卡维地洛对慢性充血性心力衰竭患者血浆炎性细胞因子及临床疗效的影响

The impact of carvedilol on plasma cytokines and clinical efficacy in patients with chronic congestive heart failure

目的 探讨卡维地洛对慢性充血性心力衰竭（CHF）患者血浆炎性细胞因子及临床疗效的影响.方法 选择住院治疗CHF患者72例,采用随机数字表将患者分为观察组与对照组.两组患者入院后予以强心、利尿和扩张血管等常规治疗.观察组患者在此基础上加用卡维地洛治疗,初始剂量3.125 ag,2次/d,逐渐递增加量,直至维持量25mg,2次/d,连用12周.观察比较两组治疗前后血浆肿瘤坏死因子-α（TNF-α）、白细胞介素-1（IL-1）和白细胞介素-6（IL-6）水平变化及临床治疗效果.结果 治疗12周后,两组血浆TNF-α、IL-1和IL-6均较前明显下降（t=3.02、3.17、2.97、2.26、2.25、2.21,均P＜0.05）,且观察组下降幅度较对照组更显著（t =2.32、2.35、2.29,均P＜0.05）；同时观察组的临床总有效率（94.44％）明显高于对照组（77.78％）（x2 =4.18,P＜0.05）,两组患者治疗期间未见明显的药物不良反应.治疗后随访1年,观察组再次住院率（61.11％）明显低于对照组（36.11％）（x2=4.50,P＜0.05）,但两组病死率差异无统计学意义（x2=0.26,P＞0.05）.结论 卡维地洛治疗CHF安全有效,能降低血浆细胞因子TNF-α、IL-1和IL-6水平,减少患者的再次住院率,改善患者的预后.

Objective To investigate the impact of carvedilol on plasma cytokines in patients with chronic congestive heart failure（CHF） and its efficacy analysis.Methods 72 hospitalized patients with CHF were randomly divided into observation group and control group.The two groups were given standard therapy after admission.The observation group were given addition of carvedilol with an initial dose of 3.125mg,2 times daily,gradually increasing amount until the maintenance dose of 25mg,2 times daily for 12 weeks.Results After 12 weeks of treatment,plasma TNF-α,IL-1 and IL-6 in both groups were significantly decreased than before （t =3.02,3.17,2.97,2.26,2.25,2.21,all P 〈 0.05） and the decline in the observation group was more significant than those in the control group（t =2.32,2.35,2.29,all P 〈 0.05）;The total clinical efficiency in the observation group（94.44%） was significantly higher（77.78%）（x2 =4.18,P 〈 0.05）,and there were no significant adverse drug reactions during treatment in both groups.During 1-year follow-up after treatment,re-hospitalization rate in the observation group （61.11%） was significantly lower than that in the control group （36.11%） （x2 =4.50,P 〈 0.05）,but there was no statistically significant difference in mortality between two groups （x2 =0.26,P 〉 0.05）.Conclusion Carvedilol is a safe and effective drug for the treatment of CHF,which can lower plasma cells factor TNF-α,IL-1 and IL-6 levels,reduce patient re-hospitalization rates,and help to improve the patients＇ prognosis.