基线或上腺激素活性变化的对临床结果的影响,在生存试验的β-阻断剂评估中
M R Bristow1, H Krause-Steinrauf, R Nuzzo
1University of Colorado Health Sciences Center, Division of Cardiology, Denver, Colo 80262, USA. michael.Bristow@uchsc.edu
Circulation
|September 1, 2004
概括
基线北上腺素水平预测慢性心力衰竭的结果. 然而,在BEST试验中,随着布辛多洛尔治疗的快速降低北上腺素,在一些患者中增加了死亡风险.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学 是一个学科.
- 临床试验 临床试验
背景情况:
- 上腺激活显著影响慢性心力衰竭 (CHF) 的结果.
- 之前的研究缺乏大规模调查基线或串行上腺素活性变化在CHF患者接受强效抗上腺素药物.
研究的目的:
- 调查基线和变化的全身静脉诺亚上腺水平和慢性心力衰竭 (CHF) 患者的临床结果之间的关系.
- 评估布辛多洛尔治疗对上腺活性的影响及其与BEST (Beta-Blocker Evaluation of Survival Trial) 患者结局的关联.
主要方法:
- 在BEST试验中,在基线,3个月和12个月测量了全身静脉诺亚上腺素水平.
- 这项研究将安慰剂与布辛多洛尔治疗进行了比较,分析了上腺素水平及其与死亡或死亡以及CHF住院的相关性.
- 多变量分析被用来确定死亡率的独立预测因素.
主要成果:
- 较高的基线北上腺素水平独立地与死亡或死亡风险增加加上CHF住院治疗的风险有关,不管治疗组.
- 在接受安慰剂治疗的患者中,3个月后上腺素的显著增加与随后更高的风险相关.
- 在接受布辛多洛尔治疗的患者中,3个月后上腺素显著减少,矛盾的是,与18%的病例死亡风险增加有关.
结论:
- 基线上腺激活活性是慢性心力衰竭 (CHF) 结果的关键预测因素.
- 虽然布辛多洛尔治疗通常会降低诺拉上腺素,但有一小部分患者由于过度交感解脱而增加死亡风险,可能会损害药物的疗效.
- 北上腺素变化和结果之间的复杂,依赖于治疗的关系凸显了在使用强大的β阻塞剂时需要仔细选择和监测患者的需要.
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