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目的:比较卡维地洛与美托洛尔治疗充血性心力衰竭(CHF)的疗效及对神经激素、细胞因子的影响。方法:选择CHF患者120例,随机分3组。A组为对照组:予以血管扩张剂、利尿剂、地高辛等常规心力衰竭治疗。B、C组在上述治疗基础上分别予以美托洛尔50mg,bid、卡维地洛25mg,bid口服,维持该剂量至6个月。用药前后分别观察左室射血分数(LVEF)、每搏输血量(SV)、短轴缩短率(FS)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、相对室壁厚度(RWT)及醛固酮(ALD)、肿瘤坏死因子-α(TNF-α)、内皮素(ET)、心钠素(ANP)等指标变化情况。结果:6个月后B组及C组LVEDD、LVESD缩小,RWT增厚,LVEF、FS、SV明显提高,而ALD、ET、TNFα、ANP水平明显降低,与治疗前及A组比较均差异有统计学意义。B、C组再入院率及病死率均明显低于A组,同时C组LVEF改善优于B组。结论:美托洛尔、卡维地洛均可明显降低CHF患者神经激素、细胞因子的水平,逆转心室重塑,改善心脏功能。卡维地洛疗效及耐受性略优于美托洛尔。
Objective: To compare the effects of carvedilol and metoprolol on the treatment of congestive heart failure (CHF) and their effects on neurohormones and cytokines. Methods: 120 CHF patients were randomly divided into 3 groups. A group as the control group: to vasodilators, diuretics, digoxin and other conventional heart failure treatment. Groups B and C were treated with Metoprolol 50mg, bid and Carvedilol 25mg, bid orally on the basis of the above treatments respectively, and the dose was maintained for 6 months. The left ventricular ejection fraction (LVEF), stroke volume (SV), short axis shortening (FS), left ventricular end diastolic dimension (LVEDD), left ventricular end systolic diameter (LVESD) (RWT), aldosterone (ALD), tumor necrosis factor-α (TNF-α), endothelin (ET) and atrial natriuretic peptide (ANP) Results: After 6 months, the LVEDD and LVESD of group B and group C decreased, RWT increased, LVEF, FS and SV increased obviously, while the levels of ALD, ET, TNFα and ANP decreased significantly compared with those before treatment and group A Statistical significance. In group B and C, the readmission rate and mortality were significantly lower than those in group A, while the improvement of LVEF in group C was better than that in group B. Conclusion: Both metoprolol and carvedilol can significantly reduce the levels of neurokines and cytokines in CHF patients, reverse ventricular remodeling and improve cardiac function. Carvedilol efficacy and tolerability slightly better than metoprolol.