美托洛尔与比索洛尔治疗舒张性心力衰竭的疗效和安全性比较

摘要

目的：比较美托洛尔与比索洛尔治疗舒张性心力衰竭的疗效和安全性。方法：150例舒张性心力衰竭患者随机分为A组（75例）和B组（75例）。两组患者均给予阿司匹林、血管紧张素转换酶抑制剂、血管紧张素受体拮抗药、钙拮抗药、利尿药及强心药等常规治疗。在此基础上，A组患者给予酒石酸美托洛尔片初始剂量6.25 mg，口服，每日2次，根据病情改善情况及耐受性酌情加量至100～200 mg，口服，每日2次；B组患者给予富马酸比索洛尔片初始剂量1.25 mg，口服，每日1次，根据病情改善情况及耐受性酌情加量至10 mg，口服，每日1次。两组疗程均为12周。观察两组患者的临床疗效，治疗前后的左心室收缩末期内径（LVESD）、左心室射血分数（LVEF）、左心室舒张末期内径（LVEDD）、心肌性能（LVTei）指数、脑钠肽（BNP）、白细胞介素-1（IL-1）、IL-6、肿瘤坏死因子-α（TNF-α）及不良反应发生情况。结果：B组患者总有效率显著高于A组，不良反应发生率显著低于A组，差异均有统计学意义（P＜0.05）。治疗前，两组患者LVESD、LVEF、LVEDD、LVTei指数和BNP、IL-1、IL-6、TNF-α水平比较，差异均无统计学意义（P＞0.05）。治疗后，两组患者LVESD、LVEDD、LVTei指数和BNP、IL-1、IL-6、TNF-α水平均显著低于同组治疗前，且B组低于A组，LVEF显著高于同组治疗前，且B组高于A组，差异均有统计学意义（P＜0.05）。结论：在常规治疗的基础上，比索洛尔治疗舒张性心力衰竭的疗效、缓解临床症状、改善心脏功能、安全性均显著优于美托洛尔。%OBJECTIVE:To compare the efficacy and safety of metoprolol and bisoprolol in the treatment of diastolic heart fail-ure. METHODS:150 patients with diastolic heart failure were randomly divided into group A(75 cases) and group B(75 cases). All patients received aspirin,angiotensin-converting enzyme inhibitors,angiotensin receptor antagonists,calcium antagonists,di-uretic and cardiac drugs and other conventional treatment;based on it,group A received Metoprolol tartrate tablet with initial dose of 6.25 mg,orally,twice a day,then increased to 100-200 mg based on improvement and tolerability;group B received 1.25 mg Metoprolol tartrate tablet,orally,once a day,then increased to 10 mg based on improvement and tolerability. The treatment course for 2 groups was 12 weeks. Clinical efficacy,and left ventricular end systolic diameter(LVESD),left ventricular ejection fraction (LVEF)and left ventricular end-diastolic diameter(LVEDD),myocardial performance index(LVTei index),brain natriuretic pep-tide(BNP),interleukin(IL)-1,IL-6,tumor necrosis factor(TNF)-α before and after treatment,and incidence of adverse reactions in 2 groups were observed. RESULTS:The efficacy in group B was significantly higher than group A,incidence of adverse reac-tions were significantly lower than group A,the differences were statistically significant (P0.05). Af-ter treatment,LVESD,LVEDD,LVTei index,BNP,IL-1,IL-6 and TNF-α in 2 groups were significantly lower than before,and group B was lower than group A,LVEF was significantly higher than before,and group B was higher than group A,the differenc-es were statistically significant(P<0.05). CONCLUSIONS:Based on the conventional treatment,bisoprolol is significantly superi-or to metoprolol in terms of efficacy,relieving clinical symptoms and improving cardiac functions in the treatment of diastolic heart failure,with better safety.