摘要
目的:观察慢性心力衰竭患者,接受β阻滞剂治疗过程中,血浆N端脑钠素原(NTproBNP)水平的动态变化,探讨其临床意义。方法:选择已接受常规治疗[利尿剂、血管紧张素转换酶抑制剂和(或)洋地黄]的住院及门诊慢性心力衰竭患者(NYHA心功能分级为II～IV,左心室射血分数≤0.40)44例,随机接受β阻滞剂比索洛尔(比索洛尔组,22例)或卡维地洛(卡维地洛组,22例)治疗。比索洛尔或卡维地洛的初始剂量分别为1.25mg每日1次或3.125mg每日2次,剂量每10天±3天递增1次,直至最大耐受或最大允许剂量(比索洛尔为10mg每日1次,卡维地洛为25mg每日2次)后4个月结束。于基线时、达到最大剂量以及结束时分别测定NTproBNP水平(ELISA法);于基线时以及结束时测定左心室射血分数(改良SIMPSON法)并评估NYHA心功能分级。结果:①基线NTproBNP水平均值明显升高为2315pg/ml,且随着心功能分级的增加而明显升高;②与用药前相比,用药后达到最大剂量以及结束时的NTproBNP血浆平均水平均明显减低;③发生心血管事件的患者NTproBNP水平明显高于未发生心血管事件的患者;④单因素回归结果显示:NTproBNP水平与超声心动图测得的左心室射血分数呈负相关关系(r=-0.338,P=0.025,n=44);⑤两组之间基线及用药后各时点NTproBNP水平及左心室射血分数均无统计学差异。结论:血浆NTproBNP水平在心力衰竭患者中明显升高,发生心血管事件的患者NTproBNP水平明显高于未发生心血管事件的患者;经常规治疗及β阻滞剂治疗后NTproBNP水平减低,左心室射血分数明显增高,两者呈明显负相关;但两种β阻滞剂治疗组之间NTproBNP水平变化无差异。
Objective: The aims of this study were to evaluate the effects of β-blockers on plasma N-terminal portion of brain natriuretic (NT-proBNP) in patients with chronic left heart failure (CHF). Methods: Forty-four patients (33 men and 11 women, mean age 57.6 years (SD=10.4) with chronic left heart failure (ejection fraction less or equal to 40% by UCG) were included in this study. All patients received conventionaltherapy and were randomly assigned to either bisoprolol (22 patients with the initial dosage 1.25 mg,qd) or carvedilol group (22 patients with initial dose 3.125 mg bid). β-blockers were increased gradually to the target or the tolerant doses. Plasma NT-proBNP concentrations were measured by ELISA. Results: The baseline plasma N-terminal BNP concentrations were 2 315 pg/ml, which were much higher than 200 pg/ml as a result of impaired systolic function. The baseline plasma concentrations of N-terminal proBNP were higher in higher NYHA group.Compared with pre-therapy, plasma NT-proBNP levels decreased at both target /tolerant doses and final time point ( all p<0.05). The baseline plasma concentrations of N-terminal proBNP were much higher in event group than non-event group. The regression result showed that the value of LVEF increased with the decreasing of BNP levels (r=-0.338,p=0.025). There were no statistical significant differences between two groups for the plasma NT-proBNP during the 6 months. Conclusions: Plasma levels of BNP increased in patients with left heart failure and decreased after β-blocker therapy in addition to other conventional therapy for 6 months, but there was no statistical significant difference between two β-blocker groups. The values of LVEF increased with the decreasing of NT-proBNP levels.
出处
《中国循环杂志》
CSCD
北大核心
2005年第3期207-211,共5页
Chinese Circulation Journal
基金
国家863计划"十五"重大科技专项"药物临床试验关键技术平台研究"课题(2002AA2Z341A)资金资助
关键词
心力衰竭
N-端脑钠素原
Β阻滞剂
Chronic left heart failure
N-terminal portion of brain natriuretic
Beta-blockers
