心衰患者外周淋巴细胞β-受体变化的相关性研究

The relationship between Changes of β-adrenoreceptor density and ventricular remodeling in patients with heart failure

目的 研究心力衰竭 (心衰 )患者外周血淋巴细胞 β -受体的变化及心室重塑的相关性。 方法 采用3 H dihydroalpnenolol (3 H DHA)放射性配基结合分析法 ,测定 5 9例NYHAⅡ～Ⅳ级心衰患者外周血淋巴细胞上 β -受体密度 ,并以心脏超声仪测定和计算左心室质量指数 (LVMI)。结果 心衰患者外周血淋巴细胞 β -受体密度随心功能分级增高而下降 ,LVMI随心功能分级增高而增高。冠心病、瓣膜病患者淋巴细胞β -受体密度均显著低于高血压患者 (P <0 0 5 )。心衰患者 β -受体密度与LVMI显著负相关 (r =-0 2 19,P <0 0 5 ) ,β -受体密度的变化出现较早 ,在心功能Ⅱ级及LVMI正常时已有明显下降。结论 外周血淋巴细胞 β-受体密度能反应心功能受损和心室重塑的程度 :β -受体密度下调与心衰病因有关 ;心衰时 β -受体系统变化早于左心室心肌结构改变 ,提示心衰患者 β -受体可能参与左心室重塑的调控。

Objectives To study the relationship between changes of β-adrenoreceptor and ventricular remodeling in patients heart failure (HF). Methods Fifty nine patients with HF (NYHA classification Ⅱ to Ⅳ) were included in study. β-adrenoreceptor density in peripheral lymphocytes was measured by 3H-dihydroalprenolol ( 3H-DHA) radio ligand binding, and left ventricle mass index (LVMI) by echocardiography. Results The further worse of cardiac function associated with the reduction of β-adrenoreceptor density; The increase of LVMI correlated closely with the degree of cardiac dys function; β-adrenoreceptor density of coronary heart diseases and valve diseases was significantly lower than that of essential hypertension patients (P<0.05). β-adrenoreceptor density decreased in HF patients significantly negatively correlated with LVMI ( r=-0.219, P<0.05). Changes of β-adrenoreceptor density emerged earlyier, decreased significantly in NYHA Ⅱ and normal LVMI patients. Conclusions The β-adrenoreceptor in peripheral blood lymbocytic can reflect the impairment of myocardium and the severity of ventricle remodeling; its density decrease correlated with the cause of HF; The regulation of myocardium β-adrenoreceptor is earlier than the pathologic structural change of left venlricular remodeling. It is sugested that the remodeling of LV might be regulated by mycardial β-adrenoreceptor pathway.