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目的:比较不同剂量美托洛尔治疗心力衰竭患者的疗效。方法:经临床确诊的慢性心力衰竭(CHF)患者182例,随机分为常规剂量组和大剂量组。常规剂量组,在基础治疗同时维持美托洛尔治疗剂量25～50 mg/d。大剂量组,在基础治疗同时美托洛尔治疗剂量逐渐递增至目标剂量或最大耐受剂量。完成试验每组各81例。两组患者美托洛尔治疗剂量稳定后维持12周,比较每组患者治疗前后临床指标[NYHA、HR、BP、左室舒张末内径(LVEDD)、左室射血分数(LVEF)、血浆去甲肾上腺素(NE)、脑钠尿肽(BNP)浓度和6min最大步行距离]的变化及两组间变化差异。结果:大剂量组有81例患者完成实验,最终美托洛尔治疗剂量为(100±30)mg/d,大剂量组治疗前后心功能分级(NYHA)明显改善,心率(85±9)次/min减慢至(73±5)次/min,LVEF由(41±4)%到(44±5)%,NE由(518±311)ng/L到(251±67)ng/L,BNP由(323±91)μg/L到(238±72)μg/L,6 min步行距离由(331±49)m提高至(339±44),均有统计学差异(P<0.05)。与常规剂量组相比,心功能分级(NYHA)有改善,心率(73±5)次/min vs.(83±9)次/min,NE(251±67)ng/L vs.(389±286)ng/L,BNP(238±72)μg/L vs.(302±103)均有统计学差异(P<0.05)。结论:常规剂量和大剂量美托洛尔治疗CHF均能在12周改善心脏重构、提高心功能和增加运动耐量,但大剂量更有效控制心率。大剂量比常规剂量更进一步抑制神经激素的过度激活,尤其降低血浆NE与BNP浓度,更充分发挥其生物学疗效。
Objective: To compare the efficacy of different doses of metoprolol in patients with heart failure. Methods: A total of 182 patients with clinically diagnosed chronic heart failure (CHF) were randomly divided into conventional dose group and high dose group. Conventional dose group, while maintaining the basic treatment of metoprolol dose 25 ~ 50 mg / d. In the high-dose group, metoprolol treatment dose gradually increased to the target dose or the maximum tolerated dose at the same time of basic treatment. Each group completed 81 trials. The metoprolol treatment doses in both groups were maintained for 12 weeks after treatment, and the clinical indexes (NYHA, HR, BP, left ventricular end-diastolic diameter, left ventricular ejection fraction, LVEF, Norepinephrine (NE), brain natriuretic peptide (BNP) concentration and maximum walking distance at 6 minutes] and the difference between the two groups. Results: In the high-dose group, 81 patients completed the experiment, and the final dose of metoprolol was (100 ± 30) mg / d. The high-dose group improved heart function class (NYHA) (51 ± 4)% to (44 ± 5)%, and NE from (518 ± 311) ng / L to (251 ± 67) ng / L, The BNP ranged from (323 ± 91) μg / L to (238 ± 72) μg / L, and the walking distance increased from (331 ± 49) m to (339 ± 44) at 6 min. Compared with the conventional dose group, the NYHA improved significantly (73 ± 5) / min vs. (83 ± 9) / min, NE (251 ± 67) ng / L vs. (389 ± 286) ng / L and BNP (238 ± 72) μg / L vs. (302 ± 103), respectively (P <0.05). CONCLUSION: Both conventional and high-dose metoprolol can improve cardiac remodeling, improve cardiac function and increase exercise tolerance at 12 weeks, but high dose can more effectively control heart rate. High dose than conventional dose further inhibit the excessive activation of neurohormones, in particular, reduce the plasma concentration of NE and BNP, to give full play to its biological efficacy.