比索洛尔对慢性心力衰竭伴左室功能降低患者心肌和肺功能的保护作用
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摘要
目的评价比索洛尔对慢性心力衰竭伴左室功能降低患者心肌和肺功能的保护作用。方法 2017年1月-2018年6月西安交通大学医学院第一附属医院心血管内科治疗慢性心力衰竭伴左心室功能降低患者182例,根据随机数字表法分为比索洛尔组(n=91)与卡维地洛组(n=91)。2组患者均进行规范抗心力衰竭治疗,比索洛尔组与卡维地洛组患者分别每日口服富马酸比索洛尔片和卡维地洛片。入院时和治疗24周后监测并比较2组患者心功能指标、心肌标记物水平、肺功能指标等。结果治疗24周后,比索洛尔组和卡维地洛组患者左心室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、左室射血分数(LVEF)、二尖瓣左室舒张早期血流峰值速度(E)与二尖瓣环舒张早期运动峰值速度(e')比值(E/e')、右室直径(RVD)及NYHA心功能分级等超声心动图指标均较入院时显著改善(比索洛尔组:t=4. 881、7. 866、11.796、4.013、2. 879,χ~2=127. 431,P均<0. 01;卡维地洛组:t=6. 423、5.521、8.1.48、3.799、3. 662,χ~2=108. 040,P均<0.01)。治疗后,2组患者N-末端脑钠肽前体(NT-proBNP)均较治疗前显著降低(比索洛尔组:t=5.054,P<0.01;卡维地洛组:t=5.023,P <0. 01),比索洛尔组超敏肌钙蛋白T(hs-TnT)较治疗前显著降低(t=21. 689,P <0.01)。治疗后比索洛尔组患者FVC_1、FEV_1、与MVV均较治疗前显著改善(t=3.257、2.586、6.123,P均<0. 01),且改善优于卡维地洛组(t=2. 612、2.189、4.199,P均<0. 01)。2组患者不良反应发生率比较差异无统计学意义(χ~2=0.098,P=0.754)。结论比索洛尔和卡维地洛治疗慢性心力衰竭伴左心室收缩功能降低患者疗效和安全性相似,但比索洛尔对慢性心力衰竭患者心肌和肺功能的保护作用优于卡维地洛。
Objective To evaluate the protective effect of bisoprolol on myocardial and pulmonary function in patients with chronic heart failure and left ventricular dysfunction. Methods From January 2017 to June 2018, 182 patients with chronic heart failure and left ventricular dysfunction were divided into bisoprolol group(n =91) and carvedilol group(n= 91) according to random number table. Both groups received standard anti-heart failure treatment. Bisoprolol fumarate tablets and carvedilol tablets were orally administered daily to the patients in the bisoprolol group and carvedilol group, respectively. Cardiac function index, myocardial marker level and pulmonary function index were monitored and compared between the two groups at admission and 24 weeks after treatment. Results After 24 weeks of treatment, left ventricular end-diastolic volume(LVEDV), left ventricular end-systolic volume( LVESV), left ventricular ejection fraction( LVEF), ratio of mitral early diastolic peak velocity( E/e'), right ventricular diameter(RVD) and NYHA cardiac function grading were measured in bisoprolol group and carvedilol group. The indexes of echocardiography were significantly improved compared with those at admission(t=4.881,t =7.866,t=11.796,t=4.013,t= 2.879,χ~2 = 127.431,P <0.01;t =6. 423,t=5.521,t = 8. 148,t=3.799,t = 3.662,χ~2 = 108. 040, P < 0. 01). After treatment, the N-terminal brain natriuretic peptide precursor(NT-proBNP) in both groups was significantly lower than that before treatment( bisoprolol group: t= 5. 054,P <0. 01; carvedilol group: t =5.023,P <0.01). Hypersensitive troponin T(hs-TnT) in bisoprolol group was significantly lower than that before treatment(t = 21.689,P < 0. 01). FVC, FEV_1 and MVV in bisoprolol group were significantly improved after treatment(t = 3.257,t=2. 586,t= 6.123,P<0.01), and were better than those in carvedilol group(t= 2. 612,t =2.189,t=4.199,P < 0. 01).There was no significant difference in the incidence of adverse reactions between the two groups(X~2=0.098,P =0.754).Conclusion Bisoprolol and carvedilol have similar efficacy and safety in the treatment of chronic heart failure with left ventricular systolic dysfunction, but the protective effect of Bisoprolol on myocardial and pulmonary function in patients with chronic heart failure is better than that of carvedilol.
Objective To evaluate the protective effect of bisoprolol on myocardial and pulmonary function in patients with chronic heart failure and left ventricular dysfunction. Methods From January 2017 to June 2018, 182 patients with chronic heart failure and left ventricular dysfunction were divided into bisoprolol group(n =91) and carvedilol group(n= 91) according to random number table. Both groups received standard anti-heart failure treatment. Bisoprolol fumarate tablets and carvedilol tablets were orally administered daily to the patients in the bisoprolol group and carvedilol group, respectively. Cardiac function index, myocardial marker level and pulmonary function index were monitored and compared between the two groups at admission and 24 weeks after treatment. Results After 24 weeks of treatment, left ventricular end-diastolic volume(LVEDV), left ventricular end-systolic volume( LVESV), left ventricular ejection fraction( LVEF), ratio of mitral early diastolic peak velocity( E/e'), right ventricular diameter(RVD) and NYHA cardiac function grading were measured in bisoprolol group and carvedilol group. The indexes of echocardiography were significantly improved compared with those at admission(t=4.881,t =7.866,t=11.796,t=4.013,t= 2.879,χ~2 = 127.431,P <0.01;t =6. 423,t=5.521,t = 8. 148,t=3.799,t = 3.662,χ~2 = 108. 040, P < 0. 01). After treatment, the N-terminal brain natriuretic peptide precursor(NT-proBNP) in both groups was significantly lower than that before treatment( bisoprolol group: t= 5. 054,P <0. 01; carvedilol group: t =5.023,P <0.01). Hypersensitive troponin T(hs-TnT) in bisoprolol group was significantly lower than that before treatment(t = 21.689,P < 0. 01). FVC, FEV_1 and MVV in bisoprolol group were significantly improved after treatment(t = 3.257,t=2. 586,t= 6.123,P<0.01), and were better than those in carvedilol group(t= 2. 612,t =2.189,t=4.199,P < 0. 01).There was no significant difference in the incidence of adverse reactions between the two groups(X~2=0.098,P =0.754).Conclusion Bisoprolol and carvedilol have similar efficacy and safety in the treatment of chronic heart failure with left ventricular systolic dysfunction, but the protective effect of Bisoprolol on myocardial and pulmonary function in patients with chronic heart failure is better than that of carvedilol.
引文
[1]杨艳敏.β受体阻滞剂在急性心力衰竭中的应用策略[J].中国急救医学,2018, 38(1):21-22. DOI:10. 3969/j. issn. 1002-1949.2018.01.005.
[2] Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J]. J Am Coll Cardiol, 2013, 62(16):e147-239.DOI:10.1016/j. jacc.2013.05.019.
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[4]胡乾配,谢波,李一梅.卡维地洛治疗慢性心力衰竭的临床研究进展[J].中华全科医学,2016, 14(4):662-664. DOI:10.16766/j. cnki. issn. 1674-4152.2016. 04.048.
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[6]周京敏,崔晓通,葛均波.中国心力衰竭的流行病学概况[J].中华心血管病杂志,2015, 43(12):1018-1021. DOI:10. 3760/cma. j. issn. 0253-3758.2015.12.002.
[7]边圆,王甲莉,程凯,等.2016年欧洲心脏病学会急性心力衰竭指南解读[J].中华急诊医学杂志,2016, 25(7):849-853.DOI:10. 3760/cma. j. issn. 1671-0282.2016.07. 001.
[8]糜涛,张存泰.老年人慢性心力衰竭[J].中华老年医学杂志,2016, 35(3):236-238. DOI:10. 3760/cma. j. issn. 0254-9026.2016.03.003.
[9]丛辉,吴珊,储海丹,等.BNP、NT-proBN P在心力衰竭患者中的应用价值再评估[J].国际检验医学杂志,2016,37(7):954-956. DOI:10. 3969/j. issn. 1673-4130.2016.07.034..
[10]吴蓝津,吴万芬,陆山河.NT-proBNP在心力衰竭中应用的研究进展[J].心血管康复医学杂志,2018, 27(1):114-117. DOI:10.3969/j. issn. 1008-0074.2018.01.32.
[11] Nakamura Y,Yoshihisa A, Takiguchi M, et al. High-sensitivity cardiac troponin T predicts non-cardiac mortality in heart failure[J].Circ J, 2014, 78(4):890-895.
[12]曹建红,邬美花,于萍,等.超敏肌钙蛋白T和胱抑素C与慢性心力衰竭患者心功能的相关性研究[J].中国心血管病研究,2016, 14(1):51-54. DOI:10.3969/j. issn. 1672-5301.2016.01.014.
[13]曹建红,范慧敏,于萍,等.超敏肌钙蛋白T和红细胞分布宽度在评估慢性心力衰竭中的临床意义[J].中国心血管病研究,2015, 13(9):810-813. DOI:10. 3969/j. issn. 1672-5301. 2015.09.011.
[14]赵妍.卡维地洛联合利尿剂对轻中度心力衰竭病人BNP及心功能的影响[J].中西医结合心脑血管病杂志,2018, 16(10):1394-1397. DOI:10.12102/j. issn. 1672-1349.2018.10.024.
[15] Tgakashio S, Yamamuro M, Izumiya Y, et al. Corongary microvascular dysfunction and diastolic load correlate with cardiac troponin T release measured by a highly sensitive assay in patients with nonischemic heart failure[J]. J Am Coll Cardiol, 2013, 62(7):632-640.DOI:10.1016/j. jacc.2013.03.065.
[16]桑明敏,朱芳一,马生龙,等.胺碘酮分别联合比索洛尔与美托洛尔治疗收缩性心力衰竭合并室性心律失常效果比较[J].疑难病杂志,2018,17(8):762-766. DOI:10. 3969/j. issn. 1671-6450.2018.08.002.
[17]蔡叶锐,魏引,张鑫,等.比索洛尔治疗肺源性心脏病并发心律失常的效果及对相关指标的影响[J].疑难病杂志,2018,17(4):347-351. DOI:10.3969/j. issn. 1671-6450.2018.04.006.
[18]李海丽,林开耀,郑伟民,等.比索洛尔不同给药时间对慢性心力衰竭患者血浆去甲肾上腺素、肾上腺素和血管紧张素水平的影响[J].疑难病杂志,2017,16(4):336-339. DOI:10. 3969/j. issn.1671-6450.2017.04.004.
[19] Barbato E, Sarno G, Berza CT, et al. Impact of alpha-and beta-adrenergic receptor blockers on fractional flow reserve and index of microvascular resistance[J]. J Cardiovasc Transl Res, 2014, 7(9):803-809. DOI:10.1007/s12265-014-9599-8.
[20]朱江波,刘纪强,孟宪文.参附注射液联合硝酸甘油治疗慢性肺源性心脏病合并心力衰竭的疗效观察[J].中西医结合心脑血管病杂志,2015, 13(9):1104-1106. DOI:10. 3969/j.issn.1672-1349.2015.09.018.
[21]周红瑜,厉旭光,颜碧清.左西孟旦对急性心力衰竭患者心功能和血流动力学及炎性因子的影响[J].中国医药,2018,13(11):1605-1608. DOI:10. 3760/j. issn. 1673-4777.2018.11.002.
[22]祖晓麟,曾玉杰,张锋,等.重组人脑钠肽对老年急性心肌梗死行急诊介入术后并发急性左心衰竭患者预后的影响[J].中国医药,2018,13(8):1141-1144. DOI:10. 3760/j. issn. 1673-4777.2018.08.006.
[23] Andersen S,Andersen A, de Man FS,et al. Sympathetic nervous system activation and(3-adrenoceptor blockade in right heart failure[J]. Eur J Heart Fail,2015, 17(4):358-366. DOI:10. 1002/ejhf.
[24] Connor HE,Drew GM. Do adrenaline-containing neurones from the rostral ventrolateral medulla excite preganglionic sympathetic cell bodies[J]. J Auton Pharmacol, 1987,7(1):87-96.
[25]张开进.慢性阻塞性肺疾病合并心力衰竭诊治进展[J].心血管病学进展,2018, 39(3):398-401. DOI:10. 16806/j. cnki. issn.1004-3934.2018.03.024.
[26] Dekleva M, Lazic JS, Soldatovic I, et al. Improvement of ventricular-arterial coupling in elderly patients with heart failure after beta blocker therapy:results from the CIBIS-ELD Trial[J]. Cardiovasc Drugs Ther, 2015,29(3):287-294. DOI:10. 1007/s10557-015-6590-9.
[2] Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J]. J Am Coll Cardiol, 2013, 62(16):e147-239.DOI:10.1016/j. jacc.2013.05.019.
[3]曹建红,范慧敏,于萍,等.超敏肌钙蛋白T和红细胞分布宽度在评估慢性心力衰竭中的临床意义[J].中国心血管病研究,2015, 13(9):810-813. DOI:10. 3969/j. issn. 1672-5301. 2015.09.011.
[4]胡乾配,谢波,李一梅.卡维地洛治疗慢性心力衰竭的临床研究进展[J].中华全科医学,2016, 14(4):662-664. DOI:10.16766/j. cnki. issn. 1674-4152.2016. 04.048.
[5]田朝伟,陈晓辉.急性心力衰竭的诊治进展:2016 ESC急慢性心力衰竭诊断和治疗指南[J].中华急诊医学杂志,2016, 25(7):854-857. DOI:10. 3760/cma. j. issn. 1671-0282. 2016. 07.002.
[6]周京敏,崔晓通,葛均波.中国心力衰竭的流行病学概况[J].中华心血管病杂志,2015, 43(12):1018-1021. DOI:10. 3760/cma. j. issn. 0253-3758.2015.12.002.
[7]边圆,王甲莉,程凯,等.2016年欧洲心脏病学会急性心力衰竭指南解读[J].中华急诊医学杂志,2016, 25(7):849-853.DOI:10. 3760/cma. j. issn. 1671-0282.2016.07. 001.
[8]糜涛,张存泰.老年人慢性心力衰竭[J].中华老年医学杂志,2016, 35(3):236-238. DOI:10. 3760/cma. j. issn. 0254-9026.2016.03.003.
[9]丛辉,吴珊,储海丹,等.BNP、NT-proBN P在心力衰竭患者中的应用价值再评估[J].国际检验医学杂志,2016,37(7):954-956. DOI:10. 3969/j. issn. 1673-4130.2016.07.034..
[10]吴蓝津,吴万芬,陆山河.NT-proBNP在心力衰竭中应用的研究进展[J].心血管康复医学杂志,2018, 27(1):114-117. DOI:10.3969/j. issn. 1008-0074.2018.01.32.
[11] Nakamura Y,Yoshihisa A, Takiguchi M, et al. High-sensitivity cardiac troponin T predicts non-cardiac mortality in heart failure[J].Circ J, 2014, 78(4):890-895.
[12]曹建红,邬美花,于萍,等.超敏肌钙蛋白T和胱抑素C与慢性心力衰竭患者心功能的相关性研究[J].中国心血管病研究,2016, 14(1):51-54. DOI:10.3969/j. issn. 1672-5301.2016.01.014.
[13]曹建红,范慧敏,于萍,等.超敏肌钙蛋白T和红细胞分布宽度在评估慢性心力衰竭中的临床意义[J].中国心血管病研究,2015, 13(9):810-813. DOI:10. 3969/j. issn. 1672-5301. 2015.09.011.
[14]赵妍.卡维地洛联合利尿剂对轻中度心力衰竭病人BNP及心功能的影响[J].中西医结合心脑血管病杂志,2018, 16(10):1394-1397. DOI:10.12102/j. issn. 1672-1349.2018.10.024.
[15] Tgakashio S, Yamamuro M, Izumiya Y, et al. Corongary microvascular dysfunction and diastolic load correlate with cardiac troponin T release measured by a highly sensitive assay in patients with nonischemic heart failure[J]. J Am Coll Cardiol, 2013, 62(7):632-640.DOI:10.1016/j. jacc.2013.03.065.
[16]桑明敏,朱芳一,马生龙,等.胺碘酮分别联合比索洛尔与美托洛尔治疗收缩性心力衰竭合并室性心律失常效果比较[J].疑难病杂志,2018,17(8):762-766. DOI:10. 3969/j. issn. 1671-6450.2018.08.002.
[17]蔡叶锐,魏引,张鑫,等.比索洛尔治疗肺源性心脏病并发心律失常的效果及对相关指标的影响[J].疑难病杂志,2018,17(4):347-351. DOI:10.3969/j. issn. 1671-6450.2018.04.006.
[18]李海丽,林开耀,郑伟民,等.比索洛尔不同给药时间对慢性心力衰竭患者血浆去甲肾上腺素、肾上腺素和血管紧张素水平的影响[J].疑难病杂志,2017,16(4):336-339. DOI:10. 3969/j. issn.1671-6450.2017.04.004.
[19] Barbato E, Sarno G, Berza CT, et al. Impact of alpha-and beta-adrenergic receptor blockers on fractional flow reserve and index of microvascular resistance[J]. J Cardiovasc Transl Res, 2014, 7(9):803-809. DOI:10.1007/s12265-014-9599-8.
[20]朱江波,刘纪强,孟宪文.参附注射液联合硝酸甘油治疗慢性肺源性心脏病合并心力衰竭的疗效观察[J].中西医结合心脑血管病杂志,2015, 13(9):1104-1106. DOI:10. 3969/j.issn.1672-1349.2015.09.018.
[21]周红瑜,厉旭光,颜碧清.左西孟旦对急性心力衰竭患者心功能和血流动力学及炎性因子的影响[J].中国医药,2018,13(11):1605-1608. DOI:10. 3760/j. issn. 1673-4777.2018.11.002.
[22]祖晓麟,曾玉杰,张锋,等.重组人脑钠肽对老年急性心肌梗死行急诊介入术后并发急性左心衰竭患者预后的影响[J].中国医药,2018,13(8):1141-1144. DOI:10. 3760/j. issn. 1673-4777.2018.08.006.
[23] Andersen S,Andersen A, de Man FS,et al. Sympathetic nervous system activation and(3-adrenoceptor blockade in right heart failure[J]. Eur J Heart Fail,2015, 17(4):358-366. DOI:10. 1002/ejhf.
[24] Connor HE,Drew GM. Do adrenaline-containing neurones from the rostral ventrolateral medulla excite preganglionic sympathetic cell bodies[J]. J Auton Pharmacol, 1987,7(1):87-96.
[25]张开进.慢性阻塞性肺疾病合并心力衰竭诊治进展[J].心血管病学进展,2018, 39(3):398-401. DOI:10. 16806/j. cnki. issn.1004-3934.2018.03.024.
[26] Dekleva M, Lazic JS, Soldatovic I, et al. Improvement of ventricular-arterial coupling in elderly patients with heart failure after beta blocker therapy:results from the CIBIS-ELD Trial[J]. Cardiovasc Drugs Ther, 2015,29(3):287-294. DOI:10. 1007/s10557-015-6590-9.