cardiac function in hemodialysis patients,so as to provide reference for clinical medications.Methods A total of 180 patients receiving maintenance hemodialysis in our hospital between December 10,2019 and December 31,2020 were selected,who were randomly divided into the carvedilol group(n=60),metoprolol group(n=60)and control group(n=60).The carvedilol group received maintenance hemodialysis+carvedilol(oral),the metoprolol group was given maintainenance hemodialysis+metoprolol succinate sustained-release tablets(oral),and the control group underwent twelve months of maintenance hemodialysis only.The incidence of acute myocardial infarction was compared between the three groups,while the differences in amino-terminal brain natropeptide precursor(NT-proBNP),high-sensitive cardiac troponin T(hs-cTNT),myoglobin(Mb)and serum creatine kinase isoenzyme(CK-MB)and LVEF among the three groups were recorded.Results It was found that the incidence of acute myocardial infarction was significantly lower in the carvecilol group and metoprolol group than in the control group(P<0.05).The levels of NT-proBNP were significantly lower in the control group,but the LVEF value was significantly higher than in the control group,and the difference was statistically significant(P<0.05).The levels of hs-cTNT,Mb and CK-MB were not significantly different from those of the control group(P>0.05).Compared with the metoprolol group,the incidence of acute myocardial infarction in the carvedilol group was slightly lower,but the difference was not statistically significant(P>0.05).There was no significant difference in NT-proBNP,hs-cTNT,Mb,CK-MB and LVEF values between the metoprolol group and the carvedilol group.Conclusion Both carvedilol and metoprolol can reduce the incidence of acute myocardial infarction and improve cardiac function in maintenance hemodialysis patients,but there is no significant difference between the two groups.