卡维地洛对老年慢性心力衰竭患者心功能的影响(1)
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[摘要] 目的 研究卡维地洛或美托洛尔对老年慢性心力衰竭患者心功能的改善作用及对血清肾上腺素受体自身抗体(α、β1、β2)的影响。方法 将72例老年心衰患者随机分为A组和B组，在常规强心、利尿治疗的同时，分别应用卡维地洛和美托洛尔进行治疗，比较两组治疗前和治疗后6个月心脏超声指标和α、β1、β2受体自身抗体的变化。结果 两组的LVEDD、LVEDV、LVSDV值明显降低，LVEF值显著升高(P<0.05)，且A组更优于B组(P<0.05)，A组的抗α抗体、抗β1抗体、抗β2抗体阳性率均较治疗前显著降低(P<0.05)，而B组仅抗β1抗体阳性率降低，余无差异(P>0.05)。结论 卡维地洛可有效改善心功能，提高心脏射血分数，改善心室重构，疗效优于美托洛尔，其机制可能与其持久地非选择性地阻断β1、β2受体和血管壁α1受体，使其最大限度地降低过度激活的神经内分泌因子介导的心肌毒性作用有关。
[关键词] 心力衰竭；肾上腺素能；自身抗体
[中图分类号] R541.6+1 [文献标识码] A [文章编号] 1673-9701(2011)24-01-03
The Effect of Carvedilol on Cardiac Function and Serum Adrenergic Receptor Autoantibodies of Elderly Patients with Chronic Heart Failure
WANG Lixia XU Hui
Department Ⅱof Internal Medicine，Zhuji City TCM Hospital，Zhuji 311800，China
[Abstract] Objective To study the effect of carvedilol or metoprolol on cardiac function and serum adrenergic receptor autoantibodies (α， β1， β2) of elderly patients with chronic heart failure. Methods All 72 cases elderly patients with heart failure were randomly divided into group A and group B， and A group and B group were treated with carvedilol and metoprolol respectively based on conventional treatment. After 6 months，cardiac echocardiography and α， β1， β2 receptor autoantibodies were compared. Results The two groups of LVEDD，LVEDV， LVSDV was significantly reduced， LVEF was significantly higher(P<0.05)，and group A was better than group B(P<0.05)，A group of anti-α antibody，anti-β1 antibody， anti-β2 antibody-positive rate was significantly lower than before treatment(P<0.05)，while group B only anti-β1 antibody positive rate lower and had no difference(P>0.05). Conclusion Carvedilol can improve heart function，increase ejection fraction，improve ventricular remodeling，and be more effective than metoprolol，which may be sustained with non-selective blocking β1，β2 receptor and vascular wall α1 receptors，to minimize the excessive activation of neuroendocrine factors mediated cardiac toxicity related to the role.
[Key words] Heart failure；Adrenergic；Autoantibodies
慢性心力衰竭(chronic heart failure，CHF)是各种心脏疾病发展到终末期的一组临床综合征。近年来随着老龄化社会的来临，CHF发病率和病死率逐年上升，迄今尚无有效根治措施[1]。大量临床研究表明 ......
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