慢性心力衰竭患者美托洛尔治疗后的BNP观察(重庆医学版).docVIP

慢性心力衰竭患者美托洛尔治疗后的BNP观察 田志1，陈明2，吴利华1 重庆市中山医院心内科 400013；2．重庆医科大学附属第一医院心内科 400016） 摘要：目的 观察慢性心力衰竭患者美托洛尔治疗后的脑钠肽（BNP）变化。方法从美托洛尔治疗慢性心力衰竭的随机临床试验(CHIME研究)中选择患者共37例，检测其药物治疗后的BNP水平，并分别与患者的超声值对照，观察两者之间的关系以及不同分组的BNP差别。结果 大剂量美托洛尔组治疗后与治疗前相比，LVEF显著增加，LVEDD、LVESD、LAD显著缩小，HR和DBP下降明显（0.4819±0.1052vs0.376±0.1148，58.35±8.34vs62.24±7.52mm，43.88±9.79vs48.09±9.83mm，36.20±6.04vs38.52±5.74mm，73.91±14.74vs86.32±13.17次/分，71.68±9.29vs78.41±9.38 mmHg）（P值分别为0.001、0.007、0.04、0.005、0.001、0.009）。大剂量美托洛尔组BNP水平高于标准治疗组（149.86±146.51vs97.2±92.43 pg/ml，P＝0.313），但无显著性差异。血浆BNP与LVEF呈明显的负相关（r＝-0.401；P＝0.014）。结论 慢性心力衰竭患者，在常规治疗的基础上加用美托洛尔，能增加LVEF，缩小心室内径，更好的改善患者心脏功能；BNP水平与LVEF呈负相关，可以作为心力衰竭的辅助诊断指标；血浆BNP是否可作为β受体阻滞剂治疗心力衰竭的疗效监测指标，需要进一步研究。 关键词：充血性心力衰竭；美托洛尔；脑钠肽 The observation of BNP after metoprolol treatment in congestive heart failure patients Tian Zhi1, Chen Ming2，Wu Lihua1 （1．Department of Cardiology,Chongqing Zhongshan Hospital 400013；2. Department of Cardiology,Chongqing University of Medical Science Affilited 1 Hospital 400016） ABSTRACT: AIM To observe the brain natriuretic peptide(BNP) change after metoprolol treatment in congestive heart failure(CHF).METHODS 37 patients from CHIME study were detected plasma BNP level after treatment,and we analyzed the difference between groups and the relations between the BNP level and the ultrasound values.RESULTS In high dose metoprolol group,LVEF increased significantly,LVEDD、LVESD、LAD reduced significantly,HR and DBP reduced significantly(0.4819±0.1052vs0.376±0.1148，58.35±8.34vs62.24±7.52mm，43.88±9.79vs48.09±9.83mm，36.20±6.04vs38.52±5.74mm，73.91±14.74vs86.32±13.17bpm，71.68±9.29vs78.41±9.38 mmHg)(P is0.001、0.007、0.04、0.005、0.001、0.009 respectively).The BNP level in high dose metoprolol is higher than control group（149.86±146.51vs97.2±92.43 pg/ml，P＝0.313）,but no statistic significance.The BNP level had negative correlation with LVEF significantly（r＝-0.401；P＝0.014）.CONCLUSION Metoprolol could increase LVEF and reduce cardiac diameter of CHF patients,thus metoprolol could