美托洛尔缓释片治疗左室射血分数保留的心力衰竭的疗效观察

摘要

Objective To evaluate the efficacy of metoprolol extended-release tablets in treatment of heart failure with preserved ejection fraction (HFpEF). Methods One hundred and thirty three patients with HFpEF were randomly assigned to receive conventional therapy and metoprolol extended-release tablets (metoprolol group, n = 69) or receive conventional therapy only ( control group, n = 64). The blood pressure, heart rate, left ventricular diastolic function were compared between the two groups. The metoprolol group was further divided into low-dosage treated group[ (47. 5 ±10) mg/d, n =40] and high-dosage group [ (95 ±20) mg/d, n - 29 ]. Results Left ventricular ejection fraction (LVEF) , left ventricular end diastolic diameter(LVEDD), blood pressure, heart rate and N-terminal pro-brain natriuretic peptide ( NT-pro-BNP) levels were improved significantly 12 months after treatment in the metoprolol group, there were significantly differences between metoprolol and control groups(P < 0. 05, P < 0. 01). The isovolumic relaxation time (IVRT) , early left ventricular filling velocity(E), velocity of left ventricular filling contributed by atrial contraction (A) , E/A and left atrial diameter( LAD) after treatment were better than those before treatments ( P < 0. 01), and also better than those in control group (P <0.01). Compared to those in low-dosage group,heart rate and plasma NTproBNP concentration in high-dosage group were significantly improved (P < 0. 01). Conclusion Metoprolol extended-release tablets can improve the heart diastolic function in patients with HFpEF; and high-dosage metoprolol may inhibit the over-activation of neural hormones and further improves biological efficacy.%目的 观察美托洛尔缓释片对左室射血分数保留的心力衰竭(heart failure with preserved ejection fraction,HFpEF)患者心功能的改善作用.方法 入选HFpEF患者133例,随机分成美托洛尔缓释片治疗组69例及对照组64例,两组患者均给予抗心力衰竭的常规治疗,但对照组不用β-受体阻滞剂.治疗组接受美托洛尔缓释片,随访12个月.比较两组患者治疗前后血压、心率及心超左室舒张功能等的变化.并比较小剂量美托洛尔缓释片组[(47.5±10) mg/d,(n=29)]及大剂量组[(95±20) mg/d,(n=40)]对心功能的改善情况及对血压、心率的影响.结果 治疗组左室射血分数(left ventricular ejection fraction,LVEF)升高、左室舒张末期内径(left ventricular end diastolic diameter,LVEDD)缩小、收缩压、舒张压降低(P＜0.05),NT-pro-BNP浓度、心率明显下降(P＜0.01).治疗组12个月后左室等容舒张时间(isovolumic relaxation time,IVRT)、左室早期充盈减慢指标E峰、A峰、E/A,以及左房内径(left atrial diameter,LAD)等左室舒张功能指标优于治疗前(P＜0.01),并优于对照组(P＜0.01).大剂量美托洛尔缓释片治疗组在治疗12个月后较小剂量治疗组心率、NT-pro-BNP浓度显著下降(P＜0.01).结论 美托洛尔缓释片治疗HFpEF可显著改善左室舒张功能.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NT-pro-BNP浓度,更充分发挥生物学效应.