卡维地洛对颈动脉粥样硬化易损斑块和氧化应激的影响  

Effect of Carvedilol on Carotid Atherosclerotic Plaques,Serum Pregnancy-associated Plasma Protein-A and Oxidized Low Density Lipoprotein

作　　者：管耘园[1] 叶炳华[1] 吴红萍[1] 卢辉和[1] 盛臻强[1] 王毅[1] 郭新荣[1] 

机构地区：[1]南通大学第二附属医院,江苏南通226001

出　　处：《中国微循环》2009年第5期391-394,共4页Journal of Chinese Microcirculation

摘　　要：目的观察卡维地洛(CAR)对颈动脉粥样斑块稳定性及血清妊娠相关蛋白-A(PAPP-A)、超敏C-反应蛋白(hsCRP)、氧化型低密度脂蛋白(oxLDL)水平的影响。方法76例高血压伴颈动脉粥样易损斑块(VP)的患者随机分为两组各38例,分别给予CAR及美托洛尔(MET)治疗6个月,治疗前后分别测定血脂、血糖、血清PAPP-A、hsCRP、oxLDL,并通过彩色超声观察患者颈动脉斑块声学密度定量(AD)值及斑块数量的变化。结果两组斑块AD值较治疗前均有增加(P<0.01),但以CAR组更显著(P<0.01);治疗后CAR组与MET组VP数量分别减少3与2个(P>0.05);两组血清hsCRP、oxLDL较治疗前均明显降低(P<0.05或0.01),以CAR组更显著(P<0.01),CAR能明显降低血清PAPP-A水平(10.24±1.21)mlu/LVS(8.83±0.81)mlu/L,(P<0.01);治疗前后血糖、心率、血压变化两组间均无统计学差异(P>0.05);PAPP-A与斑块AD值呈负相关(r=-0.6107,P<0.01),而与hsCRP呈正相关(r=0.7638,P<0.01)。结论CAR较MET有更强的稳定斑块作用,其机制可能在于CAR除β受体阻断作用外还具有抗氧化作用。Objective To investigate the effects and mechanisms of carvedilol on stability of carotid atherosclerotie plaque, serum pregnancy-associated protein-A（PAPP-A）, hypersensitive C-reaction protein （hsCRP） and oxidized low density lipoprotein（ oxLDL）. Methods 76 hypertensive patients with carotid atherosclerotic vulnerable plaques who were divided randomly into two groups with 38 for each, were treated with earvedilol and metoprolol respectively for 6 months. Lipid, blood glucose, PAPP-A, hsCRP, oxLDL were measured before and after treatment, the value of acoustic density（ AD value） of carotid atherosclerotic plaques and the number of vulnerable plaques were detected through the color Doppler ultrasonography. Results After treatment, the AD value of plaques in two groups was increased（ P 〈0.01）, but the change could be observed significantly in carvedilol group（ P 〈 0.01）, and the decreased number of plaques in carvedilol group was not significantly different from that in metoprolol group（3 vs 2, P 〉 0. 05）. Carvedilol could not only reduce the level of serum hsCRP, oxLDL more than metoprolol （P 〈0.05 or 0. 01）, but also reduce the level of serum PAPP-A obviously（P 〈0.01）. The change of blood glucose, heart rate and blood pressure before and after treatment in two groups were not significantly different （ P 〉 0.05） ; There were significant negative correlations between serum PAPP-A and AD value of plaques（ r = - 0.6107, P 〈0.01）, and positive correlations between serum PAPP-A and serum hsCRP（ r = 0. 7638, P 〈 0.01）. Conclusion Both carvedilol and metoprolol can improve the stability of the plaque, but earvedilol is superior. Its mechanisms may lie in that carvedilol still has function of antioxidation in addition to blocking β-receptor.

关 键 词：颈动脉 粥样斑块 卡维地洛 声学密度定量技术 妊娠相关蛋白-A 氧化型低密度脂蛋白 

分 类 号：R543.4[医药卫生—心血管疾病]