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Title:: Therapeutic effects of metoprolol on ventricular remodeling and proinflammatory cytokines in patients with chronic heart failure

作者:: 李振魁; 祝善俊; 黄岚; 田颖; 于林君; 周裔忠; 王江; 第三军医大学新桥医院心内科, 重庆 400037

Author(s):: LI Zhenkui; ZHU Shanjun.; HUANG Lan; TIAN Ying; YU Linjun; ZHOU Yizhong; WANG Jiang; Department of Cardiology, Xinqiao Hospital, Third Medical Military University, Chongqing 400037, China

关键词:: 美托洛尔; 心力衰竭; 慢性; 心肌重构; 肿瘤坏死因子α; 白细胞介素1β; 白细胞介素6

Keywords:: metoprolol; chronic heart failure; ventricular remodeling; tumor necrosis factorα; interleukin1β; interleukin6

分类号:: R541.6

DOI:: -

文献标识码:: A

摘要:: 目的研究β受体阻滞剂美托洛尔对慢性心力衰竭患者心肌重构和血浆肿瘤坏死因子α（TNFα）、白细胞介素1β（IL1β）和白细胞介素6（IL6）的影响。方法选取96例心力衰竭患者，左室射血分数（LVEF）≤45%，心功能（NYHA）Ⅱ～Ⅳ级，随机分为美托洛尔组和常规治疗组各48例，给于洋地黄、利尿剂、硝酸盐类及血管紧张素转换酶抑制剂（ACEI）治疗，美托洛尔组在此基础上加用美托洛尔6.25 mg，2次/d，并逐渐加量，至最大剂量100 mg，2次/d；或最大耐受剂量。治疗6月后，观察比较两组治疗前后心率、血压、心功能、心胸比率、超声心动图变化，用双抗体夹心ELISA法测定美托洛尔组治疗前后血浆TNFα、IL1β和IL6的变化。结果美托洛尔平均剂量127 mg/d，美托洛尔组和常规治疗组治疗后心功能改善（3.1±0.7 vs 1.5±0.6，P<0.01；3.0±0.7 vs 2.0±0.4，P<0.01）、LVEF提高［(34.3±7.8)% vs (46.1±10.5)%，P<0.01；(36.2±5.9)% vs (39.9±5.5)%，P<0.01］。美托洛尔组左室舒张末内径(LVEDD)比治疗前显著减小(68.0±10.6 mm vs 63.6±10.4 mm，P<0.01)、心胸比率降低（0.61±0.08 vs 0.58±0.07，P<0.05）；美托洛尔组血浆TNF1、IL1β和IL6显著降低（53±23 vs 35±14；32±12 vs 20±4；50±21 vs 21±11 pg/ml,P<0.01）。结论在慢性心力衰竭常规治疗基础上加用β1受体阻滞剂美托洛尔安全有效，可以改善心功能，逆转心肌重构，降低血浆主要细胞因子水平。

Abstract:: AIM To investigate the effects of metoprolol on the ventricular remodeling and proinflammatory cytokines in patients with chronic heart failure (NYHA class Ⅱ-Ⅳ). METHODS All the 96 patients with chronic heart failure with left ventricular ejection fraction (LVEF) ≤0.45 were recruited into the study. All of them received angiotensin converting enzyme inhibitors (ACEI), digitalis, diuretic and nitrate. The patients of metoprololtreated group were given in addition metoprolol, with the dose gradually increasing from 6.25 to 100 mg bid as maximum dose or maximum tolerated dose. After 6 months, heart rate, blood pressure, NYHA class, cardiothoracic ratio and echocardiograph were recorded. Plasma levels of tumor necrosis factorα(TNFα), interleukin1β(IL1β) and interleukin6(IL6) were measured by enzymelinked immunoassay (ELISA). RESULTS The mean dose of metoprolol was titrated to 127 mg/day (range 25-200 mg/d). The NYHA class were significantly improved and LVEF were significantly increased in metoprololtreated group and standard treatment group ［(3.1±0.7 vs 1.5±0.6, 3.0±0.7 vs 2.0±0.4］ , (34.3±7.8) % vs (46.1±10.5)%, (36.2±5.9)% vs (39.9±5.5)%, P<0.01 respectively］. The left ventricular end diastolic diameter (68.0±10.6 mm vs 63.6±10.4 mm, P<0.01) and cardiothoracic ratio (0.61±0.08 vs 0.58±0.07,P<0.05) of metoprololtreated group were decreased after the treatment. Plasma concentrations of TNFα, IL1β, IL6 were significantly decreased in metoprololtreated group after the treatment（53±23 vs 35±14；32±12 vs 20±4；50±21 vs 21±11 pg/ml；P<0.01 respectively）. CONCLUSION Metoprolol can not only be effectively used in the treatment of chronic heart failure, but also reverse ventricular remodeling and reduce the levels of plasma TNFα, IL1β, IL6.

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美托洛尔长期治疗对慢性心力衰竭患者心肌重构和炎性细胞因子的影响(PDF)

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