β1及β3肾上腺素受体自身抗体在缺血性心肌病心衰中的临床研究  

Clinical studies on level of β1, β3 receptor autoantibody of patients with heart failure of ischemic cardiomyopathy

作　　者：王婧[1] 王敬萍[1] 王慧仙[1] 杨晋静[1] 马秀瑞[1] 闫蕊[1] 

机构地区：[1]山西医科大学附属山西省心血管病医院心血管内科,山西省太原市030001

出　　处：《中国心血管病研究》2016年第6期532-536,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的 观察β1及β3肾上腺素受体自身抗体（β1-AA及β3-AA）在缺血性心肌病心衰不同时期的分布特点,探讨琥珀酸美托洛尔缓释片对不同抗体分布特点患者的疗效.方法 选择缺血性心肌病患者60例为心力衰竭组,健康对照组50例.分别于入院即刻测定两组血浆中β1-AA、β3-AA、氮末端脑钠肽前体（NT-proBNP）水平,入院后24 h内行心脏超声检查,测量左心室舒张末期内径（LVIDd）和左心室射血分数（LVEF）.心力衰竭组在琥珀酸美托洛尔缓释片治疗后7d、3个月再次测量血浆中β1-AA、β3-AA、NT-proBNP水平及LVIDd和LVEF等值;出院后1年随访其是否发生心血管事件（包括急性心力衰竭、恶性心律失常、死亡等）.结果 心衰组β1-AA/β3-AA值小于对照组[（1.53±0.33）ng/L比（1.76±0.68）ng/L,P＜0.05].心功能Ⅳ级的缺血性心肌病急性发作期患者β1-AA/β3-AA较心功能Ⅲ级患者低[（1.51±0.43）ng/L比（1.55±0.23）ng/L,P＜0.05）.随着心功能得到改善,β1-AA、β3-AA均有所下降,且二者比值短期内升高,后又有下降趋势（P＜0.05）.出院后1年时间内,与未发生心血管事件的患者相比,发生心血管事件患者的后期β1-AA/β3-AA、服用β受体阻滞剂时间/病史均较低（P＜0.01）.用全模型多元Logistic回归分析,后期β1-AA/β3-AA、服用β受体阻滞剂时间/病史为缺血性心肌病患者独立预后指标（P＜0.01）.结论 β1-AA/β3-AA失调与缺血性心肌病心力衰竭之间存在联系,可用于临床指导β受体阻滞剂治疗缺血性心肌病心力衰竭.Objective To observe the distribution characteristics of beta 1 and beta 3 adrenaline receptor autoantibody（β1-AA and β3-AA ） in ischemic cardiomyopathy heart failure of different periods, and to explore the clinical effects of beta blockers on patients with different antibody distribution characteristics. Methods A total of 60 patients with acute attack of chronic heart failure as heart failure group, and 50 healthy counter-partners（no heart failure） were chosen as control group. The plasma beta 1-AA, beta 3-AA, N-terminal pro-brain natriuretic peptide （NT-proBNP）, 24 h ultrasound examination, measurement of left ventricular end-diastolic diameter （LVIDd） and left ventrieular ejection fraction（ LVEF ） of heart failure group in hospital instantly were measured re- spectively 7 day, 3 months after Metoprolol treatment. The cardiovascular events, including death, malignant ar- rhythmia and heart failure were followed up for 1 year after discharge. Results In heart failure group, the level of β1-AA/β3-AA value was less than the control group（ 1.53±0.33 vs 1.76±0.68, P〈0.05）. In cardiac function grade 1V patients, the level of acute phase β1-AA/β3-AA was lower than grade III （1.51±0.43 vs 1.55±0.23, P〈 0.05）. With cardiac function improved,β1-AA,β3-AA were decreased, and the ratio was higher in the short term, and then have a downward trend （P〈0.05）. 1 year after discharge time, compared with patients who were not cardiovascular events, the happening of cardiovascular events in patients with late β1-AA/β3-AA time/history taking beta-blockers was lower （P〈0.01）. Multivariate Logistic regression analysis showed that the late phase level of β-AA/β3-AA, taking beta-blockers history time were independent prognostic indicators for patients with is- chemic cardiomyopathy（P〈0.01 ）. Conclusion β1-AA/β3-AA is related with ischemic cardiomyopathy heart fail- ure, may be used to guide clinical beta-blockers treatment of ischemic cardiomyopathy heart failure.

关 键 词：缺血性心肌病 心力衰竭 β1、β3肾上腺素受体自身抗体 Β受体阻滞剂 

分 类 号：R542[医药卫生—心血管疾病]