不同剂量卡维地洛对慢性心力衰竭患者外周血淋巴细胞β受体密度的干预研究

Effect of carvedilol on β -adrenoceptor density on peripheral lymphocytes from patients with chronic heart failure

目的探讨卡维地洛对慢性心力衰竭（CHF）患者外周血淋巴细胞β肾上腺素能受体（βAR）密度的干预效果。方法选择112例纽约心脏学会心功能分级Ⅱ～Ⅳ级的CHF患者，随机分为低剂量卡维地洛组（12．5mg／d）和高剂量卡维地洛组（50mg／d），每组各56例患者，共治疗12周。治疗前后行超声心动图测定左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESO）和左心室射血分数（LVEF）。^3H-双氢阿普洛尔放射配基结合分析法测定外周血淋巴细胞BAR密度最大值（βmax）。结果卡维地洛治疗结束后共有107例患者入选。与治疗前相比，两组患者治疗后的LVEDD、LVESD显著缩小，LVEF显著增加。与低剂量卡维地洛组相比，高剂量卡维地洛组患者左心室内径缩小更显著（P〈0．05），LVEF增加得更明显（P〈0．01）。心功能Ⅱ～Ⅳ级患者随心功能恶化，Bmax水半逐渐降低（P〈0．01）。低剂量卡维地洛组治疗前后βmax无显著变化（P〉0．05）；高剂量卡维地洛组治疗后较治疗前βmax显著降低（P〈0．05）。结论与低剂量卡维地洛相比，高剂量卡维地洛明显改善了CHF患者的左心室重构和左心室收缩功能，且不依赖于βAR密度的变化。

Objective To explore the effect of carvedilol on β-adrenoceptor density on peripheral lymphocytes from patients with chronic heart failure（CHF）.Methods 112 CHF patients[New York Heart Association（NYHA） class Ⅱ- Ⅳ） were randomly received either low dose carvedilol（12.5mg/d,n=56） or high dose carvedilol（50mg/d,n=56） for three months. Echocardiographic examinations were performed before and after drug administration. The maximum density of a-adrenoceptor（ β max） on peripheral lymphocytes was measured by radioligand binding assay using ^3H-dihydroalprenolol.Results The total study population consisted of 105 patients. The left ventricular end-diastolic dimension（LVEDD） and left ventricular end-systolic dimension（LVESD） were significantly decreased, the left ventricular ejection fraction（LVEF） was significantly increased after drug treatment. Compared with the low dose carvedilol group, the high dose carvedilol group showed that EVEDD and LVESD were significantly decreased（P〈0.05）, whereas LVEF significantly increased（P〈0.01）. The level of β max was much lower in those patients with more severe symptoms（NYHA class Ⅱ - Ⅴ）. The level of β max was not significantly changed before and after drug treatment in the low dose carvedilol group, but was significantly decreased after drug treatment in the high dose carvedilol group（P 〈 0.05）.Conclusion High dose carvedilol is more effective than low dose in attenuating left ventricular remodeling and in improving systolic function after heart failure. The beneficial effect ofcarvedilol is not depending on the change of β -adrenoceptor density.