关于慢性心力衰竭患者外周血淋巴细胞β肾上腺素能受体密度的研究──附92例分析

Changes of β adrenergic receptor density of lymphocyte in patients with chronic heart failure.

目的观察慢性心力衰竭(chronicheartfailure,CHF)患者外周血淋巴细胞β肾上腺素能受体(βadrenergicreceptor,βAR)密度的变化及卡维地洛对其的干预效果。方法92例心功能Ⅱ～Ⅳ级CHF患者随机分成卡维地洛组47例、美托洛尔组45例,分别于治疗前、治疗12周后行UCG测定左心室舒张末期内径(leftventricularenddiastolicdimension,LVEDd)、左心室收缩末期内径(leftventricularendsystolicdimension,LVEDs)、左心室射血分数(leftventricularejectionfraction,LVEF)、左心室内径缩短率(fractionalshortening,FS)、右心室内径(rightventriculardimension,RVD)及左心房内径(leftatrialdimension,LAD)。用同位素氢[3H]双氢烯丙洛尔(3Hdihydroalprenolol,3HDHA)放射配基结合分析法测定外周血淋巴细胞βAR密度最大值(themaximumoflymphocyteβARdensity,βmax)。结果治疗后两组患者LVEDd、LVEDs、RVD及LAD均显著缩小(均为P<0.01),LVEF、FS显著增加(均为P<0.01),且卡维地洛对LVEDs、LVEF、RVD的改善作用更优于美托洛尔(均为P<0.01)。CHF患者的βmax水平随着心功能的加重而降低(P<0.01)。经治疗后,美托洛尔组和卡维地洛组的βmax均较治疗前升高(均为P<0.01),且前者升幅高于后者(P<0.01)。结论CHF患者外周血淋巴细胞βmax水平下降,并与其严重程度密切相关。卡维地洛的非选择性βAR阻断作用使其对βmax的增高作用不如美托洛尔显著。

Objective:To observe the changes of β adrenergic receptor(βAR) density of lymphocyte in patients with chronic heart failure(CHF) and to evaluate the effect of carvedilol on βAR density. Methods: 92 CHF patients(New York Heart Association [NYHA] class Ⅱ～Ⅳ) were randomly divided into two groups: metoprolol group, carvedilol group. UCG was applied to measure left ventricular end-diastolic dimension (LVED_d), left ventricular end-systolic dimension (LVED_s), left ventricular ejection fraction (LVEF), fractional shortening (FS),right ventricular dimension(RVD) and left atrial dimension (LAD) before and after drug administration.[3H]-dihydroalprenolol(3H-DHA) radioligand binding assay was used to measure the maximum of lymphocyte βAR density(βmax).Results: Twelve weeks after treatment,LVED_d,LVED_s,LAD and RVD were significantly decreased(P<0.01),LVEF and FS was significantly increased(P<0.01) in both two groups, but the effect was more significant on LVED_s,LVEF and RVD in carvedilol group than that in metoprolol group. There was significant difference in the levels of βmax with more severe symptoms(NYHA class Ⅱ～Ⅳ).Metoprolol was more effective than carvedilol on increasing βmax(P<0.01).Conclusion: The abnormality of βmax is present in CHF patients,especially in those with more severe NYHA class.Carvedilol has less effect on increasing βmax than metoprolol probably because of its nonselective affinity for βAR.