卡托普利联合美托洛尔治疗慢性心力衰竭的临床研究

目的 观察卡托普利联合美托洛尔对慢性心力衰竭（CHF）的治疗作用,并探讨其作用机制.方法 60例CHF患者分为常规治疗组（A组）和卡托普利＋美托洛尔治疗组（B组）,观察治疗后左心室射血分数（LVEF）、左室舒张末期内径（LVEDD）、基质金属蛋白酶-9（MMP-9）和高敏C反应蛋白（hs-CRP）水平变化.酶联免疫吸附双抗体夹心法（ELISA）检测血清MMP-9表达水平;乳胶增强免疫比浊法检测血清hs-CRP表达水平.结果 B组LVEF及LVEDD（63.21±6.09）％、（58.42±5.73） mm]的改善显著优于A组（41.13±3.67）％、（66.24±4.24） mm]（t=7.62、6.54,均P＜0.01）;B组MMP-9和hs-CRP（1.31±0.24） ng/mL、（6.34±0.58） mg/L]水平显著低于A组（2.23±0.39） ng/mL、（8.31±0.74） mg/L]（t=6.82、7.03,均P＜0.01）.A和B组的有效率分别为36.7％和73.3％,差异有统计学意义（Х^2=6.90,P＜0.05）.结论 卡托普利与美托洛尔联合治疗对CHF患者心功能具有保护作用,抑制MMP-9和hs-CRP的表达可能是其主要的作用机制.

Clinical study on ACEI combined with beta-blocker in the treatment of chronic heart failure

Objective To investigate the effects of ACEI combined with beta-blocker on cardiac function in patients with chronic heart failure （CHF）and explore its action mechanisms.Methods 60 CHF patients were enrolled in this study.The patients were randomly divided into the two groups：conventional treatment group（group A,n =30）,ACEI combined with beta-blocker treatment group （group B,n =30）.The LVEF,LVEDD,MMP-9,and hsCRP were recorded after treatment.The expression of MMP-9 was measured by ELISA.The level of serum hs-CRP was measured by latex enhanced immunoturbidimetric assay.Results The improvement of LVEF and LVEDD in B group （63.21 ± 6.09） ％,（58.42 ± 5.73）mm] were better than those in A group （41.13 ± 3.67） ％,（66.24 ± 4.24） mm] （t =7.62,6.54,P ＜ 0.01）.The expressions of MMP-9 and hs-CRP in group B （1.31 ± 0.24） ng/ml,（6.34 ± 0.58） mg/L] were significantly lower than those in A group（2.23 ±0.39） ng/mL,（8.31 ±0.74） mg/L] （t =6.82,7.03,P ＜0.01）.The total effective rate in A group was 36.7％,which was significantly lower than 73.3％ in B group（x2 =6.90,P ＜ 0.05）.Conclusion The cardiac function was improved by ACEI combined with beta-blocker treatment in CHF patients.The downregulation of MMP-9 and hs-CRP may play a key role in the effective ACEI combined with beta-blocker treatment.