卡维地洛对慢性充血性心力衰竭者心功能及血浆内皮素-1和降钙素基因相关肽的影响

目的观察卡维地洛对慢性充血性心力衰竭(CHF)患者心功能和血浆内皮素(ET-1)及降钙素基因相关肽(CGRP)的影响。方法46例CHF患者随机分为对照组和卡维地洛组。两组患者均充分使用血管紧张素转化酶抑制剂、利尿剂和小剂量地高辛口服治疗,有心绞痛或心肌缺血者联用硝酸酯类药物,对照组采用低剂量(2.5~5mg)到靶剂量(20mg)的疗法。分别于治疗前及治疗8个月后测定心功能及血浆ET-1、CGRP水平。结果两组治疗后较治疗前均能显著降低心率(P<0.001),缩短左室舒张末期内径和左室收缩末期内径(P<0.001),提高左室射血分数和E/A值(P<0.001),降低血浆ET、CGRP水平(P<0.001),但以卡维地诺组改善更明显;两组间比较除血浆CGRP水平无显著差异(P>0.05)外,上述指标均有显著差异(P<0.01,P<0.001)。结论卡维地洛可更好减轻心脏耗氧,改善心室重塑和左室功能,降低血浆ET水平,阻断神经体液因素作用,提高生存质量。

Effects of Carvedilol on heart function,plasma endothelin-1 and calcitonin gene related peptide in patients with chronic congestive heart failure

Objective To observe the effects of carvedilol on plasma calcitonin gene related peptide (CGRP),endothelin-1 (ET-1) levels and heart function in patients with chronic congestive heart failure(CHF).Methods Forty-six CHF patients were randomly divided into two groups,Carvedilol group (n=24) and control group(n=22). Carvedilol group were treated with Carvedilol titrated from low dose(2.5～5 mg)to target dose(20 mg)in addition to standard therapy for control group:administered orally with angiotensin-converting enzyme inhibitor(ACEI),diuretic and low dose digoxin,who were complicated with angina or myocardial ischemia were performed with combination of nitrate drugs.The cardiac function of all patients were detected before and after 8 months therapy. The plasma concentration of ET-1 and CGRP were detected by radioimmunoassay. Results Heart rate was obviously decreased in two groups pre- and post-treatment(P<0.001),left ventricular end-diastolic dimension and left ventricular end-systolic dimension were decreased absolutely(P<0.001);left ventricular ejection fraction and value of electroimmunoassay(E/A) were increased(P<0.001);Level of plasma ET-1 and CGRP were increased(P<0.001),the indices in Carvidilol group were improved obviously better than those in control group.Level of plasma CGRP was no significance between the two groups,some other indices were significant diffrerence between the two groups(P<0.01,P<0.001).Conclusion Carvedilol can preferably lessen cardiac oxygen consumption,improve the ventricular remodeling and left ventricular function ,decrease the level of the plasma ET-1,block the nerrohumor effect and improve the life quality.