卡维地洛对扩心病患者炎症因子所致左心功能改变影响.docVIP

卡维地洛对扩心病患者炎症因子所致左心功能改变影响 　 作者：郑祝剑 徐焱 邓宇虹 鄢应根 【摘要】 目的 探讨卡维地洛对扩张性心肌病患者左室功能及炎性因子水平的影响。方法 选取60例左室射血分数（LVEF）小于40%、已经接受ACEI、地高辛、利尿剂标准治疗至少6个月的扩张型心肌病患者，随机分为卡维地洛组及对照组，每组30例。卡维地洛组在标准治疗的基础上加用卡维地洛3.125mg初始剂量，每日两次，两个星期后逐渐加量，最终将卡维地洛加到靶剂量25mg，总共服用四个月。对照组继续给予标准治疗，总共四个月。干预前后进行心功能分级评价，放射性核素测定心功能，测定肿瘤坏死因子-a（TNF-a）、白介素（IL-2、IL-6）水平。结果 卡维地洛组相对于其干预前（基线水平）纽约心功能分级有明显改善（Plt;0.001），左室射血分数从22.14±7.85%增加到27.85±11.80% (P=0.002), 但对照组无明显改变（Pgt;0.05），炎症因子IL-6(P=0.001)及TNF-α(P=0.001)水平明显下降。实验过程中，出现死亡8例（卡维地洛组1例，对照组7例，P=0.05）。结论 卡维地洛可抑制炎症因子(TNF-a、IL-6)表达从而改善心功能。 【关键词】 卡维地洛 扩张性心肌病 炎症因子 Carvedilol improves the left ventricular function in patients with dilated cardiomyopathy via attenuating the expression of inflammatory cytokines 【Abstract】 Objective To investigate the effect of carvedilol on left ventricular function(LVEF) and the level of inflammatory cytokines in patients with dilated cardiomyopathy. Methods 60 patients with dilated cardiomyopathy with an LVEF less than 40% were involved in this study.All patients have received digoxin, ACE inhibitors and diuretics for six months as the standard therapy.They were randomly divided into two groups: carvedilol group(n=30) and controlled group(n=30). The patients of carvedilol group received an initial dosage of 3.125 mg carvedilol twice daily for two weeks, and followed by increase at two-week intervals (if tolerated), first to 6.25 mg, then to 12.5 mg, and, finally, to a target dosage of 25mg twice daily.Clinical examinations, radionuclide studies ,and determinations of plasma levels of tumour necrosis factor-alpha (TNF-a),interleukin (IL-2、IL-6 ) were performed at baseline and repeated four months later. Results Patients treated with carvedilol showed a significant improvement in functional class compared with the baseline values (P=0.001), and the LVEF of carvedilol group increased from 22.14±7.85% to 27.85±11.80% (P=0.002), parallel with a decrease in the levels of cytokines (IL-6 [P=0.001] and TNF-a[P=0.001]). However,the controlled group showe