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目的:观察慢性心力衰竭患者,接受β阻滞剂治疗过程中,血浆N端脑钠素原(NTproBNP)水平的动态变化,探讨其临床意义。方法:选择已接受常规治疗[利尿剂、血管紧张素转换酶抑制剂和(或)洋地黄]的住院及门诊慢性心力衰竭患者(NYHA心功能分级为II～IV,左心室射血分数≤0.40)44例,随机接受β阻滞剂比索洛尔(比索洛尔组,22例)或卡维地洛(卡维地洛组,22例)治疗。比索洛尔或卡维地洛的初始剂量分别为1.25mg每日1次或3.125mg每日2次,剂量每10天±3天递增1次,直至最大耐受或最大允许剂量(比索洛尔为10mg每日1次,卡维地洛为25mg每日2次)后4个月结束。于基线时、达到最大剂量以及结束时分别测定NTproBNP水平(ELISA法);于基线时以及结束时测定左心室射血分数(改良SIMPSON法)并评估NYHA心功能分级。结果:①基线NTproBNP水平均值明显升高为2315pg/ml,且随着心功能分级的增加而明显升高;②与用药前相比,用药后达到最大剂量以及结束时的NTproBNP血浆平均水平均明显减低;③发生心血管事件的患者NTproBNP水平明显高于未发生心血管事件的患者;④单因素回归结果显示:NTproBNP水平与超声心动图测得的左心室射血分数呈负相关关系(r=-0.338,P=0.025,n=44);⑤两组之间基线及用药后各时点NTproBNP水平及左心室射血分数均无统计学差异。结论:血浆NTproBNP水平在心力衰竭患者中明显升高,发生心血管事件的患者NTproBNP水平明显高于未发生心血管事件的患者;经常规治疗及β阻滞剂治疗后NTproBNP水平减低,左心室射血分数明显增高,两者呈明显负相关;但两种β阻滞剂治疗组之间NTproBNP水平变化无差异。
Objective: To observe the dynamic change of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) level in patients with chronic heart failure treated with β-blocker to explore its clinical significance. METHODS: Inpatients and outpatients with chronic heart failure who had received usual treatment of diuretics, ACE inhibitors and / or digitalis (NYHA functional class II to IV, left ventricular ejection fraction ≤ 0.40 ) 44 patients were randomized to receive beta-blocker bisoprolol (bisoprolol, n = 22) or carvedilol (n = 22). The initial doses of bisoprolol or carvedilol are 1.25 mg once daily or 3.125 mg twice daily, respectively, in increments of ± 3 days every 10 days until the maximum tolerated or maximum allowable dose (bisoprolol 10mg once daily, carvedilol 25mg twice daily) after 4 months. NTproBNP levels were measured at baseline and at the maximum dose and at the end (ELISA method); left ventricular ejection fraction (modified SIMPSON method) at baseline and at the end were assessed and NYHA functional class was assessed. Results: ① The baseline mean NTproBNP level increased significantly to 2315 pg / ml, and increased significantly with the increase of heart function classification. ② Compared with the pre-dose, the average level of NTproBNP reached the maximum at the end of treatment (3) The level of NTproBNP in patients with cardiovascular events was significantly higher than that in patients without cardiovascular events. (4) The results of univariate regression showed that the level of NTproBNP was negatively correlated with left ventricular ejection fraction measured by echocardiography (r = -0.338, P = 0.025, n = 44). (5) There was no significant difference in NTproBNP level and left ventricular ejection fraction between the two groups at baseline and after administration. Conclusion: The level of plasma NTproBNP in patients with heart failure was significantly higher. The level of NTproBNP in patients with cardiovascular events was significantly higher than that in patients without cardiovascular events. The levels of NTproBNP in patients with conventional therapy and β-blocker therapy were decreased, Blood levels increased significantly, the two showed a significant negative correlation; however, there was no difference in NTproBNP levels between the two β-blocker treatment groups.