扩张型心肌病心力衰竭患者循环内分泌因子变化及β受体阻滞剂的治疗作用

Changes of Circulatory Endocrine Factors and Effects of β Blocker Treatment in Congestive Heart Failure in Patients with Dilated Cardiomyopathy

目的 :探讨扩张型心肌病合并充血性心力衰竭 (CHF)患者循环内分泌因子的变化及β受体阻滞剂的治疗作用。 方法 :扩张型心肌病合并 CHF患者 42例 ,随机分为美托洛尔组 2 2例和对照组 2 0例。两组均在治疗开始前 1天、治疗后1个月和 3个月时 ,静息状态下测定血浆去甲肾上腺素、内皮素、肾素、血管紧张素 、醛固酮浓度 ,同时做超声心动图测定左心室功能 ,摄心脏正位片测定心胸比率和心脏面积 ,并按心功能 (NYHA)分级评定心功能。 结果 :1所有患者上述血浆循环内分泌因子水平均明显增高 ,且与左心室射血分数 (L VEF)呈负相关 (P均 <0 .0 0 1) ;2治疗后 3个月 ,美托洛尔组 L VEF显著高于对照组 (P<0 .0 5 ) ,美托洛尔组心胸比率和心脏面积明显缩小 (P均 <0 .0 5 ) ;3显效患者年龄偏小、心率偏快、血浆循环内分泌因子水平较高。 结论 :扩张型心肌病合并 CHF患者存在明显的血浆循环内分泌因子异常 ,β受体阻滞剂治疗 CHF有效 ,认为主要机制是 β受体阻滞剂改善了这种内分泌异常。

Objective:To explore changes of circulatory endocrine factors and effects of β blocker therapy in congestive heart failure(CHF) in patients with dilated cardiomyopathy. Methods:Fourty two patients with dilated cardiomyopathy complicated CHF were randomized into metoprolol group ( n =22) and routine treatment group ( n =20).The levels of plasma norepinephrine,endothelin and the concentrations of plasma renin,angiotensin Ⅱ,aldosterone were measured at rest before and after 1,3 months of therapy.Meanwhile,the left ventricular function was evaluated by echocardiography,the cardio thorax ratio and the heart silhouette were measured by X ray film,cardiac function was classified by NYHA criterion. Results:①The levels of circulatory endocrine factors above mentioned in all patients were significantly increased and were negatively related to the left ventricular ejection fraction (LVEF) ( p <0 001,respectively).②After 3 months therapy,the LVEF in metoprolol group was significantly higher than in control group ( p <0 01),the cardio thorax ratio and the heart silhouette were boviously reduced ( p <0 001,respectively).③The patients who received benefits from β blocker especially were the youngers with fast heart rate and higher levels of circulatory endocrine factors. Conclusion:There is marked abnormality of circulatory endocrine factors in patients with dilated cardiomyopathy complicated CHF.Therapy with β blocker is very effective in CHF.The underlying mechanism is that β blocker improves the neuroendocrine abnormality.