卡维地洛对老年慢性心力衰竭合并室性心律失常患者血清肾上腺素受体自身抗体的影响

目的 研究卡维地洛对老年慢性心力衰竭(心衰)合并室性心律失常(室律失常)患者血清抗β1、β2和α1肾上腺素受体自身抗体的影响.方法 将68例老年冠心病心衰合并有室律失常的患者随机分为两组,在常规强心利尿治疗的同时,一组给予美托洛尔、另一组给予卡维地洛治疗,检测两组治疗前和治疗后6个月心脏超声、B型利钠肽(BNP)、动态心电图和抗β1、β2和α1受体自身抗体阳性率的改变,同时检测治疗前后血压、心率、肝和肾功能的变化.结果 与治疗前相比,两组均使心衰患者的基础心率和BNP下降,左室射血分数(LVEF值)升高,心脏功能得到改善;与美托洛尔组相比,卡维地洛治疗后收缩压和BNP下降更明显,差异有统计学意义(P<0.01).美托洛尔治疗后,可使患者血清中抗β1受体自身抗体的阳性率下降(P<0.05),而对抗β2和α1 受体自身抗体的阳性率没有影响(P>0.05).卡维地洛治疗后,血清中抗β1、β2和α1受体自身抗体的阳性率均明显下降(P<0.01),室律失常的发生率也比美托洛尔治疗组明显下降(P<0.01).结论 对老年冠心病慢性心衰合并室律失常患者,应用卡维地洛比美托洛尔能更有效地降低室律失常的发生.

Effects of carvedilol and metoprolol on expression of autoantibodies against cardiac adrenergic receptors in aged patients with chronic heart failure and ventricular arrhythmia

Objective To investigate the effects of carvedilol and metoprolol on the expression of autoantibodies against cardiac β1,β2 and α1, adrenergic receptors in aged patients with chronic heart failure (CHF) and ventricular arrhythmia (VA). Methods Sixty-eight patients with CHF and VA were randomly divided metoprolol treatment group or carvedilol treatment group on the basis of digoxin and diuretic treatment. All patients were followed up for six months cardiac function was monitored by echocardiography, VA by Holter and the three autoantibodies by enzyme-linked immunosorbent assay ( ELJSA). Results (1) Systolic blood pressure and brain natriuretic peptide (BNP) were significantly lower in carvedilol group than that in metoprolol group (P < 0.05). (2) The positive ratio of autoantibodies against the cardiacβ1 adrenergic receptor was significantly decreased compared with that of pre-treatment ( P < 0.05) in metoprolol group. The positive ratios of autoantibodies against cardiac β1,β2 and α1-adrenergic receptors were all significantly decreased compared with that of pre-treatment (P <0. 01) in carvedilol group. Moreover, the incidence of VA was significantly decreased in carvedilol group ( P < 0.05 ) but not in metoprolol group. Conclusion Carvedilol is superior to metoprolol on decreasing the incidence of VA in aged patients with chronic heart failure and ventricular arrhythmia.