卡维地洛对慢性心衰患者血浆脑钠肽水平及左心功能的影响

目的：观察卡维地洛对慢性心力衰竭（CHF）患者血浆脑钠肽（BNP）及左心室收缩功能的变化。方法：CHF患者87例，分卡维地洛治疗组（B组）44例和常规治疗组（A组）43例。随访6个月，评估两组治疗前、治疗后1个月、3个月及6个月患者心功能指标和血浆BNP浓度。结果：治疗后1个月两组血浆BNP水平较治疗前下降（P〈0．05），3个月时下降更明显。3个月组间比较有显著性差异（P〈0．05）；两组患者治疗1个月后左心室舒张末内径（LVEDD）、左心室舒张末容积（LVEDV）、左心室收缩末容积（LVSDV）及左心室射血分数（LVEF）与治疗前比较均无统计学差异（P〉0．05）；6个月时的上述指标与治疗前比较均有显著性差异（P〈0．05）。两组患者血浆BNP水平与同期测定的左心室舒张末内径呈正相关（r=0．51，P〈0．01），与LVEF呈负相关（r=-0．43，P〈0.01）。结论：卡维地洛能有效地改善CHF患者的心功能；CHF患者BNP水平的变化早于心脏超声指标的变化：血浆BNP水平可以作为治疗心力衰竭的一个可靠观察指标。

Effect of carvedilol on plasma BNP and left ventricular systolic function of patients with CHF

Objective： To investigate the clinical effect of carvedilol on the plasma brain natriuretic peptide and left ventricular systolic function of the patients with chronic heart failure （CHF）. Methods：87 cases were divided into 2 groups. In group A including 43 patients, diuretic, angiotensin converting enzyme inhibitor, vasodilator with or without digitalis were used, and group B including 44 patients were treated with carvedilol after preliminary remission in addition to the above routine treatment. After 6-month follow-ups were done, the partial cardiac function indexes, cardiac structure and plasma brain natriuretic peptide （BNP） concentration were evaluated according to the data before the treatment, after 1, 3 and 6 months of treatment. Results： After 1 month treatment, the BNP level was lower than that before treatment （P〈0.05）, and the decrease was more apparently after 3 months of treatment, moreover, it showed a significant difference （P〈0.05） between the 2 groups. No statistical difference was detected between the data before and after 1 month treatment in the two groups cases in the index of left ventricular end-diastolic diameter （LVEDD）, left ventricular end-diastolic volume （LVEDV）, left ventricular end-diastolic volume （LVEDV） and left ventricular ejection fraction （LVEF） （P〉0.05）,while the data after 6 month treatment showed significant difference （P〈0.05）. The plasma BNP concentration of 2 groups exhibited a positive correlation with LVEDD （r=0.51, P〈0.01） and a negative correlation with LVEF （r=-0.43, P〈0.01）. Conclusion：Carvedilol has the effect of improving the cardiac function of patients with CHF. The change of BNP level is earlier than echocardiography index. So BNP level can be used as a reliable index for the treatment of chronic heart failure.