Propranolol for small abdominal aortic aneurysms: Results of a randomized trial
Propranolol for small abdominal aortic aneurysms: Results of a randomized trial
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DOI：
10.1067/mva.2002.121308
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发表时间：
2002-01-01
影响因子：
4.3
通讯作者：
Laupacis, A
中科院分区：
文献类型：
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作者：
Laupacis, A
目的.动物和人体研究表明，β受体阻滞剂可能会降低动脉瘤的生长速度。我们研究了普萘洛尔是否能降低小腹主动脉瘤（AAA）的生长速度。我们以双盲方式将3.0 - 5.0 cm的无症状AAA患者随机分配接受安慰剂（n = 272）或普萘洛尔（n = 276）。患者平均观察2.5年。主要终点是通过每6个月进行一次超声扫描确定的平均年生长率。次要结局为死亡、手术、停用研究药物和生活质量（通过简明健康调查表（SP-36）测量）。主要分析采用意向治疗法。两组在基线时相似：84%为男性，平均年龄为69岁，平均AAA尺寸为3.8厘米。安慰剂组停止研究药物的患者较少（26.8% vs 42.4%; P =.0002）。两组的年增长率相似（安慰剂组为0.26 cm/y，普萘洛尔组为0.22 cm/y; P = 0.11）。安慰剂组有选择性手术的趋势（26.5% vs 20.3%; P = 0.11），但死亡率没有差异（安慰剂组，9% vs普萘洛尔组，12%; P = 0.36）。普萘洛尔组患者的SF-36生活质量评分在身体功能、身体角色和活力维度上均显著低于对照组。结论：AAAs患者对普萘洛尔的耐受性不好，普萘洛尔对小AAAs的生长速度无显著影响。
Purpose. Animal and human studies have suggested that beta-blockade may decrease the growth rate of aneurysms. We investigated whether propranolol decreases the growth rate of small abdominal aortic aneurysms (AAAs).Methods. We randomly assigned patients with an asymptomatic AAA between 3.0 and 5.0 cm to receive either a placebo (n = 272) or propranolol (n = 276) in a double-blind fashion. Patients were observed for a mean of 2.5 years. The primary end point was the mean annual growth rate as determined by means of ultrasound scanning performed every 6 months. Secondary outcomes were death, surgery, withdrawal from study medication, and quality of fife measured by means of the Short-form Health Survey (SP-36). The main analyses were performed by means of intention to treat.Results. The two groups were similar at baseline: 84% were men with a mean age of 69 years and a mean AAA size of 3.8 cm. Fewer patients in the placebo group stopped their study medication (26.8% vs 42.4%; P =.0002). The annual growth rate was similar in the two groups (placebo, 0.26 cm/y vs propranolol 0.22 cm/y; P =.11). There was a trend toward more elective surgery in the placebo group (26.5% vs 20.3%; P =.11), but there was no difference in death rate (placebo, 9% vs propranolol, 12%; P =.36). Patients in the propranolol group had significantly poorer quality of life scores in the physical functioning, physical role, and vitality dimensions of the SF-36.Conclusion: Patients with AAAs do not tolerate propranolol well, and the drug did not significantly affect the growth rate of small AAAs.