一个国际的多中心对象研究,用于治疗有症状的儿童的B-阻断剂
Puck J Peltenburg1,2, Dania Kallas3, Johan M Bos4
1Amsterdam UMC, University of Amsterdam, Heart Centre, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, The Netherlands (P.J.P., K.V.V.L., M.T., C.v.d.W., A.A.M.W.).
Circulation
|December 7, 2021
概括
非选择性β阻塞剂比β1选择性药物更有效地预防儿童的危险心脏事件. 对于这些年轻患者来说,nadolol或propranolol应该是首选的治疗方法.
科学领域:
- 心脏病学
- 儿童电生理学
- 药理学
背景情况:
- 患有多形心室性心律失常 (CPVT) 的症状儿童面临重复危及生命的心律失常事件的高风险.
- 虽然β抑制剂是标准的治疗方法,但在大型儿科队列中比较单个药物的疗效的证据是有限的.
- 这项研究解决了对贝塔阻断剂在儿科CPVT治疗中的有效性进行比较的数据的需求.
研究的目的:
- 评估不同类型的β抑制剂与诊断为CPVT的症状儿童心律失常事件的风险之间的关联.
- 为了比较非选择性与β1选择性β阻塞剂在预防心脏不良结果的有效性.
主要方法:
- 来自两个国际CPVT患者登记的数据分析,包括在18岁之前开始接受β阻断剂治疗的具有RYR2变异的症状儿童.
- 用时间依赖的Cox回归模型来确定主要 (突然心脏死亡,心脏骤停,适当的ICD冲击,昏迷) 和次要结局 (不包括昏迷) 的危险比率 (HR).
- 根据患者的初始β- 阻断剂分类:非选择性 (纳多洛尔,普拉诺洛尔) 或β1- 选择性 (阿提诺洛尔,美托普罗罗尔,比索普罗罗尔).
主要成果:
- 这项研究包括329名儿童,其中30. 1%的儿童在6. 7年的中位随访期间经历了主要结果和22. 5%的儿童经历了次要结果.
- 与非选择性药物相比,Beta1选择性β阻塞剂对初级 (HR,2. 04) 和二次 (HR,1. 99) 结果的风险显著增加.
- 与阿特诺洛尔,比索普罗洛尔和梅托普罗洛尔相比,纳多洛尔的风险较低,而与β1选择性药物相比,普罗普罗洛尔没有显著差异.
结论:
- 与非选择性β- 阻断剂相比,在患有CPVT的症状儿童中,β- 阻断剂与心律失常事件的风险增加有关.
- 纳多洛尔被确定为首选的β- 阻断剂,如果没有纳多洛尔,则作为可行的替代品,用于治疗儿科CPVT.
- 这些发现支持使用非选择性β抑制剂,特别是纳多洛尔,以改善儿童CPVT的风险管理.
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