摘要
目的探讨比索洛尔对慢性心力衰竭患者心率及神经内分泌因子昼夜节律的影响。方法入选轻到中度慢性收缩性心力衰竭患者(NYHAⅡ-Ⅲ)40例为心力衰竭组,随机分为两亚组(n=20),第1组7:00-8:00服用比索洛尔,第2组19:00-20:00服用比索洛尔;另选正常人20位作为对照组。治疗前和治疗4周后行动态心电图检查,分别于2:00、6:00、10:00、14:00、18:00、22:00共6个时间点测定血浆去甲肾上腺素(NE)、肾上腺素、血管紧张素Ⅱ(AngⅡ)、醛固酮水平。结果慢性心力衰竭患者24h平均心率明显高于正常对照组[(78.7±8.4)比(69.8±9.3)次/min,P<0.05],夜昼心率比值比正常对照组高(0.93比0.86),分别有31例(77.5%)和4例(20.0%)存在非杓型心率。慢性心力衰竭患者各个时间点血浆NE、肾上腺素、AngⅡ、醛固酮水平均比正常对照组高(P<0.01),且昼夜节律消失。相关分析发现无论是对照组还是心力衰竭组,心率与血NE、肾上腺素、AngⅡ水平呈正相关(对照组:分别r=0.6、0.5、0.6;心力衰竭组:分别r=0.7、0.5、0.4,均P<0.05),而与醛固酮水平无相关。干预后,两组心力衰竭患者夜昼心率比值明显降低(第1组:0.89比0.93,第2组:0.88比0.94),第1、2组分别有37.5%(6/16)和66.7%(10/15)的患者由非杓型心率转变为杓型心率。同样也发现两组干预后神经内分泌因子均较治疗前明显降低(P<0.05),但都对昼夜节律没有影响,且两组差异无统计学意义(P>0.05)。结论慢性心力衰竭患者存在24h心率和神经内分泌因子节律异常,不同时间服用比索洛尔均可降低慢性心力衰竭患者心率及神经内分泌因子水平,但均未显著改变昼夜节律。
Objective To investigate chronological effects of bisoprolol on circadian of heart rate （HR） and plasma neurohumoral factors in patients with chronic heart failure （HF）. Methods A total of 40 patients with mild and moderate systolic HF （NYHA 11-111 ） were included and randomly divided into group 1 （n= 20, bisoprolol was given between 7：00 and 8：00} and group 2 （n=20, bisoprolol was given between 19：00 and 20：00}. Twenty healthy people were chosen as control group. Ambulatory electrocardiogram was performed in all subjects before and after 4 week treatment. Concurrently, plasma norepinephrine {NE）, adrenergic {E）, angiotension 111 （Ang II ） and aldosterone （ Aid） levels were detected every a. hours at 2：00 till 22：00. Results The average 24 h HR and night-day HR ratio in chronic HF patients were higher than those in control group [average 24 h HR： （78.7 ± 8.4） vs （69.8 ± 9.3} per minute; ratio： 0.93 vs 0.86, all P〈0. 05-1, The nondipping HR cases were 31 （77. 5%） in HF group while 4 （20.0%） in controls. Increased plasma NE, E, Ang II and Aid levels at all the time points and disordered circadian rhythms could be found in HF patients. Correlation analysis showed that HR was positively correlated with the levels of plasma NE, E and Ang II in both HF and control groups {control group： r=0.6, 0.5, 0.6, HF group： r= 0. 7, 0. 5, 0.4; all P〈：0. 05 ）, but it was not obviously related to Ald. Night-day ratio of HR in the two HF groups was decreased significantly after intervention （group 1 ： 0. 89 vs 0. 93; group 2： 0. 88 vs 0. 94）. The cases of HR circadian variation from nondipper to dipper were 37.5%（6/16） in group 1 and 66.7% （10/15） in group 2. After the intervention, the levels of neurohumoral factors of the two groups were lowered notably （P〈0.05）,meanwhile, circadian rhythms showed no significant changes as compared with those before treatment. And there was no statistically significant difference between the two HF groups （P〉0.05）. Conclusions Circadian rhythms of HR and neurohumoral factors are abnormal in patients with chronic HF. Bisoprolol intervention at various time can lower HR and the levels of neurohumoral factors in chronic HF patients, but it can not obviously affect the circadian rhythms.
出处
《中华高血压杂志》
CAS
CSCD
北大核心
2013年第3期232-237,共6页
Chinese Journal of Hypertension
基金
福建省科技厅重点项目(2010Y0021)
