美托洛尔对心力衰竭患者血清瘦素水平的影响

目的观察心力衰竭患者血清瘦素变化及美托洛尔对其水平的影响。方法将60例心力衰竭患者随机分为常规治疗组和美托洛尔组,每组30例。常规治疗组给予包括强心药、利尿剂、血管紧张素转换酶抑制剂(ACEI)或血管紧张素Ⅱ受体阻滞剂(ARB)、硝酸酯类等药物常规治疗;美托洛尔组在常规治疗外加用美托洛尔(均从小剂量开始,起始剂量为6.25 mg/次,2次/d,后根据临床情况逐周开始增大剂量,每次增加6.25～12.5mg,最大剂量为50～100 mg/次,2次/d。)。另外选择40例同期健康体检者作为对照组。分别于入院后24 h内和治疗第6周测定血清瘦素、脑型利钠肽(BNP)水平,并行心脏彩超。结果心力衰竭患者血压、血清瘦素及BNP水平[(142.10±19.20)mmHg、(85.30±12.40)mmHg、(11.34±1.53)μg/L、(572.77±24.31)ng/L]明显高于对照组[(127.30±17.40)mmHg、(78.60±9.10)mmHg、(6.25±1.47)μg/L、(16.72±8.35)ng/L],差异有统计学意义(P<0.05);不同病因的心力衰竭患者之间瘦素水平差异无统计学意义(P>0.05);随心功能恶化瘦素水平逐渐升高(P<0.05);治疗6周后,常规治疗组和美托洛尔组患者心率、血压得到有效控制,射血分数均显著升高,血清瘦素、BNP水平均明显下降,但美托洛尔组更为明显(P<0.05)。结论血清瘦素可以作为判断心力衰竭严重程度的指标;在常规的抗心力衰竭药物的基础上加用美托洛尔能有效降低血清瘦素水平,改善心室重构及心功能。

Effects of Metoprolol on plasma leptin in patients with heart failure

Objective To investigate the serum leptin level in the patients with heart failure(HF) and the effects of Metoprolol on it.Methods Sixty patients with HF were randomly divided into the conventional treatment group(Group T,n=30) and the Metoprolol treatment group(Group M,n=30);in which the conventional treatment,including cardiotonic drug,diuretics,ACEI or ARB,nitrate and so on,were given to both groups,as additional Metoprolol was given to the participants in Group M.Forty healthy people were enrolled as control group(Group C).Serum leptin,BNP and left ventricular function were assessed within the first 24 hours after admission and 6 weeks after treatment.Results The blood pressure,serum leptin and BNP were significantly elevated in patients with HF when comparing with those in healthy controls(142.10±19.20/85.30±12.40 mmHg vs 127.30±17.40/78.60±9.10 mmHg,11.34±1.53 μg/L vs 6.25±1.47 μg/L,572.77±24.31 ng/L vs 16.72±8.35 ng/L,P<0.05);while there was no significant difference in these among patients with different primary diseases(P>0.05).The serum leptin was also increased with the aggravation of HF.Significant improvement in heart rate,blood pressure,LVEF and alleviation in serum leptin and BNP were revealed in both Group T and M after treatment,while they were significantly more prominent in Group M(P<0.05).Conclusions The serum leptin can be applied as negative index the severity of HF.Additional Metoprolol with conventional medication basis can lower the serum leptin and improve cardiac function.