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目的:探讨充血性心力衰竭(CHF)患者部分神经激素、细胞因子的变化及与心功能的关系,观察卡维地洛对神经激素、细胞因子及心功能的影响,并比较不同剂量卡维地洛疗效的差别。方法:选择CHF患者90例,随机分成A、B、C3组。A组为对照组:予以血管扩张剂、利尿剂、地高辛等常规心力衰竭治疗。B组、C组在上述治疗基础上均予以卡维地洛口服,目标剂量B组:10mg,bid,C组:20mg,bid,然后维持稳定剂量至3个月。用药前后分别观察NYHA分级,左室射血分数(LVEF)、每搏量(SV)、短轴缩短率(FS)及醛固酮(ALD)、内皮素(ET)、肿瘤坏死因子(TNFα)、心钠素(ANP)等指标变化情况。结果:CHF患者心功能越差,神经激素、细胞因子水平越高。C组3个月后ALD、ET、TNFα、ANP水平与治疗前比较显著下降,LVEF、FS、SV明显提高,NYHA分级得到改善。B组除ET、TNFα、ANP有显著下降,LVEF明显升高外,其他指标改善不显著。A组上述指标与治疗前比较虽有改善,却差异无统计学意义。结论:①CHF患者神经激素和细胞因子水平明显升高,且与心功能分级及病情严重程度呈正相关;②卡维地洛可显著降低神经激素的激活及细胞因子的浓度,改善CHF患者心脏功能,其疗效呈剂量依赖性。
Objective: To investigate the changes of some neurohormones, cytokines and their relationship with cardiac function in patients with congestive heart failure (CHF) and to observe the effects of carvedilol on neurohormones, cytokines and cardiac function, and to compare the effects of different doses of carvedilol Los curative effect difference. Methods: 90 CHF patients were randomly divided into A, B and C3 groups. A group as the control group: to vasodilators, diuretics, digoxin and other conventional heart failure treatment. Groups B and C were orally administered with carvedilol on the basis of the above treatments. The target dose was given in group B: 10 mg, bid, and group C: 20 mg bid, and then the stable dose was maintained for 3 months. NYHA class, LVEF, SV, FS and ALD, ET, TNFα, Sodium (ANP) and other indicators of changes. Results: CHF patients with worse heart function, neurohormones, cytokines levels higher. After 3 months, the levels of ALD, ET, TNFα and ANP in group C decreased significantly compared with those before treatment. The levels of LVEF, FS and SV were significantly improved and NYHA classification was improved. In group B, except ET, TNFα, ANP decreased significantly, LVEF increased significantly, other indexes did not improve significantly. A group of these indicators compared with the pre-treatment although there is improvement, but the difference was not statistically significant. Conclusions: ① The levels of neurohormones and cytokines in CHF patients were significantly increased, which were positively correlated with the grading of cardiac function and severity of illness. ② Carvedilol could significantly reduce the activation of neurohormones and the concentrations of cytokines, and improve the cardiac function, The efficacy of a dose-dependent.