目的 探討比索洛爾不同服用時(shí)間對(duì)慢性心衰患者心率和神經(jīng)內(nèi)分泌因子晝夜節(jié)律的影響。方法 入選96例慢性心衰患者和50例健康者分別作為研究組與對(duì)照組，同時(shí)根據(jù)比索洛爾不同服藥時(shí)間將研究組分成日間服藥組（7：00~8：00）與夜間服藥組（19：00~20：00），每組48例。比較研究組與對(duì)照組間的動(dòng)態(tài)心電圖結(jié)果、血漿去甲腎上腺素（NE）、血管緊張素Ⅱ（AngⅡ）、醛固酮及腎上腺素水平，以及2個(gè)亞組治療前后上述指標(biāo)的變化。結(jié)果 與對(duì)照組比較，研究組24 h心率明顯加快，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；夜晝心率比值增大，非杓型心率比例明顯增加，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；NE、AngⅡ、醛固酮、腎上腺素水平明顯升高，差異有統(tǒng)計(jì)學(xué)意義（P<0.05），研究組神經(jīng)內(nèi)分泌因子不存在晝夜節(jié)律。與治療前比較，日間服藥組和夜間服藥組24 h心率均明顯減慢，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；夜晝心率比值下降，非杓型心率比例降低，NE、AngⅡ、醛固酮、腎上腺素水平均明顯降低，組內(nèi)差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）；組間比較均無明顯差異，且均未恢復(fù)晝夜節(jié)律。結(jié)論 慢性心衰患者心率和神經(jīng)內(nèi)分泌因子的晝夜節(jié)律消失，夜間服用比索洛爾較日間服用并不會(huì)明顯恢復(fù)其心率和神經(jīng)內(nèi)分泌因子的晝夜節(jié)律。

Objective Toinvestigate the effects of bisoprolol different taking timeon circadian rhythm of heart rate and neuroendocrine factors in patients with chronic heart failure. Methods A total of 96 patients with chronic heart failure and 50 healthy subjects were enrolled as the case group and the control group, and the case group were divided into day taking medicine group (7:00-8:00) and night taking medicine group (19:00-20:00) according to different administration time of bisoprolol,48 cases in each group. The dynamic ECG results, plasma norepinephrine (NE), angiotensin Ⅱ (Ang Ⅱ), aldosterone and epinephrine levels were compared between the case group and the control group, and the changes of the above indexes before and after treatment were compared between the 2 subgroups. Results Compared with the control group, in the case group, the heart rate of 24 h was significantly accelerated (P < 0.05). The ratio of heart day and night rate increased, and non dipper heart rate increased significantly (P < 0.05); the levels of NE, AngⅡ, aldosterone and epinephrine increased significantly (P < 0.05), and there was no circadian rhythm in the neuroendocrine factors in the case group (P > 0.01). Compared with the before treatment, the heart rate of 24 h were significantly slower in the day taking medicine group and the night taking medicine group (P < 0.05), the rate of heart rate decreased day and night, non dipper heart rate reduction, the levels of NE, AngⅡ, aldosterone and epinephrine decreased obviously (P < 0.05), and the circadian rhythm was not recovered (P > 0.01). Conclusion Circadian rhythms of heart rate and neuroendocrine factors disappear in patients with chronic heart failure,and taking bisoprolol at night do not significantly restore the circadian rhythm of heart rate and neuroendocrine factors compared with those taken during the day.