【摘要】 目的:探讨充血性心力衰竭(CHF)患者部分神经激素、细胞因子的变化及与心功能的关系,观察卡维地洛对神经激素、细胞因子及心功能的影响,并比较不同剂量卡维地洛疗效的差别。方法:选择CHF患者90例,随机分成A、B、C3组。A组为对照组:予以血管扩张剂、利尿剂、地高辛等常规心力衰竭治疗。B组、C组在上述治疗基础上均予以卡维地洛口服,目标剂量B组:10mg,bid,C组:20mg,bid,然后维持稳定剂量至3个月。用药前后分别观察NYHA分级,左室射血分数(LVEF)、每搏量(SV)、短轴缩短率(FS)及醛固酮(ALD)、内皮素(ET)、肿瘤坏死因子(TNFα)、心钠素(ANP)等指标变化情况。结果:CHF患者心功能越差,神经激素、细胞因子水平越高。C组3个月后ALD、ET、TNFα、ANP水平与治疗前比较显著下降,LVEF、FS、SV明显提高,NYHA分级得到改善。B组除ET、TNFα、ANP有显著下降,LVEF明显升高外,其他指标改善不显著。A组上述指标与治疗前比较虽有改善,却差异无统计学意义。结论:①CHF患者神经激素和细胞因子水平明显升高,且与心功能分级及病情严重程度呈正相关;②卡维地洛可显著降低神经激素的激活及细胞因子的浓度,改善CHF患者心脏功能,其疗效呈剂量依赖性。更多还原

【Abstract】 Objective:To observe the change of neurohormone,cytokines in patients with congestive heart failure(CHF) and the relation of these neurohormone, cytokines with cardiac function, investigate the influence of nonselective β-block carvedilol on cardiac function, levels of neurohormone ,cytokines ,and to compare the difference of therapy effect with different does of carvedilol. Method:Ninety patients with CHF resulting from coronary heart disease (CHD) ,hypertensive heart disease ,dilated cardiomyopathy(DCM)(NYHAⅡ-Ⅳ,LVEF<0.45) were divided into three groups at random. A was the control group treated with nitroglycerin,diuretics,digoxin. B and C group were treated in the same way as the A besides carvedilol was added. The beginning does of carvedilol was 2.5 mg twice daily, and in B group dose was slowly titrated up to the target 10 mg twice daily, in C group to the 20 mg twice daily, and then treated with this dose for three months. NYHA functional class,left ventricular ejection fraction(LVEF),stroke volume(SV),fractions shortening (FS),and variety of aldosterone( ALD),endothelin(ET),tumor necrosis factor-α(TNFα),atrial natriuretic polyeptide( ANP) of patients were observed before and after therapy. Result:Plasma levels of ALD, ET, TNF-α, and ANP in CHF patients with NYHA Ⅲ-Ⅳ were higher than those in patients with NYHAⅡ. After treatment with Carvedilol 20 mg bid, plasma ALD, ET, TNF-α, and ANP levels were declined significantly . LVEF, FS , SV were raised obviously. NYHA was improved. After treatment with carvedilol 10 mg bid, plasma ALD, ET, TNF-α,and ANP levels were declined obviously, LVEF was raised significantly. The others were not changed significantly. Conclusion:Neurohormone, cytokines levels in patients with CHF were high significantly, and it were correlated with the severity of CHF. Carvedilol can decrease the levels of neurohormone, cytokines, and improve cardiac function. This therapy effect is dependent on the dose of Carvedilol.更多还原