美托洛尔和卡维地洛对慢性心力衰竭的影响

目的比较选择性β1受体阻滞剂美托洛尔和非选择性β受体阻滞剂卡维地洛治疗对慢性心力衰竭(CHF)代谢底物、细胞因子及心脏功能的影响。方法选择CHF患者86例(CHF组)及健康体检者25例(正常对照组)。CHF组患者又随机分为美托洛尔组(43例)和卡维地洛组(43例)。记录两组CHF患者治疗前后心功能分级及不良事件次数及TNF-α、白细胞介素-1β(IL-1β)和白细胞介素-6(IL-6)含量。所有入选者均测定血清游离脂肪酸(FFA)含量。结果美托洛尔组和卡维地洛组患者经过治疗后心功能明显改善(P<0.01),其中卡维地洛组更加明显(P<0.01)。美托洛尔组不良事件40次,卡维地洛组不良事件24次(P<0.01)。血浆TNF-α、IL-1β和IL-6较治疗前显著降低(P<0.05)。卡维地洛组较美托洛尔组TNFα和IL-1β降低更明显(P<0.01,P<0.05)。CHF组患者血清FFA含量同正常对照组比较明显升高(P<0.01)。治疗后卡维地洛组血清FFA较美托洛尔组降低更明显(P<0.01)。结论β受体阻滞剂可以改善CHF患者心功能,降低血浆细胞因子及FFA水平,非选择性的β受体阻滞剂卡维地洛优于选择性的β1受体阻滞剂美托洛尔。

Effects of metoprolol and carvedilol on chronic heart failure

Objective To explore the effects of carvedilol and metoprolol on the plasma levels of free fatty acid(FFA),cytokines and cardiac function in patients with congestive heart failure(CHF).Methods Eighty-six patients with CHF were randomly divided into carvedilol group(n=43) and metoprolol group(n=43).Plasma levels of FFA,tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),interleukin-6(IL-6) and NYHA cardiac function class were examined at baseline and 6 months after the treatment.Twenty-five age-matched subjects without disease served as control group and their plasma level of FFA was examined.Results NYHA class of all CHF patients was improved after treatment,especially in carvedilol group.The level of FFA was markedly higher in patients with CHF than in control group.The plasma levels of TNF-α,IL-1β,IL-6 and FFA were significantly decreased in patients with CHF after 6 months of treatment and more significantly in the carvedilol group than in metoprolol group except IL-6.Conclusions FFA was increased remarkably in patients with CHF.Carvedilol and metoprolol can improve cardiac function and the plasma levels of FFA and cytokines.Carvedilol is more efficacious than metoprolol.