美托洛尔与卡维地洛在慢性心功能不全病人中的耐受性和有效性研究

目的:观察美托洛尔与卡维地洛对慢性心力衰竭(CHF)病人达到目标剂量时的耐受性、不良反应及短期疗效。方法:71例CHF患者,随机分成美托洛尔组(n=35)、卡维地洛组(n=36),在常规抗心力衰竭治疗基础上从小剂量开始逐渐加用美托洛尔与卡维地洛,直至目标剂量维持。随访3个月,观察两药的耐受性,以及治疗前后的生活质量评分、6分钟步行试验、左室射血分数和BNP水平。结果:①美托洛尔与卡维地洛组用药前的基线特征在两组间无显著差异(P> 0．05)。②美托洛尔与卡维地洛组均有良好的达标率,但卡维地洛组用药达标所需时间明显少于美托洛尔组[(46．3± 8．4)d对(65．7±13．2)d,P<0．05)]。③两组病人在3个月的治疗结束后其反应心脏功能的指标,包括生活质量评分、6 分钟步行试验及LVEF均有明显改善,而血浆B型利钠尿多肽(BNP)水平均明显降低,两组病人治疗后其血浆BNP分别降低23％和44％,卡维地洛组的降低幅度更大(组间比较,P<0．05)。结论:卡维地洛和美托洛尔均具有良好的达标率, 均能明显改善心功能,提高生活质量,但卡维地洛组具有更好的耐受性;卡维地洛组在降低血浆BNP浓度方面更具优势,因此在改善病人的长期存活率方面更有价值。

A Comparison of Tolerance and Effectiveness Between Metoprolol and Carvedilol in Patients with Chronic Heart Failure

Objective:To compare the tolerance and effectiveness between metoprolol and carvedilol in patients with chronic heart failure(CHF) .Methods: 71 CHF patients randomly received metoprolol or carvedilol from low dosage at the basis of regular regimen to the dosage which was increasingly added to target dose for three months. The left ventricular function was compared before and after the therapy,and tolerance and side effects were observed during the therapy.Results:Both metoprolol and carvedilol have well tolerance to reach target dose,but carvedilol were more easy to reach target dosage because the time of adjusting dosage were shorter than those treated with metoprolol. Both metoprolol and carvedilol increase life quality grade LVEF, prolong time of six minutes exercise test,and decrease BNP concentration.Compared with metoprolol,patients treated with carvedilol showed larger decrease in BNP level(44% VS 23%, P < 0.05). Conclusion: Both meteprolol and carvedilol had good tolerance in CHF patients, but carvedilol was more convenient in dosage adjusting. Both meteprolol and carvedilol had significant effect in improving left ventricular function. The more remarkable lowering of BNP in carvedilol group suggest that carvedilol may has a role in changing long-term prognosis of patients with CHF.