卡维地洛治疗扩张型心肌病心力衰竭的疗效及对血浆细胞凋亡抑制因子的影响

Effects of carvedilol on congestive heart failure in patients with dilated cardiomyopathy and its effect on APO-1/Fas

目的 :观察卡维地洛治疗国人扩张型心肌病 ( DCM)心力衰竭 ( HF)的临床疗效 ,以及对血浆细胞凋亡抑制因子 ( APO- 1/ Fas)的反应。方法 :2 4例 DCM HF患者在洋地黄、利尿剂、血管紧张素转换酶抑制剂和硝酸盐类扩血管药物治疗基础上 ,随机分为卡维地洛组和常规组 (加用安慰剂 )。治疗前与治疗 3个月后应用超声心动图测量左室短轴缩短分数 ( FS) ,射血分数 ( EF) ,左室舒张末内径 ( L VDD) ,室间隔厚度 ( IVS)和左室后壁厚度( L VPW) ;以 EL ISA法测定患者血浆 APO- 1/ Fas浓度。结果 :治疗 3个月后 ,两组心功能均有显著改善 ,但卡维地洛组 L VDD[( 60 .5± 6.7)∶ ( 66.3± 6.3 ) m m,P<0 .0 5 ],[EF( 4 9.4± 9.8) %∶ ( 4 1.3± 6.2 ) % ,P<0 .0 5 ],D/T( 3 .0 8± 0 .62∶ 3 .69± 0 .79,P <0 .0 5 )改善比常规组更明显。治疗前两组 CHF患者血浆 APO- 1/ Fas水平均显著高于正常水平 ,且与 EF负相关 ( r =- 0 .73 ,P <0 .0 0 1) ,治疗 3个月后卡维地洛组 APO- 1/ Fas显著低于常规组 [( 0 .94± 0 .2 6)∶ ( 1.18± 0 .3 2 ) μg/ L,P <0 .0 5 ]。结论 :卡维地洛对 CHF心肌的保护作用可能与抑制心肌细胞凋亡有关。

Objective: This study is to determine the clinical effects of carvedilol in Chinese patients with CHF, and the response of plasma cell apoptosis inhibition factor (APO 1/Fas) to carvedilol. Method:All 24 patients with CHF secondary to dilated cardiomyopathy (DCM) were treated with digitalis, diuretics, ACEI and/or nitroglycerin, and were divided randomly into ① carvedilol group additionally, treated with carvedilol; ② conventional treatment group: additionally receiving placebo. The fraction shortening (FS), left ejection fraction (EF), stroke volume (SV), left ventricular diastolic dimension (LVDD), interventricular septum (IVS) and left ventricular posterior wall (LVPW) were measured with echocardiography and the concentration of plasma APO 1/Fas was examined with the method of ELISA before and 3 months after treatment. Result:After treated for 3 months, the cardiac function improved markedly in both groups, but that of carvedilol group improved more significantly than that of conventional group, such as LVDD [( 60.5 ± 6.7 ) vs ( 66.3 ± 6.3 )mm, P< 0.05 ], EF[( 49.4 ± 9.8 )% vs ( 41.3 ± 6.2 )%, P< 0.05 ], and D/T [( 3.08 ± 0.62 ) vs ( 3.69 ± 0.79 ), P< 0.05 ]. Before treatment, level of plasma APO 1/Fas in all 24 patients with CHF increased significantly than that in normal subjects and it was correlated negatively with EF (r= -0.73 , P< 0.001 ), and the level of APO 1/Fas was dicreased significantly in carvedilol group than that of conventional treatment group ( 0.94 ± 0.26 ) vs ( 1.18 ± 0.32 )μg/L, P< 0.05 ) after treated for 3 months. Conclusion:Caverdilol posseses protective effect on myocardium in Chinese patients with CHF, and it may related to inhibition of myocytes apoptosis.