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1、慢性心力衰竭患者美托洛尔治疗后的BNP观察田志I陈明彳，吴利华I（1・重庆市中山医院心内科400013；2.重庆医科大学附属第一医院心内科400016）摘要：目的观察慢性心力衰竭患者美托洛尔治疗后的脑钠肽（BNP）变化。方法从美托洛尔治疗慢性心力衰竭的随机临床试验（CHIME研究）中选择患者共37例,检测其药物治疗后的BP水平，并分别与患者的超声值对照，观察两者之间的关系以及不同分组的BNP差别°结果大剂量美托洛尔组治疗后与治疗前相比,LVEF显著增加,LVEDD、LVESD、LAD显著缩小，HR和
2、DBP下降明显（0.4819±0.1052vs0.376±0.1148,58.35±8.34vs62.24±7.52mm,43.88±9.79vs48.09±9.83mm,36.20±6.04vs38.52±5.74mm73.91±14.74vs86.32±13.17次/分，71.68±9.29vs78.41±9.38mmHg）（F值分别为＜0.00k0.007、0.04、0.005、0.001、0.009）o大剂量美托洛尔组BNP水平高于标准治疗组（149.86±146.51vs97.2±92.43
3、pg/ml,313）,但无显著性差异。血浆BNP与LVEF呈明显的负相关（厂=-0.401；80.014）。结论慢性心力衰竭患者，在常规治疗的基础上加用美托洛尔，能增加LVEF,缩小心室内径，更好的改善患者心脏功能；BP水平与LVEF呈负相关，可以作为心力衰竭的辅助诊断指标；血浆BNP是否可作为P受体阻滞剂治疗心力衰竭的疗效监测指标，需要进一步研究。关键词：充血性心力衰竭；美托洛尔；脑钠肽TheobservationofBNPaftermetoprololtreatmentincongestiveh
4、eartfailurepatientsTianZhi1,ChenMing2,WuLihua1(1.DepartmentofCardiology,ChongqingZhongshanHospital400013；2.DepartmentofCardiology,ChongqingUniversityofMedicalScienceAff订ited1Hospital400016)ABSTRACT:AIMToobservethebrainnatriureticpeptide(BNP)changeafterm
5、etoprololtreatmentincongestiveheartfailure(CHF).METHODS37patientsfromCHIMEstudyweredetectedplasmaBNPlevelaftertreatment,andweanalyzedthedifferencebetweengroupsandtherelationsbetweentheBNPlevelandtheultrasoundvalues.RESULTSInhighdosemetoprololgroup,LVEFi
6、ncreasedsignificantly,LVEDD、LVESD>LADreducedsignificantly,HRandDBPreducedsignificantly(0.4819±0.1052vs0.376±0.1148,58.35±8.34vs62.24±7.52mm,43.88±9.79vs48.09±9.83mm,36.20±6.04vs38.52±5.74mm,73.91±14.74vs86.32±13.17bpm,71・68±9・29vs78.41土9.38mmHg){Pis<0.0
7、01>0.007、0.04、0.005、0.001、0.009respectively).TheBNPlevelinhighdosemetoprololishigherthancontrolgroup(149.86±146.51vs97.2±92.43pg/ml,P—0.313),butnostatisticsignificance.TheBNPlevelhadnegativecorrelationwithLVEFsignificantly(r=-0.401；P=0.014).CONCLUSIONMe
8、toprololcouldincreaseLVEFandreducecardiacdiameterofCHFpatients,thusmetoprololcouldimprovecardiacfunctionbetterthancustomtreatment;theBNPlevelhadnegativecorrelationwithLVEF;plasmaBNPlevelwasnotagoodindicatoronmedicationof卩-blocker
