卡维地洛对心力衰竭病人肾上腺素能受体自身抗体及镁代谢的影响  

Effect of carvedilol on autoantibodies against cardiac adrenergic receptors and magnesium metabolism in patients with congestive heart failure

作　　者：杨永健[1] 张鑫[1] 杨大春[1] 速晓华[1] 

机构地区：[1]成都军区总医院心血管内科,成都610083

出　　处：《岭南心血管病杂志》2007年第2期122-125,共4页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨卡维地洛对慢性心力衰竭病人肾上腺素能受体β1、β2、α1自身抗体及Mg2+代谢的影响。方法慢性心功能不全病人60例,分为卡维地洛组36例和常规治疗组24例,正常对照为健康体检者30例。常规治疗组用血管紧张素转化酶抑制药、利尿剂和强心苷。卡维地洛组在常规治疗的基础上加用卡维地洛。随访6个月,用超声心动图测定心功能参数,酶联免疫吸附实验测定血浆β1、β2、α1自身抗体,测外周单核细胞Mg2+含量及24h尿Mg2+排泄量。结果治疗后,卡维地洛组左心室舒张末内径和收缩末内径分别为(57±6)mm和(43±6)mm,显著低于常规治疗组的(64±4)mm和(52±5)mm,差异有统计学意义(P<0.01);左心室射血分数为0.51±0.08,显著高于常规治疗组的0.42±0.06(P<0.01)。治疗后卡维地洛组3种抗体阳性率及抗体滴度均显著低于治疗前(P<0.01),且卡维地洛组3种抗体阳性率及抗体滴度均显著低于常规治疗组,差异有统计学意义(P<0.01)。心力衰竭病人尿Mg2+排泄量明显升高(P<0.01),单核细胞Mg2+含量降低(P<0.01)。结论β1、β2、α1受体参与心力衰竭的发生和发展过程,卡维地洛通过阻断β1、β2、α1受体改善心功能,同时减少尿镁排泄,增加细胞内镁水平。Objectives To investigate the effect of carvedilol on cardiac function and autoantibodies against cardiac β1,β2 and α1 adrenergic receptors in patients with congestive heart failure （CHF）. Methods Sixty patients with CHF were randomly divided into two groups, regular treatment group treated with ACE inhibitor, digoxin and diuretic, and carvedilol treatment group treated with carvedilol on the basis of regular treatment. Patients were followed up for six months, cardiac function parameters were measured by echocardiography, serum antibody levels of cardiac β1, β2 and α1 adrenergic receptors were detected by immunosorbent assay （ELISA） respectively. Results After treatment with carvedilol, left ventrlcular end-diastolic diameter （LVEDd） and left ventricular endsystolic diameter （LVESd） （57±6） mm and （43±6） mm were smaller than that （64±5 mm） and （52±5）mm in the regular treatment group, and LVEF （0.51±0.08） was higher than （0.42±0.06） in the regular treatment group （P 〈 0.01） ; the positive ratio and titers of cardiac β1, β2 and α1 adrenergic receptor antibodies all decreased significantly compared with that of pre-treatment in carvedilol group （P〈 0.01 ）, and they were lower than that of regular treatment group （P〈0.01）. There was a significant increase in urine magnesium excretion （UME）, and a significant decrease in mononuclear magnesium content （MMC） in patients with CHF compared with control group （P〈0.01）. Conclusions Cardiac β1, β2 and α1 adrenergic receptors involve the process of pathophysiology and development of CHF. Carvedilol inhibits this process and improves cardiac function by inhibiting cardiac β5, β2 and α1 adrenergic receptors, it also decreases significantly plasma UME and increases MMC in patients with CHF.

关 键 词：卡维地洛 心力衰竭 充血性 受体 肾上腺素能 

分 类 号：R541.61[医药卫生—心血管疾病]