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大剂量美托洛尔治疗心力衰竭的临床试验

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2011年第1期
页码:
86-90,99
栏目:
临床研究
出版日期:
2010-10-27

文章信息/Info

Title:
Clinical research of large dosages of β-blocker (metoprolol) in treatment of heart failure
作者:
邓兵; 戚秀卿; 刘洋; 许嘉鸿; 罗明; 徐文俊; 蒋金法
同济大学附属同济医院心内科，上海 200065
Author(s):
DENG Bing;  QI Xiu-qing;  LIU Yang;  XU Jia-hong;  LUO Ming;  XU Wen-jun;  JING Jin-fa
Department of Cardiology, Tongji Hospital Affiliated to Tongji University, Shanghai 200065, China
关键词:
心力衰竭; 充血性; 美托洛尔; 心功能; 脑钠尿肽; 6分钟步行距离
Keywords:
Heart failure;  congestion;  metoprolol;  heart function;  BNP;  6 minute walking distance
分类号:
R972:R541.61
DOI:
-
文献标识码:
A
摘要:
目的: 比较不同剂量美托洛尔治疗心力衰竭患者的疗效。方法: 经临床确诊的慢性心力衰竭（CHF）患者182例，随机分为常规剂量组和大剂量组。常规剂量组，在基础治疗同时维持美托洛尔治疗剂量25～50 mg/d。大剂量组，在基础治疗同时美托洛尔治疗剂量逐渐递增至目标剂量或最大耐受剂量。完成试验每组各81例。两组患者美托洛尔治疗剂量稳定后维持12周，比较每组患者治疗前后临床指标［NYHA、HR、BP、左室舒张末内径（LVEDD）、左室射血分数（LVEF）、血浆去甲肾上腺素（NE）、脑钠尿肽（BNP）浓度和6min最大步行距离］的变化及两组间变化差异。结果: 大剂量组有81例患者完成实验，最终美托洛尔治疗剂量为(100±30)mg/d，大剂量组治疗前后心功能分级（NYHA）明显改善，心率(85±9)次/min减慢至(73±5)次/min，LVEF由(41±4)%到(44±5)%，NE由（518±311）ng/L到(251±67)ng/L，BNP由（323±91）μg/L到(238±72)μg/L，6 min步行距离由(331±49)m提高至(339±44)，均有统计学差异（P<0.05）。与常规剂量组相比，心功能分级（NYHA）有改善，心率(73±5)次/min vs.(83±9)次/min， NE(251±67)ng/L vs.(389±286)ng/L，BNP(238±72)μg/L vs.(302±103)均有统计学差异(P<0.05)。结论: 常规剂量和大剂量美托洛尔治疗CHF均能在12周改善心脏重构、提高心功能和增加运动耐量，但大剂量更有效控制心率。大剂量比常规剂量更进一步抑制神经激素的过度激活，尤其降低血浆NE 与BNP浓度，更充分发挥其生物学疗效。
Abstract:
AIM: To compare the therapeutic effect of β-blockers at different dosages on heart failure (HF) patients and to elucidate the necessity of treating HF with target or maximum tolerance dosages of β-blockers. METHODS: A total of 182 patients with confirmed chronic HF were selected and divided randomly into normal-dosage group and high-dosage group. One hundred and sixty-two patients completed the study in which a daily dosage of 25 to 50 mg of metoprolol combined with basic therapy was administrated in normal-dosage group, whereas in high-dosage group, the dosage of metoprolol gradually increased until target or maximum tolerance dosage plus basic therapy. Clinical indexes in both groups (NYHA, heart rate, blood pressure, left ventricular end-diastolic dimension, left ventricular ejection fraction, plasma NE, BNP concentration and 6-min maximum walking distance) were compared after 12 weeks of metoprolol treatment of stable dosage. RESULTS: Eight-one patients completed the experiment in the high-dosage group with the final metoprolol dosage reaching (100±30)mg/day. Among the 81 patients, the metoprolol dosage was 75 mg/day for 36 patients (44.44%), 100 mg/day for 23 patients (28.40%), 125 mg/day for 12 patients (14.81%), 150 mg/day for 8 patients (9.88%), and 200 mg/day for 2 patients (2.47%). In the high-dosage group when compared before and after treatment, NYHA significantly improved, HR decreased from (85±9)l/min to (73±5)l/min, LVEF(%) increased from 41±4 to 44±5, NE(ng/L) decreased from 518±311 to 251±67, BNP(μg/L) decreased from 323±91 to 238±72, and the 6-min walking distance (m) increased from 331±49 to 339±44. Compared with those in normal dosage group, NYHA significantly improved whereas HR decreased from (83±9)l/min to (73±5)l/min, NE(ng/L) decreased from 389±286 to 251±67, and BNP(μg/L) decreased from 302±103 to 238±72. CONCLUSION: It is appropriate to use metoprolol to treat HF by gradually increasing the dosage and adjusting the dosage according to HR, BP, and HF indexes. Normal or high dosages of metoprolol improve cardiac remodeling, increase heart function and enhance exercise tolerance within 12 weeks but high dosages more efficiently control the HR. Large dosages of metoprolol inhibit the over activation of neural hormones, specifically in decreasing plasma NE and BNP concentration so as to improve its biological efficacy and ameliorate long-term prognosis of HF.

参考文献/References

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备注/Memo

备注/Memo:
收稿日期：2009-09-20.作者简介：邓兵，副主任医师，硕士Email:doctor_deng@yahoo.cn
更新日期/Last Update: 2010-10-27