卡维地洛对慢性心力衰竭患者细胞凋亡基因PDCD5表达的影响

The effect of carvedilol on apoptosis gene PDCD5 expression in chronic heart failure patients

目的与正常人群比较,观察慢性心力衰竭患者外周静脉血凋亡基因PDCD5血清抗体变化以及卡维地洛治疗的影响。方法采用酶联免疫方法测定慢性心力衰竭患者(n=20,左室射血分数<45%)外周静脉血PDCD5抗体,并与正常人群(n=20)对比,经卡维地洛治疗(70%患者达到目标剂量25mg,2次/d)6个月,复查PDCD5抗体及超声心动图,并观察临床状况的变化。结果慢性心力衰竭患者血清PDCD5抗体A值3.5±1.4显著高于正常对照组1.9±1.0(P<0.01),卡维地洛治疗后该值显著下降至2.5±1.2(P<0.05)。卡维地洛治疗后心功能NYHA分级提高0.3(P<0.05),左室射血分数由35.5%±7.8%增加至42.7%±9.6%(P<0.05),左室舒张末期内径降低5.3mm(P=0.043),左室收缩末期内径降低8.1mm(P<0.01)。结论与正常人群比较,慢性心力衰竭患者血清存在凋亡基因PDCD5抗体,卡维地洛治疗后该抗体滴度下降提示卡维地洛具有抗细胞凋亡作用。

Objective To observe the changes of serum PDCD5 antibody in chronic ischemic heart failure patients and the effect of carvedilol treatment.Methods Twenty chronic ischemic heart failure patients, 11 males and 9 females, aged 58±13, with the left ventricular ejection fraction (LVEF) <45% by echocardiography and New York Heart Association (NYHA) cardiac function classification Ⅱ-Ⅲ, were treated with carvedilol for 6 months with a target dosage of 50 mg/d. The serum PDCD5 antibody was tested by ELISA before and after carvedilol treatment and compared with those of 20 healthy persons.Results The A value of PDCD5 antibody in the heart failure patients was 3.5±1.4 , significantly higher that in than healthy persons (1.9±1.0, P<0.01). After treatment of carvedilol, the A value of PDCD5 antibody in the heart failure patients decreased to 2.5±1.2 (P<0.05). In 6 months maintenance treatment, 14 (70%) patients reached the dosage 50 mg/d, 4 (20%) reached 25 mg/d, and 2(10%) reached 12.5 mg/d. Five patients (25%) had side effect such as dizziness, nausea and cough, one patient (5%) was hospitalized for 3 weeks because of heart failure, no patient died. After treatment of carvedilol, the NYHA degree increased by 0.3 (P<0.05), LVEF increased from 35.5%±7.8% to 42.7%±9.6%(P<0.05), left ventricular end-diastolic diameter decreased 5.3 mm(P<0.05), and left ventricular end-systolic diameter decreased by 8.1 mm (P<0.01).Conclusion The titer of apoptosis gene PDCD5 antibody in the serum of chronic ischemic heart failure patients are higher, which shows apoptosis and treatment of carvedilol significantly decreases its titer.