卡维地洛对慢性心衰神经内分泌、心功能及血管内皮功能的影响

Effects of carvedilol on neurohormone,cardiac function and vascular endothelial function in patients with chronic heart failure

目的:观察卡维地洛对慢性心衰患者神经内分泌、心功能及血管内皮功能的影响。方法:60例慢性心力衰竭患者随机分为常规治疗对照组(常规组,30例)和卡维地洛组(30例)。对照组给予洋地黄、利尿剂、血管紧张素转化酶抑制剂等常规治疗,卡维地洛组在给予常规治疗的基础上加用卡维地洛。治疗前及治疗6个月后放射免疫法测定血浆血管紧张素Ⅱ(AngⅡ)及内皮素-1(ET-1)水平,超声心动图检测心功能,血管超声检测肱动脉血管内皮功能的变化。结果:两组治疗后较治疗前AngⅡ及ET-1水平显著降低(P<0.01),卡维地洛组改善更明显(P<0.01);两组左房内径、左室舒张末期内径(LVEDd)和左室收缩末期内径(LVESd)明显缩短,左室射血分数(LVEF)显著增高,但两组间无显著差异(P>0.05);卡维地洛能显著改善血管内皮功能(P<0.01),且较常规治疗组明显(P<0.01)。结论:卡维地洛抑制心衰患者的神经内分泌激活,逆转心室重塑,改善心功能和血管内皮功能。

Objective： To investigate effects of carvedilol on neurohormone, cardiac function and vascular endothelial function in patients with congestive heart failure （CHF）. Methods： Sixty CHF patients were randomly divided into routine therapy control group （control group, n=30） and carvedilol group （n= 30）. The patients in control group received the conventional treatment, including digitalis, diuretic, angiotensin-converting enzyme inhibitor and so on. The patients in carvedilol group were treated with carvedilol in addition to conventional treatment. Before and 6 months after treatment, the plasma concentration of angiotensin Ⅱ and ET-1 were detected with radio immunoassay, cardiac function was examined by echocardiography and vascular endothelial function was detected with brachial artery ultrasound scanning. Results： Levels of plasma angiotensin Ⅱ and ET- 1 significantly decreased after treatment in two groups （P〈0.01）, and these parameters more improved in carvedilol group （P〈0. 01）. The left atrial diameter, left ventricular end-diastolic diameter and end-systolic diameter significantly decreased （P〈0.01）, left ventricular ejection fraction significantly increased （P〈0.01） in two groups, and there were no significant difference between two groups （P〉0.05）. Endothelial dysfunction in carvedilol group significantly improved （P〈0.01） and more than that of control group （P〈0.01）. Conclusion： Carvedilol suppresses neurohormonal activation, reverses ventricular remodeling and improves cardiac function and endothelium function in patients with CHF.