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《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:

2003年第4期

页码:

316-318

栏目:

临床研究

出版日期:

2003-07-01

文章信息/Info

Title:

The effects of Carvedilol on cardiac function and plasma level of brain natriuretic peptide and norepine phrinein patients with heart failur

作者:

罗晓颖; 戚文航

上海第二医科大学附属瑞金医院心内科,上海 200025

Author(s):

LUO Xiao-ying;  QI Wen-han

Department of Cardiology, Ruijin Hospital, Shanghai Second Medical University, Shanghai 200025, China

关键词:

心力衰竭; 慢性; 卡维地洛; 血浆脑钠肽

Keywords:

chronic heart failure;  Carvedilol;  plasma brain natriuretic peptid

分类号:

R541.6

DOI:

-

文献标识码:

A

摘要:

目的:观察卡维地洛对慢性心力衰竭(CHF)患者心功能、脑钠肽(BNP)和去甲肾上腺素(NE)水平的影响。方法:已接受常规治疗,病情稳定的CHF患者60例,随机分为两组:卡维地洛组(33例),常规治疗(对照)组(27例)。卡维地洛组在常规治疗基础上加用卡维地洛,从小剂量(5mg·d-1)逐渐加至靶剂量(50mg·d-1)治疗6个月。治疗前后观察NYHA分级、心率、血压、超声心动图、BNP和NE。结果:卡维地洛组较对照组LVEDD(64±8vs60±4mm),LVESD(52±7vs48±5mm)和LVMI(161±23vs134±19g/m2)显著下降(P<0.05),LVEF显著升高(39%±12% vs45% ±10%)(P<0.05),血浆BNP(103±60vs72±55pg·mL-1)和NE(0.62±0.29vs0.46±0.14ng·mL-1)显著降低(P<0.05);另外,卡维地洛治疗前后患者血浆BNP降低值与LVEDD(r=0.81),LVESD(r=0.78)和LVMI(r=0.70)减少呈正相关(P<0.01),而与LVEF负相关(r=-0.88)(P<0.01)。结论:卡维地洛能明显改善CHF患者的血流动力学,抑制神经内分泌的过度激活,改善心功能;血浆BNP可作为评价β受体阻滞剂治疗CHF疗效的监测指标之一。

Abstract:

AIM: To analyze the effects of carvedilol on changes in plasma brain natriuretic peptide (BNP) and norepinephrine (NE) level and cardiac function in patients with chronic heart failure (CHF). METHODS: 60 patients with CHF who had already received conventional therapy were randomly divided into two groups, the Carvedilol group (33 patients) and the conventional group (27 patients). Patients in the Carvedilol group were given Carvedilol titrated to the target dosage (from 5mg·d-1 to 50mg·d-1). NYHA functional class, heart rate, blood pressure, plasma BNP and NE levels, and echocardiographic in dices were evaluated before and after 6 months' therapy. RESULTS: After 6-month therapy, Carvedilol significantly decreased LV end-diastolic and-systolic dimensions (LVEDD: 64±8 vs 60±4mm, LVESD: 52±7 vs 48±5mm ), and LVMI (161±23 vs 134±19g/m2) (P<0.05) , increased LV ejection fraction (LVEF:39%±12% vs 45%±10%) (P<0.05), and attenuated BNP (103±60 vs 72±55pg·mL-1) and NE (0.62± 0.29vs0.46± 0.14ng·mL-1)(P< 0.05), compared with the patients in the conventional group. Meanwhile, changes in BNP level were positively correlated with those in LVEDD (r=0.81), LVESD (r=0.78), and LVMI (r=0.70)(P<0.01), and negatively correlated with those in LVEF (r=-0.88) (P<0.01). CONCLUSION: Carvedilol may stabilize hemodynamics, suppress neurohormonal activation, and improve cardiac functionin CHF patients and plasma BNP level may serve as a therapeutic indicator for beta-blocker treatment in CHF patients.

参考文献/References

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[3] Joglar JA, Acusta AP, Shusterman NH, et al. Effect of Carvedilol on survival and hemodynamics in patients with atrial fibrillation and left ventricular dysfunction: retrospective analysis of the US Carvedilol Heart Failure Trials Program [J] . Am Heart J, 2001, 142:498-501.

[4] 曾佑平, 张利华. 卡维地洛治疗扩张型心肌病复杂型室性心律失常的疗效评价 [J] . 心脏杂志, 2003, 15(2):121-123.

[5] Klinge R, Hystad M, Kjekshus J, et al. An experimental study of cardiac natriuretic peptides as markers of development of congestive heart failure [J] . Scand J ClinLab Invest, 1998, 58:683-691.

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备注/Memo

备注/Memo:

收稿日期：2002-06-13.

常用功能

更新日期/Last Update: 2003-07-01