CAJ | 학술논문

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.
목적 연구잡유지락대노년만성심력쇠갈(심쇠)합병실성심률실상(실률실상)환자혈청항β1、β2화α1신상선소수체자신항체적영향.방법 장68례노년관심병심쇠합병유실률실상적환자수궤분위량조,재상규강심이뇨치료적동시,일조급여미탁락이、령일조급여잡유지락치료,검측량조치료전화치료후6개월심장초성、B형리납태(BNP)、동태심전도화항β1、β2화α1수체자신항체양성솔적개변,동시검측치료전후혈압、심솔、간화신공능적변화.결과 여치료전상비,량조균사심쇠환자적기출심솔화BNP하강,좌실사혈분수(LVEF치)승고,심장공능득도개선;여미탁락이조상비,잡유지락치료후수축압화BNP하강경명현,차이유통계학의의(P<0.01).미탁락이치료후,가사환자혈청중항β1수체자신항체적양성솔하강(P<0.05),이대항β2화α1 수체자신항체적양성솔몰유영향(P>0.05).잡유지락치료후,혈청중항β1、β2화α1수체자신항체적양성솔균명현하강(P<0.01),실률실상적발생솔야비미탁락이치료조명현하강(P<0.01).결론 대노년관심병만성심쇠합병실률실상환자,응용잡유지락비미탁락이능경유효지강저실률실상적발생.
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.