卡维地洛对不稳定性心绞痛患者血管内皮功能及炎症标志物的影响

The Effects of Carvedilol on the Endothelial Function and Inflammation Markers in Patients With Unstable Angina Pectoris

目的:观察卡维地洛对不稳定性心绞痛患者血管内皮功能及炎症标志物的影响。方法:采用随机、对照和单盲方法将86例不稳定性心绞痛患者分为常规治疗组(n=43)和卡维地洛组(n=43)。疗程均为4周。治疗过程中有6例被剔除,其中常规治疗组4例,卡维地洛组2例。正常组(20例)不予任何治疗。治疗前后分别采用高分辨率血管超声检测肱动脉血流介导性舒张功能变化,测定血中高敏C反应蛋白(hsCRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)含量。结果:①不稳定性心绞痛患者肱动脉血流介导性舒张功能较正常人明显减弱[(5.8±2.7)%比(13.8±3.6)%,P＜0.001],hS-CRP、TNF-α及IL-6水平明显高于正常组(P均＜0.01)。②常规治疗组和卡维地洛组治疗前肱动脉血流介导性舒张功能无显著差异。治疗后卡维地洛组肱动脉血流介导性舒张功能明显增强,与治疗前比较有非常显著性差异[(5.7±2.1)%比(8.6±1.8)%,P＜0.001],而常规治疗组治疗前后无明显变化。治疗后肱动脉血流介导性舒张功能增强与hsCRP、TNF-α、IL-6含量减少具有明显相关性(r=-0.68、-0.62、-0.65,P均＜0.01)。③卡维地洛治疗后血中hsCRP、TNF-α、IL-6含量均显著降低(P均＜0.01),而常规治疗前后则无明显差异(P均＞0.05)。结论:不稳定性心绞痛患者的血管内皮损伤与炎症具有密切关系。卡维地洛对不稳定性心绞痛患者具有明显的改善内皮功能作用和抗炎效应。抗炎作用可能是卡维地洛重要的药理作用之一。

Objective： To observe the effects of carvedilol on the endothelial function and inflammation markers in patients with unstable angina pectoris（UAP）. Methods： Eighty-six cases with UAP were divided into routine treatment group（ group A, n =43）and carvedilol group（ group B, n = 43） in a randomized, controlled and single blind trial. During trial,6 cases were rejected. A healthy control group was set up （n = 20）. Before and after the treaLment course, the high sensitive C-reactive protein（hsCRP） ,tumor necroses factor-α（TNF-α） and interleukin-6（IL-6） of plasma were assayed. The flow-mediated dilatation（FMD） function in brachial artery was measured by high-resolution ultrasound. Results：①In UAP patients, the artery FMD function was significantly reduced comparing to the health[ （5.8 ± 2. 7）% vs. （ 13.8 ± 3.6）% ,P 〈 0. 001 ], as well as concentration of hsCRP, TNF-α and IL-6 significantly increased （P 〈 0 01 ）. ②Before treatment FMD function in group A wa.＇ not different from that of group B, FMD function After treatment in group A was markedly increased than that before treatment [ （ B. 6 ± 1.8） % vs. （5.7 ± 2. 1 ） %, P 〈 0. 001 ], but there was no apparent change in groupB（P 〉0. 05）. The enhancement of FMD function correlated markedly with decreases of hsCRP, TNF-α and IL-6 （r = -0. 68, - 0. 62, - 0.65, P 〈 0.01 ）. ③After treatment, the levels of hsCRP, TNF-α and IL-6 decreased apparently （ P 〈 0. 01 ）, however, no change was observed in B group（P 〉0. 05）. Conclusion： The endothelial dysfunction related closely with inflammation in UAP. Carvedilol can enhance endothelial function and decrease plasma inflammation marker level of UAP. Anti-inflammation mechanism may be one of the key pharmaceutical actions of carvedilol.