卡维地洛对慢性心力衰竭患者血浆N末端脑利钠肽原和心率变异性的影响

目的：探讨卡维地洛对慢性心力衰竭心率变异性和血浆N末端脑利钠肽原（ NT-proBNP ）的影响。方法将106例慢性心力衰竭患者按照数字表法随机分为对照组与观察组各53例。对照组采用常规治疗加用美托洛尔，观察组采用常规治疗加用卡维地洛。两组共治疗6个月。测定治疗前后两组的心率变异性和血浆NT-proBNP。结果对照组总有效率为83．0％，观察组总有效率为94．3％，观察组总有效率明显高于对照组（χ2＝6．26，P ＜0．05）。两组全部窦性心搏 RR 间期的标准差（SDNN）、RR 间期平均值标准差（SDANN）、相邻RR间期差值的均方根（RMSSD）和相邻NN之差＞50 ms的个数占总窦性心搏个数的百分比（PNN50）在治疗前差异均无统计学意义（t＝0．284、0．360、0．410、0．302，均P＞0．05），治疗后两组SDNN、SDANN、RMSSD和PNN50均有明显升高（t＝3．095、9．184、3．622、4．302、2．261、4．522、2．921、2．992，P＜0．05或P＜0．01），且观察组较对照组升高更明显（t＝8．065、3．116、3．209、2．171，P＜0．05或P＜0．01）。两组治疗后血浆NT-proBNP均明显降低（t＝7．093、9．773，均P＜0．01），与对照组比较，观察组降低更明显（t ＝4.773，P＜0.01）。结论卡维地洛可以更明显改善慢性心力衰竭心率变异性和血浆NT-proBNP的表达。

Effect of carvedilol on heart rate variability and plasma NT-proBNP in patients with chronic heart failure

Objective To study the effect of carvedilol on heart rate variability and plasma N-terminal brain natriuretic peptide（NT-proBNP） in patients with chronic heart failure.Methods 106 patients with chronic heart fail-ure were randomly divided into the two groups ..53 patients in the control group were treated by the conventional ther-apy plus metoprolol ,while 53 patients in the observation group were treated by the conventional therapy plus carve -dilol.They were treated for six months .Heart rate variability and plasma NT-proBNP were measured before and after treatment in the two groups .Results The total effective rate of the control group was 83.0%,which was significantly lower than 94.3% of the observation group （χ2 =6.26,P〈0.05）.Before treatment,SDNN,SDANN,RMSSD and PNN50 between the two groups had no significant differences （t=0.284,0.360,0.410,0.302,all P〉0.05）.After treatment,SDNN,SDANN,RMSSD and PNN50 were significantly increased （t=3.095,9.184,3.622,4.302,2.261, 4.522,2.921,2.992,P 〈0.05 or P 〈0.01）.Compared with the control group,those in the observation group increased more significantly （t=8.065,3.116,3.209,2.171,P〈0.05 or P〈0.01）.After treatment,plasma NT-proBNP were significantly decreased in the two groups （t=7.093,9.773,all P〈0.01）.Compared with the control group,plasma NT-proBNP of the observation group decreased more significantly （t=4.773,P〈0.01）.Conclusion Carvedilol can more significantly improve heart rate variability and plasma NT-proBNP in patients with chronic heart failure.