艾司洛尔联合卡维地洛对冠状动脉粥样硬化性心脏病患者心功能、炎症反应、免疫及氧化应激的影响

Effects of esmolol combined with carvedilol on cardiac function,inflammatory reaction and oxidative stress in patients with coronary atherosclerotic heart disease

目的:观察艾司洛尔联合卡维地洛对冠状动脉粥样硬化性心脏病(冠心病)患者心率(HR)、左心功能、抗动脉粥样硬化因子、免疫功能、炎症反应及氧化应激的影响。方法:2015年12月—2019年12月三门峡市中心医院收治的101例冠心病患者,按照硬币投掷的方法随机分为观察组(n=51)与对照组(n=50)。两组均给予常规治疗,对照组加用卡维地洛口服治疗,观察组加用艾司洛尔静脉滴注联合卡维地洛口服治疗。比较两组治疗前、治疗8周后的心率(HR),左室射血分数(LVEF),每博量(SV),左心室舒张末期内径(LVDD),心排血量(CO),血浆血红素加氧酶1(HO-1)、血浆脂联素(APN)、CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、可溶性细胞间黏附分子-1(sICAM-1)、超敏C-反应蛋白(hs-CRP)、超氧化物歧化酶(SOD)、丙二醛(MDA)、一氧化氮(NO)水平的变化,并观察不良反应发生情况。结果:治疗8周后,两组LVEF、SV、CO、HO-1、APN、CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、SOD水平均较治疗前升高(P<0.05),而HR、LVDD、CD8^(+)、IL-6、TNF-α、ICAM-1、hs-CRP、MDA、NO水平较治疗前下降(P<0.05),且观察组变化更明显(P<0.05);观察组不良反应总发生率为9.80%(5/51例),对照组为16.00%(8/50例),两组间比较差异无统计学意义(χ^(2)=0.864,P>0.05)。结论:艾司洛尔联合卡维地洛可有效改善冠心病患者的左心功能,降低炎症及氧化应激反应,促进免疫功能的恢复,且可进一步调节HO-1、APN等因子改变,有利于病情转归。

Objective:To observe the effects of esmolol combined with carvedilol on heart rate(HR)left cardiac function,antiatherosclerotic factor,immune function,inflammatory reaction and oxidative stress in patients with coronary atherosclerotic heart disease(CHD).Methods:One hundred and one CHD patients were selected from Sanmenxia Central Hospital from December 2015 to December 2019,and randomly divided into observation group(n=51)and control group(n=50)according to the coin tossing method.The two groups were given conventional treatment,and control group was treated with carvedilol,and observation group was given esmolol combined with carvedilol.The heart rate(HR),left ventricular ejection fraction(LVEF),stroke volume(SV),left ventricular end diastolic diameter(LVDD),cardiac output(CO),plasma heme oxygenase(HO-1),adiponectin(APN),CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+),interleukin-6(IL-6),tumor necrosis factor(TNF-α),soluble intercellular adhesion molecule-1(sICAM-1),high sensitivity C-reactive protein(hs-CRP),superoxide dismutase(SOD),malondialdehyde(MDA),nitric oxide(NO)were compared between the two groups before treatment and after 8 weeks of treatment,also the occurrence of adverse reactions were recorded.Results:After 8 weeks of treatment,the levels of LVEF,SV,CO,HO-1,APN,CD3^(+),CD4^(+),CD4^(+)/CD8^(+)and SOD in the two groups were higher than those before treatment(P<0.05),while the levels of HR,LVDD,CD8^(+),IL-6,TNF-α,sICAM-1,hs-CRP,MDA and NO were lower than those before treatment(P<0.05),and the changes were more obvious in observation group(P<0.05).The total incidence rate of adverse reactions was 9.80%(5/51)in observation group and 16.00%(8/50)in control group(χ^(2)=0.864,P>0.05).Conclusions:Esmolol combined with carvedilol can effectively improve the cardiac function,reduce inflammatory response and oxidative stress response and promote the recovery of immune function of CHD patients.And it also can further regulate the changes of HO-1 and APN,and thus being beneficial for disease outcomes.