靶剂量比索洛尔治疗慢性心力衰竭对心脏β_1和M_2受体自身抗体和心功能的影响

Impact on the cardiac function and autoantibodies against the cardiac β_1-adrenergic and M_2-muscarinic receptors as treated with bisoprolol at target dosage in patients with chronic heart failure

目的 探讨靶剂量 β受体阻滞剂比索洛尔治疗慢性心力衰竭时对血清中抗心脏 β1和M2 受体自身抗体和心功能的影响。方法 5 8例慢性心力衰竭患者随机分为常规治疗组 (血管紧张素转换酶抑制剂 +利尿剂 +地高辛 )和比索洛尔组 (常规治疗组药物 +比索洛尔 ) ,随访半年 ,观察二组治疗前后心功能和两种自身抗体的变化。结果 ( 1)二组治疗后均较治疗前左心室收缩末径、舒张末径及NYHA分级下降 ,左室射血分数升高 (P <0 0 1) ,比索洛尔组的上述变化均较常规治疗组明显 (P <0 0 5 )。 ( 2 )常规治疗组治疗后两种自身抗体阳性率和滴度有下降趋势 ,但无显著性意义 (P>0 0 5 ) ;比索洛尔组治疗后 β1和M2 受体自身抗体阳性率 (均为 2 8 95 %和 31 5 8% )较治疗前 (均为5 5 2 6 % )明显下降 (P <0 0 5 )。β1受体自身抗体转阴率为 4 7 6 2 % ,M2 受体自身抗体转阴率为4 2 86 % ;未转阴者 ,β1和M2 受体自身抗体滴度 (分别为 1∶6 2 18和 1∶71 2 7)较治疗前明显降低 (均为 1∶14 4 92 ,P <0 0 1)。结论 β1和M2 受体自身抗体在慢性心力衰竭发病中起着重要作用 ,β受体阻滞剂可通过阻断 β1和M2 受体自身抗体对心脏的不利作用而进一步阻止心脏扩大 ,延缓心室重塑 。

Objective To study the effect of bisoprolol at target dosage in the cardiac function and autoantibodies against the cardiac β 1 adrenergic and M 2 muscarinic receptors as treated in patients with chronic heart failure(CHF) Methods A total of 58 patients with CHF were divided randomly into 2 groups, one was regular treatment group treated with ACEI+digoxin+diuretic, another was bisoprolol treatment group treated with bisoprolol in addition to the above regular treatment All the patients were followed up for half a year and observed the changes of cardiac function and the two autoantobodies Results (1) LVESD, LVEDD and NYHA class in both groups reduced significantly, LVEF increased evidently after treatment compared with pre treatment ( P <0 01), particularly in bisoprolol group, the reduction of LVESD, LVEDD and NYHA class [(47 73±7 03) mm, (59 34±6 32)mm, (2 26±0 55)], the increase of LVEF (47 32±8 46)% was more obvious than those in regular treatment group [LVESD (52 48±8 63)mm, LVEDD (63 58±7 31)mm, LVEF(42 23±7 68)%, NYHA 2 40±0 68, P <0 05] (2) There was a decline trend in the positive ratio and average titer of autoantibodies against the β 1 adrenergic and M 2 muscarinic receptors in regular treatment group after treatment compared with pre treatment, but no significant difference( P >0 05) But in bisoprolol group, the positive ratio of autoantibodies against the β 1 and M 2 receptors after treatment (28 95%, 31 58%, respectively) decreased significantly compared with pre treatment (55 26, 55 26, respectively, P <0 05) 47 62% of the patients with autoantibodies against the β 1 adrenergic receptor, 42 86% of the patients with autoantibodies against the M 2 muscarinic receptor showed no autoantibodies in the serum through bisoprolol treatment The average titer of autoantibodies against the β 1and M 2 receptors in the rest patients after treatment (1∶62 18, 1∶71 27, respectively) declined significantly compared with pre treatment (1∶144 92, 1∶144 92, respectively, P <0 01) Conclusion Autoantibodies against the cardiac β 1 adrenergic and M 2 muscarinic receptors play an important role in the pathophysiology of CHF, β blockade can neutralize the harmful effect of the two autoantibodies in the heart