卡维地洛对慢性心力衰竭患者心肌胶原网络重构及心功能的影响

目的探讨卡维地洛对慢性心力衰竭(CHF)患者心肌胶原网络重构及心功能的影响。方法将49例CHF患者随机分为常规治疗组(24例)和卡维地洛组(25例),后者在常规抗心力衰竭治疗基础上加用卡维地洛。治疗6个月,观察2组患者血清Ⅲ型前胶原末端肽(P ⅢNP)、Ⅳ型前胶原末端肽(P ⅣNP)含量的变化,以及左室结构和舒缩功能参数的改变。结果经过6个月治疗,2组患者血清P ⅢNP、P ⅣNP含量明显降低,左室重量指数(LVMI)下降,舒缩功能改善(P<0.05或P<0.01),但以卡维地洛组改善更为明显,与常规治疗组比较均存在显著性差异(P<0.05或P<0.01)。血清P ⅢNP、P ⅣNP水平与LVMI呈正相关,与左室舒缩功能呈负相关,并与同期测定的血浆血管紧张素Ⅱ和醛固酮含量有良好的相关性。结论CHF患者心肌胶原网络重构与心脏功能密切相关,在应用利尿剂、血管紧张素转化酶抑制剂基础上,加用卡维地洛能更好地减轻胶原网络重构,改善心功能。

Effect of carvedilol on myocardial interstitial collagen network remodeling and cardiac function in patients with chronic heart failure

Objective To investigate the effect of carvedilol on myocardial interstitial collagen network remodeling in patients with chronic heart failure (CHF) .Methods 49 patients with CHF were randomly divided into routine treatment group ( n = 24) and carvedilol treatment group ( n =25) , with a treatment course of six months . The serum levels of pro-collagen Ⅲ (P Ⅲ NP),pro-collagen Ⅳ (P Ⅳ NP) were measured. Doppler ultrasound was used to determine the parameters of left ventricular structure as well as systolic and diastolic functions. Results After 6-month' s treatment, the decreases of serum P Ⅲ NP, P Ⅳ NP and LVMI were more significant in carvedilol treatment group than those of routine treatment group. The left ventricular systolic and diastolic functions were significantly improved in carvedilol treatment group, as compared with those of routine treatment group ( P < 0.05 or P <0.01).P Ⅲ NP and P Ⅳ NP were correlated positively with LVMI, and negatively with the left ventricular diastolic and systolic function. P Ⅲ NP and P Ⅳ NP were correlated with Angll, Ald, respectively. Conclusion Carvedilol can improve left ventricular function, and decrease serum P Ⅲ NP,P Ⅳ NP and reduce LVMI.