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目的:探讨贝拉普利与琥珀酸美托洛尔单用及联用对左室射血分数正常的心力衰竭(HFNEF)的疗效及其对左室肥厚的逆转和舒张功能的改善作用。方法:选取符合HFNEF诊治中国专家共识(CHFS 2010)诊断标准的患者120例。随机双盲分为3组,每组各40例。分别给予贝拉普利(A组),琥珀酸美托洛尔(B组)或两药合用(C组)进行治疗。随访6个月,比较各组患者血压,临床症状[6min步行试验(6MWT)]以及前体脑钠肽(NT-proBNP)的变化,超声心动图检测舒张早期二尖瓣环运动速度比值(E/E’)、左室舒张期充盈速度比值(E/A)、组织多普勒E峰减速时间(DT)、左房容积指数(LAVI)等指标,观察心室舒张功能的改变。结果:与治疗前相比,治疗6个月后6MWT:A组[(342.2±67.1)∶(399.7±62.5)m,P<0.05],B组[(328.3±58.4)∶(495.5±82.2)m,P<0.05],C组[(337.3±45.1)∶(534.5±77.3)m,P<0.05]。DT:A组[(297.1±74.1)∶(256.6±75.7)ms,P<0.05],B组[(302.6±83.2)∶(237.4±61.3)ms,P<0.05],C组[(311.8±67.0)∶(215.5±44.3)ms,P<0.05];NT-proBNP:A组[(410.8±156.7)∶(240.1±95.6)ng/L,P<0.05],B组[(366.1±120.4)∶(126.7±39.5)ng/L,P<0.05],C组[(379.2±147.3)∶(108.2±29.8)ng/L,P<0.05]。其中,C组在6MWT、E/A比值方面较A、B组变化更明显,差异有统计学意义。结论:贝拉普利与琥珀酸美托洛尔单用治疗HFNEF效果良好,而两药合用疗效更佳,值得提倡。
Objective: To investigate the curative effect of benazepril and metoprolol succinate alone and in combination on left ventricular ejection fraction (HFNEF) and its effect on left ventricular hypertrophy reversal and diastolic function. Methods: A total of 120 patients were selected according to the diagnostic criteria of HFNEF for diagnosis and treatment of Chinese experts (CHFS 2010). Randomized double-blind divided into 3 groups, 40 cases in each group. Patients were assigned to bevacizumab (group A), metoprolol succinate (group B), or to both groups (group C). The 6-month walking test (6MWT) and the change of precursor brain natriuretic peptide (NT-proBNP) were compared between the two groups. Echocardiography was used to detect the ratio of mitral annulus velocity (E / E ’), left ventricular diastolic filling velocity ratio (E / A), tissue Doppler edema reduction time (DT) and left atrium volume index (LAVI) were measured to observe the changes of ventricular diastolic function. RESULTS: After 6 months of treatment, 6MWT in group A [(342.2 ± 67.1) vs (399.7 ± 62.5) m, P <0.05] and in group B (328.3 ± 58.4 vs 495.5 ± 82.2) m, P <0.05], C group [(337.3 ± 45.1): (534.5 ± 77.3) m, P <0.05]. DT: [(297.1 ± 74.1): (256.6 ± 75.7) ms in group A [(302.6 ± 83.2): (237.4 ± 61.3) ms, P < 67.0), (215.5 ± 44.3) ms, P <0.05]; NT-proBNP: A group (410.8 ± 156.7): (240.1 ± 95.6) ng / L, : (126.7 ± 39.5) ng / L, P <0.05], and group C [(379.2 ± 147.3): (108.2 ± 29.8) ng / L, P <0.05]. Among them, C group in 6MWT, E / A ratio of A, B group changes more obvious, the difference was statistically significant. Conclusion: The combination of beraprost and metoprolol succinate alone is effective in treating HFNEF, and the combined effect of the two drugs is better and should be advocated.