根据功能对心房动患者的β-阻塞剂和通道阻塞剂的比较
José Antonio Parada Barcia1,2, Sergio Raposeiras Roubin1,3,4, David González Fernández1
1Cardiology Department, University Hospital Alvaro Cunqueiro, Vigo, Spain.
Clinical cardiology
|April 26, 2024
概括
在中度慢性病 (CKD) 患者中,β-阻断剂 (BB) 和非二皮里丁通道阻断剂 (ND-CCB) 显示出与心房 (AF) 相似的住院率. 然而,使用ND-CCB与重症CKD患者的住院病例增加有关.
科学领域:
- 心脏病学 心脏病学
- 腎臟病學 (nephrology) 是一種醫學.
- 药理学 药理学是指药理学的学科.
背景情况:
- 在慢性病 (CKD) 中,心房动 (AF) 的管理通常涉及节奏控制.
- β-阻断剂 (BB) 和非二皮里丁通道阻断剂 (ND-CCB) 是控制心率 (HR) 的主要药物.
- 关于BB与ND-CCB在CKD患者的比较疗效的研究有限.
研究的目的:
- 为了比较由于AF患者的HR控制不良而导致的住院病例,AF患者接受了速率控制疗法.
- 分析基于膜过率 (GFR) 水平的差异.
- 评估BB和ND-CCB在CKD中的安全性和有效性.
主要方法:
- 从2014年1月到2020年4月,对2804名AF患者进行了回顾性队列研究.
- 患者接受BB或ND-CCB治疗以控制速率.
- 快速心室反应 (RVR),缓慢心室反应 (SVR) 或心脏起器插入的住院治疗是主要终点,使用竞争风险回归分析.
主要成果:
- 在BB和ND-CCB之间,GFR>60mL/min/1.73m2 (sHR0.850,p=0.442) 的住院治疗没有显著差异.
- 对于GFR30-59毫升/分钟/1.73平方米 (sHR1.242,p=0.333) 没有显著差异.
- 在GFR<30mL/min/1.73m2 (sHR4.53,p=0.026) 的患者中,随着ND-CCB的使用,观察到HR控制不良的住院病例增加 (sHR 4.53,p=0.026).
结论:
- 对于GFR≥30mL/min/1.73m2的AF患者,ND-CCB和BB之间的选择没有影响HR控制不良的住院治疗.
- 在GFR<30毫升/分钟/1.73米2的患者中,发现了ND-CCB使用与因HR控制不良而增加的住院病例之间的潜在关联.
- 需要进一步的研究,以调查这些药物在严重功能受损 (GFR < 30 mL/min/1.73 m2) 患者的特定作用.
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