卡维地洛改善顺铂致肾小管上皮细胞凋亡

目的 观察顺铂致急性肾衰竭(ARF)中肾小管上皮细胞凋亡情况及卡维地洛(carvedilol)对其影响,并探讨其作用机制。方法 雄性Wistar大鼠随机分为盐水对照组、顺铂组、卡维地洛对照组、卡维地洛治疗组。测定BUN、Scr、尿乙酰氨基葡糖苷酶(NAG)、肾组织丙二醛(MDA)与超氧化物歧化酶(SOD)的含量。苏木素-伊红染色(HE)观察肾脏病理改变。原位缺口末端标记法(TUNEL)与DNA电泳观察肾小管上皮细胞的凋亡。Western印迹检测caspase-3的蛋白表达。结果 顺铂组大鼠BUN、Scr、尿NAG升高;肾脏病理改变加重;大量的肾小管上皮细胞凋亡; MDA含量增加,SOD活性降低;caspase-3的蛋白表达增加。上述指标在卡维地洛治疗组均得到改善,BUN从(58.33±19.93)降至(28.74±19.62)mmol/L;Scr从(425.56±97.96)降至(253.90±134.87)μmol/L;NAG从(224.77±75.86)降至(137.52±26.38)U/L;MDA从(18.13±7.01)降至(9.74±1.68)nmol/mg蛋白;SOD从(30.05±12.20)升至(64.67±20.64)U/mg蛋白;caspase-3的蛋白表达从1.94±0.73降至1.25±0.52;细胞凋亡从(42.5±12.6)%降至(23.7±8.4)%;肾组织病理损害也明显改善。结论 肾小管上皮细胞凋亡是顺铂致ARF的重要原因之一。卡维地洛能减轻顺铂的肾毒性,降低肾小管上皮细胞凋亡,其机制可能与减少活性氧(ROS)的产生,部分抑制了caspase依赖的凋亡途径有关。     

大鼠肥厚心肌能量代谢胚胎型转换的分子机制及卡维地洛的作用

目的　观察腹主动脉缩窄术后大鼠肥厚心肌能量代谢转换及卡维地洛的作用 ,探讨卡维地洛减弱压力负荷性心肌能量代谢胚胎型转换的分子调控机制。方法　用卡维地洛对腹主动脉缩窄术 (CAA)后 4周的雄性Wistar大鼠进行干预 ,12周后观察腹主动脉缩窄组 (CAA)和卡维地洛干预组 (CAR)及假手术组 (SH)大鼠各项指标的变化。结果　CAA组大鼠左室心肌明显肥厚 ( 3 .41± 1.3 0vs 2 .46± 1.3 1,P <0 .0 5 ) ,血清和心肌游离脂肪酸蓄积 ,左室肥厚心肌M CPT Ⅰ和MCADmRNA的表达下调 (P <0 .0 5 )。卡维地洛治疗 12周后能够明显改善上述各项指标的变化 (P <0 .0 5 )。结论　压力负荷性大鼠肥厚心肌能量代谢发生胚胎型转换 ;卡维地洛通过减少左室心肌脂肪酸氧化限速酶和关键酶的基因表达 ,减弱心肌胚胎型能量代谢的转换从而改善肥厚心肌的能量代谢 ,这可能是卡维地洛心肌保护作用的机制之一。     

卡维地洛与美托洛尔治疗慢性心力衰竭的对比观察

目的比较卡维地洛与美托洛尔治疗慢性心力衰竭的疗效。方法将徐水县人民医院收治的86例慢性心力衰竭患者随机分为卡维地洛组(n=43)和美托洛尔组(n=43),两组在常规抗心力衰竭治疗的基础上分别加用卡维地洛和美托洛尔,观察两组治疗前后左心室舒张末期内径(LVEDd)、左心室收缩末期内径(LVEDs)、每搏量(SV)、左心室射血分数(LVEF)变化,观察治疗后纽约心脏病协会(NYHA)心功能改善情况及治疗期间不良反应发生情况。结果治疗6个月后,两组LVEDd、LVEDs均较治疗前减小(P<0.05);SV及LVEF均较治疗前显著增加(P<0.05)。但卡维地洛组LVEDd减少及LVEF增加更显著(P<0.05)。卡维地洛组NYHA心功能改善有效率显著高于美托洛尔组(P<0.05),不良反应发生率显著低于美托洛尔组(P<0.05)。结论卡维地洛治疗慢性心力衰竭安全、有效,效果优于美托洛尔,值得临床推广应用。     

卡维地洛与美托洛尔治疗高原慢性充血性心力衰竭疗效的对比研究

目的 比较卡维地洛与美托洛尔治疗高原慢性心力衰竭(CHF)的疗效.方法 90例CHF患者随机分成3组:常规治疗组(20例)给予血管紧张素转化酶抑制剂、利尿剂、地高辛等常规心力衰竭治疗.美托洛尔组(34例)、卡维地洛组(36例)在上述治疗基础上分别给予美托洛尔50 mg,2次/d;卡维地洛25 mg,2次/d口服.随访半年,治疗前、后采用超声心动图测定患者心功能并进行疗效观察.结果 治疗后美托洛尔组、卡维地洛组左心室舒张末期内径(LVEDD)[分别为(57.3±6.5)、(57.2±6.9)mm]和左心室收缩末期内径(LVSED)[分别为(46.6±7.0)、(44.0±6.9)mm]显著低于常规治疗组[分别为(64.7±9.1)、(53.4±9.8)mm],左心室射血分数(LVEF)显著高于常规治疗组[分别为(47.5±8.1)%、(52.9±8.5)%、(42.8±9.2)%](P均＜0.05).卡维地洛组LVEF改善优于美托洛尔组(P＜0.05).死亡情况:常规治疗组4例,美托洛尔组1例,卡维地洛组无死亡.美托洛尔组、卡维地洛组病死率均明显低于常规治疗组(P均＜0.05).结论 美托洛尔、卡维地洛均可明显改善高原CHF患者心功能.卡维地洛疗效及耐受性略优于美托洛尔.

Abstract：

Objective To compare the effect of carvedilol and motoprolol on high altitude chronic congestive heart failure (CHF). Methods Ninety patients with high altitude chronic CHF were divided into three groups randomly:Twenty patients in the regular treatment group treated with angiotensin-converting enzyme inhibitor (ACEI) ,diuretics and digoxin; motoprolol (50 mg twice daily) was given in the motoprolol group( 34cases) additional to regular treatment; carvedilol (25 mg twice daily) was given in the carvedilol group(36cases ) additional to regular treatment. All the patients were followed up for six months and measured the changes of cardiac function by echocardiography. Results Left ventricular end-diastolic dimension (LVEDD) was ( 57. 3 ± 6. 5 ) mm and (57.2 ± 6. 9) mm in the carvedilol group and the motoprolol group respectively, and left ventricular end-systolic dimension (LVESD) was (46. 6 ± 7.0) mm and (44. 0 ± 6. 9 ) mm in the carvedilol group and the motoprolol group respectively, which were all significantly smaller than that in the regular treatment group ([64.7 ±9. 1]mm and [53.4 ±9.8]mm for LVEDD and LVESD,respectively) (Ps ＜0.05). Left ventricular ejection fraction (LVEF) in the carvedilol group and the motoprolol group ( [47.5 ± 8. 1] % and [52. 9 ±8.5] % ,respectively) was higher than that in regular treatment group( [42. 8 ±9. 2]% ) (Ps ＜0. 05).The improvement of LVEF in the carvedilol group was better than that in the motoprolol group (P ＜ 0. 05 ). One case died in the motoprolol group and no death in the carvedilol group,4 cases died in the regular treatment group,the mortality in the motoprolol group and the carvedilol group was significantly lower than that in the regular treatment group. Conclusion Carvedilol and motoprolol significantly improved cardiac function in high latitude CHF patients,and the effect of Carvedilol is slightly better than that of motoprolol.     

卡维地洛对正常青年男性血压的影响

目的探讨健康男性青年服用β受体阻滞剂卡维地洛后不同血药浓度下静息坐位血压与用药前比较有无显著性变化,以评价卡维地洛的降压特点,为临床用药提供试验依据。方法对20名健康男性青年在服用卡维地洛20mg前及服药后0.5、1、2、3、4、6、8、10、24h分别测血药浓度,并监测各时间点坐位静息血压,并将数据进行统计分析。结果血压变化与血药浓度的变化没有明显相关性,与用药前血压比较有显著性降低,即P〈0.01。结论卡维地洛对正常健康男性降压迅速,并可长时间维持降压作用。无明显副反应,受试者耐受性良好。     

Peripheral artery disease and outcomes after myocardial infarction: An individual-patient meta-analysis of 28,771 patients in CAPRICORN,EPEHESUS, OPTIMAAL and VALIANT

Objectives

To examine the prevalence of peripheral artery disease (PAD) and the relationship between PAD and cardiovascular (CV) outcomes in subjects with left ventricular systolic dysfunction, heart failure or both after acute myocardial infarction (MI).

Background

PAD is associated with poorer prognosis in patients with stable and unstable coronary heart disease but whether PAD is associated with worse outcomes following substantial acute MI is unknown.

Methods

Univariate and multivariate Cox proportional hazards modelling was used to compare clinical outcomes in an individual-patient meta-analysis of 4 trials (CAPRICORN, EPHESUS, OPTIMAAL and VALIANT).

Results

Of the 28,771 patients randomized, 2357 (8.2%) had PAD. These patients were older and had more co-morbidity and were less likely to be prescribed aspirin or a beta-blocker compared to patients without PAD. Over a mean follow-up of 2.7 years, 5121 (17.8%) patients died and 15,055 (52.3%) experienced CV death or hospitalization. PAD was an independent predictor of all individual and composite CV outcomes examined (including heart failure), with the exception of stroke. In patients with PAD (compared to those without PAD), the adjusted hazard ratio (HR) for all-cause mortality was 1.25 (95% CI 1.15–1.37; p < 0.001) and the HR for CV death, non-fatal MI, non-fatal stroke or heart failure hospitalization was 1.24 (1.16–1.33; p < 0.001).

Conclusions

PAD is common and is an independent predictor of worse outcomes in patients already at high risk after MI because of left ventricular systolic dysfunction, heart failure or both. These patients represent an important group for intensive application of secondary preventive therapies.     

卡维地洛治疗心肌梗死后左心功能不全的疗效分析

目的探讨卡维地洛治疗心肌梗死后左心功能不全的疗效。方法选择64例急性心肌梗死后合并左心功能不全患者随机分为卡维地洛组和对照组。两组患者均予以常规内科治疗,卡维地洛组加用卡维地洛3．125mg,每日2次,逐渐加量,维持剂量25mg,每日2次,连用12个月。结果治疗12个月后,两组患者彩色多普勒超声心动图LVEDD、LVESD、LVEF数值均较治疗前明显改善（P〈0．05或P〈0．01）,且卡维地洛组改善幅度明显优于对照组（P〈0．05）。同时两组患者的6min步行试验均较治疗前明显升高（P〈0．05或P〈0．01）,且卡维地洛组上升的幅度明显优于对照组（P〈0．05）。治疗12个月后,卡维地洛组临床治疗的总有效率及12个月生存率高于对照组（x^2=5．33、4．27,均P〈0．05）,再次住院率明显低于对照组（x^2=4．27,P〈0．05）。结论卡维地洛治疗心肌梗死后左心功能不全能有效防止左心室重构,改善左心功能,提高患者治疗有效率及生存率,降低再次住院率。改善患者生活质量及预后。     

卡维地洛联合曲美他嗪 心宝丸治疗慢性心力衰竭疗效观察

目的观察卡维地洛联合曲美他嗪、心宝丸治疗慢性心力衰竭的临床疗效。方法选择确诊为慢性心力衰竭患者104例,随机分为2组,治疗组在常规扩管、利尿、强心的基础上口服卡维地洛联合曲美他嗪、心宝丸,对照组在常规扩管、利尿、强心的基础上口服倍他乐克。连续观察6个月,评估其临床治疗的有效性。结果治疗组总有效率为83.0%,对照组总有效率为64.7%,2组比较差异有统计学意义（P〈0.05）。结论卡维地洛联合曲美他嗪、心宝丸治疗慢性心力衰竭,临床疗效确切且用药安全性好,值得临床推广应用。     

卡维地洛与倍他乐克治疗老年应激性高血压的临床疗效比较

目的：比较卡维地洛与倍他乐克治疗老年应激性高血压的临床疗效。方法将我院收治的114例老年应激性高血压患者随机分为卡维地洛治疗组（观察组）与倍他乐克治疗组（对照组）各57例,比较两组血压控制效果及不良反应情况。结果两组患者治疗后血压水平较治疗前均有所改善（P 〈0.05）,观察组改善情况优于对照组（P 〈0.05）。观察组不良反应发生率低于对照组（P 〈0.05）。结论卡维地洛治疗老年应激性高血压的临床疗效优于倍他乐克,且具有较高安全性,值得临床推广使用。     

卡维地洛联合尼可地尔对冠心病心肌缺血及左室舒张功能不全的疗效

目的：研究卡维地洛联合尼可地尔对冠心病心肌缺血及左室舒张功能不全的临床疗效。方法：选取冠心病心肌缺血及左室舒张功能不全患者110例进行对比研究,随机编号法分为常规组55例和联合组55例。常规组进行拜阿司匹林、消心痛等常规治疗,联合组在此基础上加用卡维地洛和尼可地尔,比较两组治疗前后心电图、左室舒张功能和NT—proBNP的变化。结果：在心电图改善情况上两组治疗后患者ST段压低次数、持续时间及心肌缺血总负荷与治疗前比较均明显下降,但联合组下降程度比常规组更加明显,比较差异均有统计学意义（P〈0．05）。在左室舒张功能和NT—proBNP上,常规组治疗前后无明显变化,联合组治疗后比治疗前明显降低,且联合组治疗后比常规组下降更明显,比较差异均有统计学意义（P〈0．05）。结论：尼可地尔和卡维地洛联合疗法能够强化冠心病心肌缺血的治疗和预后效果,显著改善患者左室舒缓功能。