Mayo Clin Proc:β受体阻滞剂增加冠心病糖尿病患者死亡风险

2018-04-11 卢芳 中国循环杂志

一项日本研究表明,β受体阻滞剂或会增加糖尿病患者死亡风险,尤其是有冠心病的糖尿病患者。


一项日本研究表明,β受体阻滞剂或会增加糖尿病患者死亡风险,尤其是有冠心病的糖尿病患者。
 
研究显示,对于糖尿病患者而言,使用β受体阻滞剂会增加49%的全因死亡风险;服用选择性β1受体阻滞剂和比索洛尔、美托洛尔和卡维地洛等特异性β受体阻滞剂也是如此,会比不服用者分别增加60%和55%的全因死亡风险。
 
尤其是在糖尿病冠心病患者中,服用β受体阻滞剂者全因死亡风险更高,会增加64%的风险;但在无糖尿病的冠心病患者中,使用β受体阻滞剂则全因死亡风险却明显下降。
 
研究者在倾向得分匹配的Cox比例风险模型中分析结果也与上述结果相似。
 
研究者指出,β受体阻滞剂被证明可改善心梗后以及左心室收缩功能不全慢性心衰患者生存率,但在其他无心梗或左心室收缩功能不全慢性心衰的冠心病患者中从未被发现改善生存率。此外,在糖尿病冠心病或心衰患者中的有效性也是模糊的。
 
在伴随的述评中,述评专家指出,这项在糖尿病患者中进行的研究结果是“发人深省”的。
 
“基于心梗后人群所得的可靠试验结果,使得β受体阻滞剂打着‘心脏保护’的招牌将其适应证不加判断地推广到其他人群,如高血压、糖尿病、慢性肾病,甚至脑血管病。尽管缺乏有力的循证医学证据,β受体阻滞剂还是被极大范围地推广到临床,到今天很多不恰当的β受体阻滞剂适应证还是深印临床医师脑海。”述评专家指出。
 
而且,研究者和述评专家均指出,目前支持β受体阻滞剂获益的大部分数据,先于再灌注时代和各种新型口服抗凝药物、降脂药物以及肾素 - 血管紧张素系统阻滞剂面市的新新时代,都有“几十岁”了。
 
“这些后来的治疗手段显著降低了心梗后患者的总体风险,使得更难证明β受体阻滞剂在其中是真有其效,还是滥竽充数了。”述评专家说。
 
尤其是β受体阻滞剂相关的低血糖和增重等不良反应,以及中心血压的可能升高,均在动脉硬化患者中影响更为明显,而糖尿病患者多有动脉硬化。
 
研究数据来自于1999-2010年美国全国健康与营养检查调查,共纳入2840例糖尿病患者和14684例无糖尿病者;糖尿病患者中,697例服用β受体阻滞剂;无糖尿病患者中1584例服用β受体阻滞剂。其中服用β受体阻滞剂的人群中冠心病和慢性心衰明显多见。
 
原始出处:

 Tetsuro Tsujimoto, et al. Risk of All-Cause Mortality in Diabetic Patients Taking β-Blockers. Mayo Clin Proc. 2018;93:409-418.

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    2018-10-07 linlin2312
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    2018-11-12 zhyy88
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    2018-04-13 sunylz
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    2018-04-11 1e0f8808m18(暂无匿称)

    B阻带剂对糖尿病冠心病者慎用.

    0

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