卡维地洛对慢性心衰合并肾功能不全患者肾功能的影响

目的:评价卡维地洛对慢性心衰(CHF)合并慢性肾功能不全(CRF)患者肾功能的影响。方法:入选27例CHF合并CRF患者,在充分抗心力衰竭治疗的基础上,加用卡维地洛,观察不同阶段左室射血分数(LVEF)和肾功能的变化。结果:卡维地洛治疗后,LVEF在治疗3个月后开始升高,12个月后显著高于基线水平(p<0.01)。治疗后1个月,血肌酐(Scr)升高(p<0.05),3个月时回落到基线水平以下(p<0.05),12个月时仍低于基线水平(p<0.05);治疗后1个月,内生肌酐清除率(Ccr)先轻度下降(p<0.05),3个月时回升高于基线水平(p<0.01),12个月时仍显著高于基线水平(p<0.01)。卡维地洛对尿微量白蛋白和24h尿蛋白定量影响不大(p>0.05)。结论:第三代β-受体阻滞剂卡维地洛,可改善慢性心衰合并慢性肾功能不全患者的心功能,早期引起肾功能的轻度降低,随后肾功能显著改善。

Effects of carvedilol on renal function in chronic heart failure patients with chronic renal failure

Objective: The effects of carvedilol on renal function in chronic heart failure(CHF) patients with chronic renal failure (CRF) was estimated. Methods: 27 CHF patients with CRF were chosen to receive carvedilol in association with routine treatment for heart failure. The changes of left ventricular ejection fraction (LVEF) and parameters of renal function were recorded and analyzed in various phases. Results: The LVEF at the end of third and twelveth months after therapy were higher than at basic line(all p < 0.01). The serum creatinine increased one month after therapy(p < 0. 05), but decreased subsequently under basic line either at the end of third month or twelveth month(all p < 0.05). Similarly, endogenous creatinine clearance rate(Ccr)decreased at the end of first month(p< 0.05), and then exceeded basic level at the end of third month or twelveth month(all p < 0.01). However, the microalbuminuria and total urine protein within 24 hours were not altered after therapy at any phases (all p > 0.05). Conclusion: Carvedilol, the third generation of beta-blocker, may induce transient decrease of renal function, but can improve heart function and renal function in CHF patients with CRF.