摘要
目的观察卡维地洛对充血性心力衰竭(CHF)的疗效及其对血清可溶性Fa(ssFas)的影响。方法60例CHF患者在洋地黄、利尿药、血管紧张素转换酶抑制剂和硝酸酯类药物治疗基础上,随机分为卡维地洛组30例和安慰剂组30例;另设健康对照组30例,均为体检结果正常的人。卡维地洛组和安慰剂组在治疗前与治疗3个月后均应用心脏超声测量左室短轴缩短率(FS),射血分数(EF),心搏量(SV),舒张末左室内径(LVEDD),舒张末室间隔厚度(IVSTd)和舒张末左室后壁厚度(LVPWTd),D/T=LVEDD/(IVSTd+LVPWTd);并以ELISA方法分别测定健康对照组,卡维地洛组与安慰剂组在治疗前与治疗3个月后的血清sFas浓度。结果治疗3个月后,卡维地洛组与安慰剂组患者的心功能均有显著改善,卡维地洛组LVEDD[(60.5±6.7)mmvs(66.3±6.3)mm,P<0.05],FS[(23.8±6.4)%vs(17.8±6.1)%,P<0.05],EF[(49.4±9.8)%vs(41.3±6.2)%,P<0.05],D/T[(3.08±0.62)mmvs(3.69±0.79)mm,P<0.05]改善比安慰剂组更显著。治疗前两组CHF患者血清sFas水平明显高于健康对照组。治疗3个月后卡维地洛组sFas水平的降低比安慰剂组的降低更为显著[(0.94±0.26)μg/Lvs(1.18±0.32)μg/L,P<0.05],sFas水平与EF呈显著负相关(r=-0.73,P<0.001)。结论①常规治疗加用卡维地洛对CHF的疗效优于单纯的常规治疗;卡维地洛对CHF的治疗作用可能部分表现在心脏重构得到改善。②血清sFas水平可能间接反映CHF患者心肌细胞的凋亡状态;卡维地洛对心脏重构的改善可能与其对心肌细胞凋亡的影响有关。
Objective To investigate the clinical effects of carvedilol on congestive heart failure （CHF） and its effects on serum soluble Fas （sFas）. Methods Sixty patients with CHF underwent converntional treatment, such as digitalis, diuretics, angiotensin-converting enzyme inhibitor （ACEI）, and nitroglycerin, and were divided randomly into two equal groups： carvedilol group [20 males and 10 females, aged （61.23±2.87）], treated with carvedilol with the maximum tolerable dose of （30±5） mg/d in addition; and placebo group [18 males and 12 females, aged （60.12±2.62）], receiving placebo in addition. 30 healthy subjects were used as normal control group. Fraction shortening （FS）, left ejection fraction （EF）, stroke volume （SV）, left ventricular diastolic dimension （LVEDD）, interventricular septum thick degree （IVSTd）, and left ventricular posterior wall thick degree （LVPWTd） were measured with echocardiography, and the concentration of serum sFas was examined by ELISA before treatment and 3 months after the treatment. Results Three months after the treatment, the LVEDD of the carvedilop group was （60.5±6.7） mm, significantly lower than that of the placebo group [（66.3±6.3） mm, P〈0.05], the FS of the carvediloip group was （23.8±6.4）%, significantly higher than that of the placebo group [（17.8±6.1）%,], the EF of the carvedilol group was （49.4±9.8）%, significantly higher than that of the placebot group [（41.3±6.2）%], and the D/T of the carvedilop group was 3.08±0.62, significantly lower than that of the placebo group （3.69±0.79） （all P〈0.05）. Before treatment the level of serum sFas of all 60 patients with CHF was significantly higher than that of the normal subjects and it was correlated negatively with EF （r=-0.73, P〈 0.001）. Three months after the treatment the serun sFas level of the carvedilol group was （0.94±0.26） μg/L, significantly lower than that of the placebogroup [（1.18±0.32） μg/L, P〈 0.05 ]. Conclusion ① The curative effect of conventional treatment combined with carvedilol is better than that of pure conventional treatment on CHF. Part of the mechaniosm may be the improvement of myocardiac reconstruction.② The serum sFas level indirectly reflects the stastus of apoptosis of myocytes. The effect of carvedilol on the improvrement of myocardiac reconstruction may be related to its influence ion the myocyte apoptosis.
出处
《中国急救复苏与灾害医学杂志》
2008年第6期353-356,共4页
China Journal of Emergency Resuscitation and Disaster Medicine
