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目的建立β受体阻滞剂美托洛尔治疗心力衰竭的量效关系,并考察影响疗效的主要因素。方法收集心力衰竭患者病历106例,美托洛尔维持剂量分别为12.5、25、50、71.5和100 mg/d。通过线性模型拟合美托洛尔剂量与N-脑利钠肽前体(N-proBNP)和心率变化值间的关系,并经多元数据分析考察年龄、性别、心率基线值、N-proBNP基线值和左室射血分数基线值对疗效影响。结果服用美托洛尔后N-proBNP和心率均明显下降(P<0.05),但N-proBNP的下降与剂量未见显著性相关,但心率下降值与剂量呈正相关,经多元数据分析发现N-proBNP基线值对美托洛尔疗效有显著影响。结论结合N-proBNP基线值,可以根据患者心率下降情况调整美托洛尔剂量为临床治疗提供参考。
Objective To establish a dose-response relationship of metoprolol, a beta-blocker, in the treatment of heart failure, and to investigate the main factors influencing curative effect. Methods A total of 106 patients with heart failure were enrolled in the study. The metoprolol doses were maintained at 12.5, 25, 50, 71.5 and 100 mg / day, respectively. The relationship between metoprolol dose and the change of N-proBNP and heart rate was fitted by linear model. Multivariate analysis was performed to investigate the relationship among age, gender, heart rate baseline, N-proBNP baseline Effect of baseline and left ventricular ejection fraction on efficacy. Results After metoprolol treatment, the N-proBNP and heart rate were significantly decreased (P <0.05), but the decrease of N-proBNP did not correlate with the dose, but the decrease of heart rate was positively correlated with the dose. According to multivariate analysis, N- ProBNP baseline values have a significant effect on the efficacy of metoprolol. Conclusion According to the baseline value of N-proBNP, the dose of metoprolol can be adjusted according to the decrease of heart rate in patients.