心力衰竭患者心肌 β 受体系统调控在左心室重塑中的作用  

Regulation of myocardium β adrenoreceptor pathway in ventricular remodeling of heart failure patients

作　　者：姜红[1] 戴闺柱[1] 冯宗忱[1] 

机构地区：[1]武汉同济医科大学心血管病研究所

出　　处：《中华医学杂志》1997年第4期249-251,共3页National Medical Journal of China

摘　　要：目的研究心力衰竭患者心肌β受体系统调控在左心室重塑中的作用。方法对２０例ＮＹＨＡⅡ～Ⅲ级开胸换瓣患者，用３Ｈ－ｄｉｈｙｄｒｏａｌｐｎｅｎｏｌｏｌ（３Ｈ－ＤＨＡ）放射配基，结合分析法测定β受体密度最大结合量（Ｂｍａｘ），用放射免疫法测定淋巴细胞内环核苷酸（ｃＡＭＰ）水平，并以心脏超声仪测定和计算左心室重量指数（ＬＶＭＩ）。结果心衰患者心肌Ｂｍａｘ和ｃＡＭＰ均与ＬＶＭＩ显著负相关（ｒ＝－０．７７，Ｐ＜０．０１和ｒ＝－０．４６，Ｐ＜０．０５）。Ⅲ级心功能患者心肌和血淋巴细胞Ｂｍａｘ（６３±１２ｆｍｏｌ／ｍｇｐｒｏ和５１４±１１５ｆｍｏｌ／１０７ｃｅｌ）显著低于Ⅱ级患者（９４±２０ｆｍｏｌ／ｍｇｐｒｏ和７０２±１３８ｆｍｏｌ／１０７ｃｅｌ）；ＬＶＭＩ增高组心肌和血淋巴细胞Ｂｍａｘ（６２±１２ｆｍｏｌ／ｍｇｐｒｏ和５１６±１２２ｆｍｏｌ／１０７ｃｅｌ）显著低于ＬＶＭＩ正常组（９２±２１ｆｍｏｌ／ｍｇｐｒｏ和６８２±１４６ｆｍｏｌ／１０７ｃｅｌ）。结论Ｂｍａｘ能反映心室重塑和心功能受损的程度；心肌细胞的信息传导改变早于左心室重塑的改变。Objective To study the role of myocardium β adrenoreceptor pathway in ventricular remodeling of heart failure patients. Methods β adrenergic receptor density (Bmax) and the content of cAMP were measured in the papillae of left ventricle and blood lymphocyte of 20 patients with heart failure (CHF) (NYHA classification Ⅱ to Ⅲ). Bmax was investigated by 3H dihydroalpneolol as ligand, cAMP by competitive immunoassay, and left ventricle mass index (LVMI) by echocardiogram. Results The Bmax and cAMP in failing myocardium were significantly negatively were correlated with LVMI ( r =-0.77, P < 0.01 and r =-0.46, P <0.05 respectively). The Bmax of myocardium and blood lymphocyte in CHF patients with NYHA Ⅲ (63±12 fmol/mgpro and 514±115 fmol/10 7 cell), was significantly lower than that of NYHA Ⅱ patients (94±20 fmol/mgpro and 702±138 fmol/10 7cell); and that in patients with abnormal LVMI (62±12 fmol/mgpro and 516±122 fmol/10 7 cell) decreased more significantly than that in normal LVMI patients. Even in normal LVMI patients (92±21 fmol/mgpro and 682±146 fmol/10 7 cell), the Bmax of blood lymphocyte was already decreased ( P <0.01), when comparing with the controls. Thelymphocyte cAMP content was more significantly decreased than that of the controls ( P <0.05). Conclusions The B max can reflect the severity of ventricle remodeling and the impairment of myocardium. The regulation of myocardium intracellular messenger transduction is earlier than the pathologic structural change of LV remodeling.

关 键 词：心力衰竭 重塑 左心室 心肌 β 受体 

分 类 号：R541.603[医药卫生—心血管疾病] R361.3[医药卫生—内科学]