慢性心力衰竭患者心脏β1受体自身抗体与心功能及QTcd的相关性分析

目的通过β1肾上腺素受体自身抗体水平的检测，分析其与心功能及心电图表现的相关性，并观察β受体阻滞剂卡维地洛的治疗作用。方法65例慢性心力衰竭患者采用酶联免疫法测定患者血清中β1受体自身抗体水平，据此分为β1受体自身抗体阳性组（β1阳性组）30例和β1受体自身抗体阴性组（β1阴性组）35例，采用超声心动图测量左室舒张末径，左室收缩末径和左室射血分数进行心功能检测，常规12导心电图测量QTcd值。在血管紧张素转换酶抑制剂、利尿剂和洋地黄制剂治疗基础上加用β受体阻滞剂卡维地洛，随访半年。结果（1）治疗前β1阳性组左室舒张末径显著大于β1阴性组[（66．01±5．47）vs（63．07±5．64）mm；P〈0．05）]，左室收缩末径大于β1阴性组[（54．24±8．43）vs（50．72±6．12）mm；P=0．052）]，左室射血分数显著低于β1阴性组[（32．16±9．00）vs（36．64±8．20）％；P〈0．05）]。治疗后两组左室舒张末径、收缩末径均较治疗前显著减小（P〈0．01），左室射血分数较治疗前提高（P〈0．01）。β1阳性组左室舒张末径、收缩末径和左室射血分数与β1阴性组无差异（P〉0．05）。（2）治疗前β1阳性组心率显著高于β1阴性组[（94±14）vs（87±16）次／min；P〈0．05）]，β1阳性组QTcd值显著大于β1阴性组[（71．14±34）vs（58．33±14）ms；P〈0．05）]，治疗后两组心率及血压均较治疗前显著减低（P〈0．01），β1阳性组QTcd值较治疗前显著减低（P〈0．05），β1阳性组心率和QTcd值与β1阴性组无显著差异（P〉0．05）。结论β1受体自身抗体阳性者心功能较差且QTcd值长，β受体阻滞剂可以抑制心肌重构，改善心功能，减小QT离散度，提示β1受体自身抗体参与心力衰竭的病理生理过程，阳性者可能临床预后差。

Relationship between expression of autoantibodies against cardiac β1-adrenergic recepotr and heart function,QTcd in patients with chronic heart failure

Objective To investigate the relationship between expression of autoantibodies against cardiac β1 adrenergic receptor and heart function, QTcd in patients with chronic heart failure （CHF）, and to observe the thera peutic effectiveness of β receptor blocker, Methods Autoantibodies against cardiac β1-adrenergic receptor in serum were detected in 65 patients with CHF by means of enzyme linked immune assay and were found positive in thirty patients who constituted β1 positive group, The other thirty-five patients constituted β1 negative group, The parameters, such as left ventricular end-diastolic diameter（LVEDD）, left ventricular end-systolic diameter（LVESD） and left ventricular ejection fraction （LVEF） were measured with echocardiography, and QTcd was measured with routine 12- lead electrocardiogram, Carvedilol was added to ACEI, diuretics and digitalis, All patients were followed up for 6 months, Results （1） Before treatment, the LVEDD in β1 positive group was much greater than that in β1 negative group[（66.01±5.47）mmvs （63. 07± 5. 64）mm, P〈0. 05], the LVESD was also greater than that in β1 negative group [（54. 24±8.43）mm vs （50. 72±6. 12）mm, P=0.052], The mean value of LVEF in β1 positive group was much lower than that in β1 negative group [ （ 32. 16 ±9. 00） % vs （ 36, 64 ± 8. 20） % .P 〈 0. 05], After treatment,LVEDD and LVESD decreased and LVEF rose significantly in both groups（P〈 0. 01 ）. There was no significant difference in LVEDD, LVESD and LVEF between the two groups（P〉0. 05）. （2） Before treatment, the heart rate of patients in β1 positive group was much higher than that in β1 negtive group[（94± 14） beat/min vs （87± 1 6） beat/min, P〈0. 051. The value of QTcd in β1 positive group was much greater than that in β1 negative group[（71.14±34）ms vs（58.33± 14）ms, P〈0. 05]. After treatment, the heart rate and blood pressure of both groups decreased significantly （P〈0. 01）. The value of QTcd in β1 positi