Benefit of combination β-blocker and endoscopic treatment to prevent variceal rebleeding: A meta-analysis

AIM: To determine whether the association of β-blockers with endoscopic treatment is superior to endoscopic treatment alone for the secondary prophylaxis of oesophageal variceal bleeding. METHODS: Randomised controlled trials comparing sclerotherapy (SCL) with SCL plus β-blockers (BB) or banding ligation (BL) with BL plus BB were identif ied.Main outcomes were overall and 6, 12 and 24 mo rebleeding rates, as well as overall and 6, 12 and 24 mo mortality. Two statistical methods were used: Yusuf-Peto, and Der Simonian and Laird. Inter-trial heterogeneity was systematically taken into account. RESULTS: Seventeen randomised controlled trials were included, 14 with SCL and 3 with BL. Combination β-blocker and endoscopic treatment signif icantly reduced rebleeding rates at 6, 12 and 24 mo and overall [odds ratio (OR): 2.20, 95% conf idence interval (CI): 1.69-2.85, P<0.0001] compared to endoscopic treatment alone. Mortality at 24 mo was signif icantly lower for the combined treatment group (OR: 1.83, 95% CI:1.16-2.90, P= 0.009), as well as overall mortality (OR: 1.43, 95% CI:1.03-1.98, P= 0.03). CONCLUSION: Combination therapy should thus be recommended as the fi rst line treatment for secondary prophylaxis of oesophageal variceal bleeding.

Effect of β-blocker therapy in diabetic patients with stable coronary heart disease: a meta-analysis

Background β-blocker (BB) therapy is a cornerstone for the treatment of coronary heart disease (CHD).The evidence of the benefit from long-term BB therapy in diabetic patients with stable CHD is scarce.This meta-analysis summarizes the evidence relating to the BB therapy in diabetic patients with stable CHD.Methods A meta-analysis was performed according to PRISMA and MOOSE guidelines for reporting of systematic reviews of observational studies.PubMed,Embase,and Cochrane central were searched and two authors independently screened studies for eligibility.The quality of studies was assessed with the Newcastle Ottawa scale.The primary outcome of interest was all-cause mortality,cardiovascular (CV) mortality and major adverse cardiovascular events (MACE) in diabetic patients with and without BB therapy.A generic inverse variance model was used to pool odds ratio or hazards ratio from included studies to calculate the overall effect estimate.The significance threshold was set at P-value < 0.05.Heterogeneity was assessed by I2.Results Four non-randomized studies with 9515 participants were selected for the analyses.Four studies were post-hoc analyses of randomized controlled trials,and one article was an analysis of a nationally representative survey.In a fixed effects model,BB therapy in diabetic patients with stable CHD was found to be associated with increased risk of CV mortality,and MACE (27% and 32% respectively;P-value < 0.05) and was not associated with a reduction in all-cause mortality (HR 1.12;95% CI: 0.94–1.33;P-value = 0.22).Conclusion BB therapy in diabetic patients with stable CHD appears to be linked to higher mortality.Large randomized trials are needed in this population to confirm these findings.

Nonselective β-blockers may induce development of portal vein thrombosis in cirrhosis

Currently, nonselective β-blockers(NSBBs) are commonly used for the prevention of variceal bleeding in liver cirrhosis. The beneficial effects of NSBBs are primarily attributed to the reduction in cardiac output by blockade of β1 receptors and vasoconstriction of the splanchnic circulation by the blockade of β2 receptors. The prognostic value of occlusive portal vein thrombosis(PVT) in cirrhotic patients has been increasingly recognized. The most important risk factor for the development of PVT in liver cirrhosis is the decreased portal vein inflow velocity. Collectively, we propose that the use of NSBBs potentially increases the development of portal vein thrombosis by reducing portal vein inflow velocity. The hypothesis should be confirmed by prospective cohort studies, in which cirrhotic patients without prior PVT treated with and without NSBBs are enrolled, and the development of PVT during followup is compared between the two groups. Additionally,subgroup analyses should be performed according to the dosage of NSBBs and the reduction of portal inflow velocity after use of NSBBs.

Flow-injection-enhanced chemiluminescence method for the determination of three β-blockers

Objective To develop a rapid,simple and sensitive chemiluminescence method for the determination of three β-blockers (bisoprolol,atenolol and propranolol). Methods The chemiluminescence of cerium (Ⅳ)-sulfite system was obviously sensitized by adding anyone of three β-blockers in acid media. A new chemiluminescence method was set up by combining with flow-injection technique and used to determine the three β-blockers. Results Good linear ranges were obtained at the concentrations of 2.0×10-7g/mL-4.0×10-5g/mL,1.0×10-7g/mL-3.0×10-5g/mL and 7.0×10-7g/mL-1.0×10-5g/mL,respectively,with the detection limits of 5.0×10-8g/mL,7.0×10-8g/mL and 5.0×10-8g/mL (S/N=3),respectively,and the relative standard deviations for 11 times consecutive injections of 1.0×10-6g/mL bisoprolol,atenolol and propranolol were 3.57%,2.21% and 2.26%,respectively. Conclusion The developed method is sensitive,accurate,rapid and of low cost. And it can be applied to determine bisoprolol,atenolol and propranolol in pharmaceutical preparations.

Improvement of MDA and SOD Expression and Optic Neuroprotection in Glaucoma Mice by Travoprost and β-Blocker

Objective:The goal of this study was to see if travoprost and β-blockers improved MDA and SOD expression as well as neuroprotection in glaucoma mice.Methods:One hundred healthy SPF SD rats were randomly allocated into five groups:travoprost and β-blocker group,travoprost group,β-blocker group,model group and blank group,with 20 rats in each group.We created a glaucoma mouse model in which the blank group and the model group received the same volume of saline,the β-blocker group received β-blocker,the travoprost group received travoprost,and the travo Prost and β-blocker groups received travo Prost and βreceptor blockers.Retinal cell apoptosis level,intraocular pressure level,MDA and SOD levels were measured after drug administration.Results:The results showed that the levels of intraocular pressure,the apoptosis rate of optic nerve,SOD and MDA of retina in travoprost and β-blocker group,travoprost group,β-blocker group and model group were greater than those in blank group(P<0.05).In comparison to the model group,the intraocular pressure level,optic nerve apoptosis rate,and retinal MDA level in the travoprost and β-blocker group continued to fall,while the retinal SOD level was considerably elevated(P<0.05).The continuous application of travoprost and β-blocker resulted in a constant drop in intraocular pressure,optic nerve apoptosis rate and MDA level in the retina,whereas the SOD level was dramatically elevated(P<0.05).Conclusion:In glaucoma mice,travoprost in combination with a β-blocker can greatly increase MDA expression,SOD and neuroprotection.

真实世界中伊伐布雷定在急性心肌梗死住院患者中使用状况的单中心回顾性分析

目的 分析本中心急性心肌梗死住院患者伊伐布雷定的使用状况。方法 回顾性分析2019年1月至2020年4月天津市人民医院1 021例急性心肌梗死住院患者的临床资料,连续选取其中100例资料完整的使用伊伐布雷定、合用或未合用美托洛尔缓释片的患者作为观察组,另外连续选取同期100例使用美托洛尔缓释片、未使用伊伐布雷定的患者作为对照组。比较两组患者的基线特征、治疗前后心率、收缩压和舒张压变化;分析观察组伊伐布雷定的使用原因;描述观察组伊伐布雷定和美托洛尔缓释片的剂量调整情况;记录观察组中与伊伐布雷定相关的不良反应。结果 两组患者的前壁心肌梗死和非ST段抬高型心肌梗死比例、Killip心功能分级Ⅰ和Ⅱ级比例、治疗前心率、收缩压和舒张压、治疗前左心室射血分数、主动脉内球囊反搏植入比例、肌酸激酶峰值和B型利钠肽峰值比较,差异均有统计学意义(均为P<0.01)。对照组治疗前后心率、收缩压和舒张压变化均有统计学差异(均为P<0.001);观察组治疗前后心率变化有统计学差异(P<0.001),收缩压和舒张压变化无统计学差异(均为P>0.05)。观察组使用伊伐布雷定的主要原因为医生担心患者血压偏低或心功能不能耐受β受体阻滞剂。观察组初始有89例(89.0%)患者合用了美托洛尔缓释片,伊伐布雷定和美托洛尔缓释片的剂量呈“此消彼长”的变化,未出现与伊伐布雷定相关的严重不良反应。结论 本中心的数据表明,在临床实践中伊伐布雷定通常用于心率偏快、血压偏低、合并心功能不全的急性心肌梗死患者,特别是前壁心肌梗死患者。通过与β受体阻滞剂联合使用,调整剂量,可以安全、有效地控制急性心肌梗死患者住院期间心率。

5种β受体拮抗剂类药物中的N-亚硝基类杂质的含量研究

目的测定普萘洛尔、美托洛尔、阿替洛尔、艾司洛尔、比索洛尔原料药/制剂中N-亚硝基类杂质含量,明确其含量的关注阈值。方法采用超高效液相色谱-四极杆/静电场轨道阱高分辨质谱技术。以ACE Excel 3 C18-AR为色谱柱,以含0.01 mol/L乙酸铵的0.2%甲酸溶液-甲醇为流动相进行梯度洗脱,流速为0.60 mL/min,柱温为40℃,进样量为5μL;以可加热的电喷雾离子源为离子源,以全扫描-选择离子监测模式进行正离子扫描。采用该法对10家企业生产的15批β受体拮抗剂类药物原料药/制剂中N-亚硝基类杂质含量进行测定,并采用Discovery Studio软件对待测杂质进行毒性预测和关注阈值估算。结果5种β受体拮抗剂类药物中,N-亚硝基普萘洛尔、N-亚硝基美托洛尔、N-亚硝基阿替洛尔、N-亚硝基艾司洛尔、N-亚硝基比索洛尔检测质量浓度的线性范围分别为1.01~503.38、1.02~508.38、0.97~483.63、1.11~554.27、1.05~523.92 ng/mL(r>0.999),定量限分别为1.04、0.25、0.05、0.55、1.05 ng/mL,检测限分别为0.52、0.08、0.02、0.17、0.52 ng/mL,精密度、重复性、加样回收率、稳定性、耐用性试验的RSD均小于7.5%(n=6或n=5)。15批样品中,除1批样品外,其余批次均检出了N-亚硝基普萘洛尔(1.07~8.91 ng/mg)、N-亚硝基美托洛尔(1.43~3.37 ng/mg)、N-亚硝基阿替洛尔(1.33 ng/mg)、N-亚硝基艾司洛尔(0.19 ng/mg)、N-亚硝基比索洛尔(1.27 ng/mg)。经预测,上述5种杂质有不同程度的生育毒性、致突变性、致癌性,关注阈值分别为1.0、0.4、4.3、0.2、46.7 ng/mg。结论所建方法简单快捷、灵敏度高、专属性强,估算的关注阈值明确,可用于多种β受体拮抗剂类药物中N-亚硝基类杂质的含量控制。

外用β受体阻滞剂和脉冲燃料激光治疗低、中风险血管瘤的效果对比

目的比较外用β受体阻滞剂和激光治疗低、中风险血管瘤的效果。方法将2018年10月—2021年9月本院收治的262例低、中风险婴幼儿血管瘤患者根据治疗方式分为脉冲燃料激光组(85例)、外用0.5%噻马洛尔组(91例)和外用2%卡替洛尔组(86例)。对比各组的疗效。脉冲燃料激光治疗采用595nm PDL联合1064nm Nd:钇铝石榴石(yttrium aluminum garnet,YAG),每月1次,持续治疗1~6月。其余两组将外用β受体阻滞剂湿敷于瘤体上,持续30min,每日湿敷2次。结果总有效率方面,激光组与噻马洛尔组的差异不明显,无统计学意义(P>0.05),但与卡替洛尔组相比,组间差异显著,有统计学意义(P<0.05)。激光组疗程为(3.47±1.46)月,明显快于外用β受体阻滞剂组,组间差异显著,有统计学意义(P<0.05)。噻马洛尔组的疗程(9.33±5.80月)较卡替洛尔组(5.57±2.57月)长,但噻马洛尔组有效率(85.4%)较卡替洛尔组(79.3%)高。三组血管瘤疗效与性别、风险等级没有相关性。浅表性血管瘤的疗效明显优于混合性。结论无论是脉冲燃料激光还是外用β受体阻滞剂均对低、中风险血管瘤有效。激光治疗较外用β受体阻滞剂控制快、疗程短。建议尽早开始治疗,最好在出生3月以内,并坚持用药保证一定的疗程,使治疗效果达到最优。

超高龄持续性心房颤动患者心率变异性与基础临床特征的关系分析

目的 探讨超高龄(≥80岁)持续性心房颤动(简称房颤)患者的心率变异性(HRV)与基础临床特征的关系。方法 选取108例超高龄持续性房颤患者纳入房颤组,另选取127例超高龄窦性心律老人纳入对照组,监测24 h动态心电图,比较2组心率、HRV时域指标[正常RR间期标准差(SDNN)、全程每5 min RR间期平均值的标准差(SDANN)、相邻NN间期差值的均方根(RMSSD)、全程记录中5 min NN间期标准差平均值(SDNN index)、心率变异指数(HRV index)和相邻NN间期差值>50 ms的心搏数占NN间期总搏数的百分比(PNN50)]。收集房颤患者的基础临床特征,采用多元线性回归分析探讨HRV时域指标与心率、基础临床特征的相关性。结果 房颤组的SDNN、RMSSD、HRV index、PNN50、SDNN index均高于对照组,差异有统计学意义(P<0.01)。多元线性回归分析结果显示,SDNN升高与高血压(P=0.001)、服用β受体阻滞剂(P=0.003)、心率慢(P<0.001)显著相关,RMSSD升高与高血压(P=0.040)、服用β受体阻滞剂(P=0.002)、心率慢(P<0.001)显著相关,HRV index升高与心力衰竭(P=0.003)、心率慢(P<0.001)显著相关,PNN50升高与心率慢(P=0.004)显著相关;SDNN index升高与服用β受体阻滞剂(P=0.002)、心率慢(P<0.001)显著相关,SDANN升高与高血压(P=0.006)、心率慢(P<0.001)、服用达比加群(P=0.021)显著相关。结论 超高龄持续性房颤患者的HRV与基础临床特征存在相关性,该现象可能源于自主神经系统的活动状态。

β受体阻滞剂应用于小儿充血性心力衰竭的系统评价与Meta分析

目的 系统评价β受体阻滞剂对小儿充血性心力衰竭患者的疗效,为临床用药提供证据。方法 从PubMed、Embase、the Cochrane Library及CNKI、万方、维普数据库中检索相关前后对照试验与随机对照试验,检索时限自建库起至2023年10月31日。结局指标有左心室射血分数(LVEF)、左心室短轴缩短率(LVFS)、左心室舒张末期内径(LVDD)、左心室收缩末期内径(LVSD)、N端B型脑钠肽(NT-proBNP)、心率、血压及心功能改善情况。结果 共纳入20项符合标准的研究,包含1 068例患儿,包括扩张型心肌病、心内膜弹力纤维增生。Meta分析显示,在常规心力衰竭药物治疗的基础上,使用β受体阻滞剂(琥珀酸美托洛尔、比索洛尔及卡维地洛),对改善患儿LVEF[MD=13.06,95%CI(11.67,14.45),P <0.001]、LVFS [MD=6.96,95%CI(6.54,7.37),P <0.001]、LVDD [MD=-6.43,95%CI(-7.58,-5.28),P <0.001]和LVSD [MD=-8.30,95%CI(-8.83,-7.76),P <0.001]效果显著;也可改善患儿血压、心率、NT-proBNP和心功能。结论 在常规心力衰竭药物治疗的基础上使用β受体阻滞剂的联合方案可提高小儿充血性心力衰竭患者的心功能及改善心力衰竭症状,推荐将β受体阻滞剂积极应用于该类患儿的常规治疗方案中。

环糊精键合相拆分和测定人血浆中β-受体阻滞剂对映体

本文采用一种新型的桥联双β-环糊精固定相,通过优化色谱条件,实现了常见β-受体阻滞剂卡维地洛、阿罗洛尔和阿替洛尔6种对映体的完全分离,分离度分别为1.6、1.9和1.7。以R-阿普洛尔为内标,建立了一种能同时测定人体血浆中上述6种对映体含量的液相色谱新方法。血浆样品碱化后用乙酸乙酯提取和净化,选择极性有机相体系(乙腈/甲醇/三乙胺/冰乙酸),通过梯度洗脱完全拆分对映体,柱后二极管阵列检测(275 nm),内标法定量。结果表明,在各自质量浓度范围内,6种β-受体阻滞剂对映体波长响应值与含量呈良好的线性关系(R2为0.9923~0.9989)。对映体的检测限(S/N=3)和定量限(S/N=10)分别在0.4~1.5 mg/L和1.5~4.0 mg/L范围内,样品加标平均回收率为85.96%~103.88%,测定结果的日内和日间的相对标准偏差范围分别为1.88%~3.29%和3.02%~5.17%。该方法具有操作简便、结果准确性和手性分离度高等优点,可同时测定多个对映体,提高分析效率,降低测试成本。

β受体阻滞剂对自发性高血压大鼠血管老化的影响

[目的]探讨β受体阻滞剂在自发性高血压大鼠(SHR)血管老化中的防治作用及其潜在机制。[方法]将24只3月龄雄性SHR随机分为安慰剂组、硝苯地平组、硝苯地平+美托洛尔组、美托洛尔组,分别以食用淀粉、硝苯地平缓释片60 mg、硝苯地平缓释片40 mg+美托洛尔缓释片75 mg、美托洛尔缓释片150 mg灌胃治疗,普通饲料喂养9个月,动态观察大鼠血压、心率及一般情况。HE染色观察大鼠股动脉形态学特征,离体股动脉血管环灌流实验检测血管舒缩功能,免疫荧光组织学染色和实时聚合酶链反应(RT-PCR)测定衰老相关基因p53、p21及内质网应激相关基因CHOP、XBP1的表达。[结果]与安慰剂组相比,硝苯地平组、硝苯地平+美托洛尔组、美托洛尔组收缩压下降约30%,舒张压下降约20%,心率分别下降了9%、36%、41%(均P<0.01)。与安慰剂组相比,硝苯地平组、硝苯地平+美托洛尔组、美托洛尔组舒缩功能显著改善,内膜中膜厚度分别下降了24%、14%、37%(均P<0.01);与硝苯地平组、硝苯地平+美托洛尔组相比,美托洛尔组舒缩功能显著改善,内膜中膜厚度分别下降了18%、27%(均P<0.01)。与安慰剂组相比,硝苯地平组p53蛋白、p53 mRNA、p21蛋白、p21 mRNA、CHOP蛋白、CHOP mRNA、XBP1蛋白、XBP1 mRNA的表达水平分别下降了35%(P<0.01)、23%(P<0.05)、25%(P<0.01)、3%(P>0.05)、51%(P<0.01)、24%(P>0.05)、21%(P<0.01)、23%(P>0.05),硝苯地平+美托洛尔组分别下降了36%(P<0.01)、42%(P<0.01)、4%(P>0.05)、24%(P<0.05)、32%(P<0.01)、44%(P<0.05)、13%(P<0.01)、42%(P<0.05),美托洛尔组分别下降了47%(P<0.01)、43%(P<0.01)、42%(P<0.01)、49%(P<0.01)、78%(P<0.01)、56%(P<0.01)、32%(P<0.01)、81%(P<0.01)。与硝苯地平组、硝苯地平+美托洛尔组相比,美托洛尔组进一步抑制衰老和内质网应激相关基因的表达。[结论]SHR的动脉存在明显老化,β受体阻断剂在抑制SHR血管老化方面优于钙通道阻断剂,且高剂量β受体阻断剂改善血管老化程度优于联合用药,其机制可能与抑制内质网应激有关。

扩张型心肌病患者心内血栓形成危险因素及预测模型研究

目的探究扩张型心肌病(DCM)患者心内血栓形成的危险因素,基于此构建列线图预测模型并进行验证及评价。方法该研究纳入诊断为DCM的88例合并心内血栓患者和544例无心内血栓患者,并将研究对象按7∶3比例随机分为训练集和验证集。通过单因素及多因素Logistic回归分析筛选出DCM患者心内血栓形成的独立危险因素,借助R软件构建列线图预测模型。应用受试者工作特征曲线(ROC)、Hosmer-Lemeshow拟合优度检验和校准曲线、决策曲线对模型进行验证及评价。结果二元Logistic回归分析显示:年龄、心房颤动(房颤)、左心室舒张末内径(LVEDD)、脑钠肽(BNP)和β受体阻滞剂与DCM患者心内血栓形成独立相关。基于此5项因素构建列线图预测模型并进行验证,结果显示训练集和验证集的ROC曲线下面积分别为0.823(95%CI:0.760~0.887)、0.803(95%CI:0.705~0.901),表明模型具有良好的鉴别能力;校准曲线的Hosmer-Lemeshow检验结果分别为^(χ2)=6.679、P=0.572和^(χ2)=2.588、P=0.958,显示预测结果与实际结果具有良好的一致性;决策曲线显示阈值在0.05~0.92区间内,临床净获益较高。结论基于年龄、房颤、LVEDD、BNP和β受体阻滞剂5项因素构建的列线图预测模型,具有良好的鉴别能力、校准能力和临床获益,能有效指导临床医师进行早期危险因素干预,降低心内血栓发生的风险。

(S)-普萘洛尔的合成、应用及剂型研究进展

(S)-普萘洛尔是一种重要的β受体阻滞剂,用于治疗心血管疾病、焦虑症、甲状腺功能亢进等多种疾病。本文综述了迄今为止用于制备(S)-普萘洛尔的化学合成方法,如不对称拆分法、手性源合成法和不对称催化法。讨论了(S)-普萘洛尔口服和外用等多种新剂型,以及(S)-普萘洛尔在心血管疾病、焦虑症、甲状腺功能亢进、特发性震颤等疾病上的应用。本文期望为(S)-普萘洛尔的合成方法、应用和剂型研究提供参考。

Determination of 23 β_2-agonists and 5 β-blockers in animal muscle by high performance liquid chromatography-linear ion trap mass spectrometry

A high performance liquid chromatography-linear ion trap mass spectrometry method using isotope dilution technique has been developed for the simultaneous determination of 23 β2-agonists and 5 β-blockers in animal muscle tissues. Pork and chicken muscle samples were acid hydrolyzed and extracted with 5% trichloracetic acid in water, and then cleaned up using MCX solid phase extraction (SPE) cartridge. Methanol and 0.1% formic acid were used as mobile phases for gradient elution. A Waters AtlantisT3 column was used for separation. ESI positive ion scan mode was used with selective reaction monitoring. 9 β2-Agonists labeled by the deuterium isotope were used as internal standards for quantification. The linear ranges of 23 β2-agonists and 5 β-blockers were 5-200 μg/L, the coefficient of correlation was not less than 0.995, and the limit of detection for each compound in the muscle tissue was below 0.2 μg/kg. The recoveries of each compound in the spiked samples at three levels 5, 10, 20 μg/kg were in the range of 47.3%-123.7%, and the relative standard deviations were in the range of 3.2%-25.7%. The developed method is sensitive and specific for the determination of β2-agonists and β-blockers in pork and chicken muscle samples.

Association of Hypertension and <i>β</i>-Blocker Use with Depression during Pregnancy

Objective: To evaluate the association between hypertension and β-blocker (BB) use and antepartum depression risk. Patients and Methods: We conducted a retrospective cohort study of women who delivered within our integrated health system between 2009 and 2015, and completed an Edinburgh Postnatal Depression Scale (EPDS) during pregnancy. Increased depression risk was defined as EPDS score ≥ 10, or an affirmative answer to question ten, endorsing self-harm. Antepartum hypertension was determined by blood pressure measurements and provider ICD-9 codes. Regression analyses examined the independent associations of BB use and hypertension on antepartum depression risk. Results: Of 9192 deliveries during the study time frame, 5% were hypertensive. Within the hypertensive group, 103 (22%) used a single agent BB (BB Group), 325 (68%) required no antihypertensive medication (No-Med Group), and 48 (10%) used a non-BB single agent or multi-agent therapy (All-Other Group). After adjusting for covariates, compared to normotensive pregnancies, antepartum hypertension was significantly associated with both EPDS score ≥ 10 (adjusted odds ratio [aOR] 1.61, 95% confidence interval [CI] 1.17 - 2.21) and endorsement of self-harm (aOR 1.76, 95% CI 1.05 - 2.95). In further analyses of depression risk in hypertensive pregnancies, there was no difference between the BB Group and No-Med Group (EPDS score ≥ 10, aOR 1.22, 95% CI 0.56 - 2.63;self-harm, aOR 0.84, 95% CI 0.32 - 2.21), or between the All-Other Group and No-Med Group (EPDS ≥ 10, aOR 1.42, 95% CI 0.57 - 3.54;self-harm, aOR 1.04, 95% CI 0.29 - 3.74). Conclusion: Women with antepartum hypertension have increased risk for depression and thoughts of self-harm. β-Blocker use is not associated with further increased risk.

伊伐布雷定联合β受体阻断剂治疗慢性心力衰竭的有效性和安全性的Meta分析

目的:系统评价伊伐布雷定(IVA)联合β受体阻断剂治疗慢性心力衰竭(CHF)的有效性和安全性。方法:计算机检索PubMed、Embase、the Cochrane Library、Web of Science、中国知网、万方数据库、维普数据库和中国生物医学文献数据库等,搜集IVA联合β受体阻断剂治疗CHF的随机对照试验(观察组患者予以IVA联合β受体阻断剂治疗,对照组患者单纯使用β受体阻断剂治疗),检索时限为建库至2023年4月12日,应用RevMan 5.4和Stata 16软件进行Meta分析。结果:共纳入39项研究,涉及3794例患者。Meta分析结果显示,观察组患者总有效率显著高于对照组,心率显著低于对照组,心功能指标显著优于对照组(左心室射血分数高于对照组,左心室收缩末期内径、左心室舒张末期内径低于对照组,6 min步行距离长于对照组),不良反应发生率显著低于对照组,差异均有统计学意义(P<0.05)。结论:IVA联合β受体阻断剂在提高CHF患者总有效率、降低心率和改善心功能方面疗效显著,安全性好,值得临床推广应用。

60岁以上退行性瓣膜性心脏病合并心力衰竭的治疗研究进展

退行性瓣膜性心脏病往往会导致心力衰竭的发生,患者常因心功能失代偿合并血流动力学改变加重自身的心脏负担,最终导致心力衰竭的发生。早期退行性瓣膜性心脏病往往无明显临床表现,但疾病对心脏功能和结构的损害呈递进式的影响。国内外目前对该疾病的治疗进行了大量研究,并取得了一些成果。现对退行性瓣膜性心脏病的诊断、检测指标、危险因素及治疗方法等进行综述,以期为临床治疗提供更好的指导。

β受体阻滞剂在心衰患者中的应用进展

心力衰竭(心衰)是心血管内科较为常见的循环功能障碍的一类综合征,治疗药物包括利尿剂、血管紧张素转化酶抑制剂(ACEI)类药物等,达到降低心脏负担、利尿消肿、增强心肌收缩力等目的。随着对心衰的不断研究,β受体阻滞剂在心衰的临床治疗中已成为较为常见的药物,对于最初β受体阻滞剂的争议性限制应用,后期多个大规模医学试验为β受体阻滞剂在心衰治疗中提供有力依据。为了进一步研究β受体阻滞剂在心衰的临床使用现状和安全性,本文对近年来应用β受体阻滞剂治疗心衰的进展进行如下综述。

沙库巴曲缬沙坦钠与缬沙坦联合β受体阻滞剂在维持性血液透析合并心力衰竭患者中的应用效果比较

目的比较沙库巴曲缬沙坦钠与缬沙坦联合β受体阻滞剂在维持性血液透析合并心力衰竭患者中的应用效果。方法选取2020年8月—2022年8月厦门弘爱医院收治的维持性血液透析合并心力衰竭患者60例,采用随机数字表法分为观察组和对照组,各30例。在常规β受体阻滞剂治疗基础上,对照组予缬沙坦胶囊治疗,观察组则予沙库巴曲缬沙坦钠片治疗,2组均治疗40周。比较2组治疗前后透析指标(干体质量、体质量增长、超滤量、收缩压、舒张压)、炎性因子[超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)]、超声心电图指标[左室射血分数(LVEF)、左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)、心输出量、室间隔舒张末期厚度(IVSTD)、左室后壁舒张末期厚度(LVPWTD)]变化及不良反应。结果治疗40周后,2组干体质量、体质量增长、超滤量均较治疗前无明显变化(P>0.05),收缩压、舒张压及hs-CRP、TNF-α、IL-6水平均较治疗前降低,且观察组低于对照组(P<0.05或P<0.01);观察组LVEF、心输出量均较治疗前增加,LVESD、LVEDD、IVSTD、LVPWTD较治疗前减小,且观察组各项指标治疗后优于对照组(P<0.05或P<0.01)。对照组心输出量治疗后增加(P<0.01),其余各项指标治疗前后差异无统计学意义(P>0.05)。观察组与对照组不良反应总发生率(23.33%vs.33.33%)比较差异无统计学意义(χ^(2)=0.739,P=0.390)。结论相较于缬沙坦,沙库巴曲缬沙坦钠联合β受体阻滞剂在维持性血液透析合并心力衰竭患者中的应用效果更佳,可明显改善患者血压,减轻炎性反应,对心肌重构具有积极改善作用。