卡维地洛对充血性心力衰竭患者神经激素及左室功能影响临床研究

Clinic Research of the Effect of Carvedilo on the Level of Neurohormones and Left Ventricular Function of Patients with Congestive Cardiac Failure.

目的探讨卡维地络对心衰患者血浆心钠素、精氨酸加压素、血管紧张素Ⅱ水平以及对左室功能的影响。方法自2003年8月-2005年9月入选充血性心力衰竭患者60例，随机分为卡维地洛组和对照组，两组均为30例。卡维地洛治疗组在给予洋地黄利尿剂等药物常规抗心衰的基础上加用卡维地洛，起始剂量3．125mg，每日次，1周后逐渐增量为3．125mg，每132次。每周剂量递增，至8周时增为12．5mg每日2次，并维持治疗至6个月。对照组除不用卡维地洛外其他治疗相同。两组患者在服药前及服药6个月后分别测血浆中ANP、AVP、PRA、AngⅡ、ALD水平，应用超声心动图测量室间隔、左室后壁厚度、左房右房左室右室腔内径及左室射血分数，比较两组患者左心功能及神经激素水平的变化。结果6个月后卡维地洛组血浆中ANP、AVP、PRA、AngⅡ、ALD水平明显下降，左室收缩和舒张功能明显改善，表现在左室最大上升速率（dp／dtmax），主动脉血流最大速度（vp）及-dp／dtmax的绝对值增大，左室射血分数（LVEF）升高，左室射血前期（PEP）、左室射血时间（ET）、加速时间（AT）缩短，左室等容舒张期时间（IVRT）缩短，二尖瓣血流舒张早期最大流速（EV）升高，二尖瓣血流心房收缩期最大流速（AV）降低，E波与A波流速比值（EV／EA）升高，左房、左室内径明显缩小。结论卡维地洛能明显改善充血性心力衰竭患者左室的收缩和舒张功能，减轻左心室的重构，降低血浆ANP、AVP、PRA、AngⅡ、ALD水平。

Objective To research the effect of carvedilol on the levels of plasma Atrial Natriuretic Peptide（ANP） ,arginine vaso- pressin （AVP） ,Angiotensin Ⅱ （Ang Ⅱ ） and left ventricular function of patients with congestive heart failure （CHF） . Methods Sixty patients with congestive cardiac failure from August 2003 to September 2005 were selected, and randomly divided into two groups, carvedilol group and control group. Each group contained 30 cases. Control group patients were treated with conventional drugs such as digitalis and diureticum etc. Carvedilol was added on the basement of conventional drugs to carvedilol group patients. Initial dose of carvedilol was 3. 125 mg once daily. And the dose gradually increased. It was 3. 125 mg twice daily after one week, and increased to 12.5 mg twice daily after 8 weeks. Then this dose was maintaining for 6 moths. The levels of plasma ANP, AVP, PRA, Ang Ⅱ , ALD, interventricular sep- turn, thickness of posterior left ventricle, inner diameter of each cardiac atrium and cardiac ventricle, and left ventricular ejection fraction were measured before and after six months＇ treatment with echocardiogram,and the left ventricular function and the neurohormonal level were compared between the two groups. Results The levels of plasma ANP.AVP,PRA 、Ang Ⅱ ,ALD decreased as well as the left ventric- ular contractile and diastolic function improved significantly after 6 months＇ treatment with carvedilol. Statistical analysis showed that Left ventricular maximal upstroke velocity, absolute value of maximal velocity of aortic flow （vp） and dp/dtmax, left ventricular ejection fraction （LVEF） rised obviously; left ventricular preejection period （PEP） , left ventricular ejection time （ET） and accelerating time （AT） , left ventricular isovolumetric relaxation time （IVRT） shortened significantly; peak flow rate of mitral valvular blood flow relaxation earlier peri- od （EV） rised; peak flow rate of mitral valvular blood flow atrial systole period（AV） degraded,the flow rate ratios of E wave and A wave （EV/EA） increased, and the diameters of left atrium and ventricle reduced markedly. Conclusion This study showes that carvedilol can improve the left ventricular contractile and diastolic function, alleviate the left ventricular remodeling,and decreased the levels of plasma ANP,AVP,PRA,Ang Ⅱ ,ALD of the patients with CHF.