卡维地洛对扩张型心肌病心肌β１和M2受体自身抗体的影响_临床医学论文.docVIP

卡维地洛对扩张型心肌病心肌β１和M2受体自身抗体的影响_临床医学论文 卡维地洛对扩张型心肌病心肌β１和M2受体自身抗体的影响_临床医学论文 作者：王庸晋 王治平 姜胜 李启富 胡耀东 【摘要】 　　目的：探讨卡维地洛对扩张型心肌病（DCM）患者血清心肌β1和M2受体自身抗体的影响。方法：50例DCM患者随机分为卡维地洛治疗组和常规治疗对照组，随访6个月，观察两组的心功能和血清两种自身抗体的变化情况。结果：两组治疗后较治疗前心脏的左室收缩末径、左室舒张末径均减小，左室射血分数增加，心功能NYHA分级改善（0.01），卡维地洛组前述变化较常规组更明显（0.05）。卡维地洛组心肌β1和M2受体自身抗体滴度较治疗前明显降低（0.01），常规组治疗前后两种自身抗体滴度有下降趋势，但无显著差异（Pgt;0.05）。结论：卡维地洛可能通过阻断心肌β1和M2受体自身抗体对心脏的不利作用抑制DCM患者的心室重塑，改善心功能。 【关键词】 卡维地洛　扩张型心肌病　β1受体　M2受体　自身抗体 Abstract Objective：To explore the effect of carvedilol on serum autoantibodies against the cardiac β1 and M2 receptor in patients with idiopathic dilated cardiomyopathy.Methods：Fifty patients with idiopathic dilated cardiomyopathy were randomly divided into carvedilol group and routine therapeutic control group and followed 6 months. The changes on cardiac function and two kinds of serum autoantibodies were observed. Results：LVESD and LVEDD decreased,LVEF increased and NYHA stage improved significantly in both groups (0.01)after 6 months treatment while these changes were greater in carvedilol group than in routine therapeutic control group (0.05).Average titer of autoantibodies against the cardiac β1 and M2 receptor decreased significantly in carvedilol group (0.01) after 6 months treatment but no significant difference was found in routine therapeutic control group (Pgt;0.05) after treatment.Conclusion:Carvedilol improved left ventricular remodeling and cardiac function by blocking the effect of serum autoantibodies against the cardiac β1 and M2 receptor in patients with idiopathic dilated cardiomyopathy. Key words Carvedilol;Idiopathic dilated cardiomyopathy;β1-receptor; M2-receptor;Autoantibodie 近年来，国内外研究发现在扩张型心肌病患者的血清中存在心脏G-蛋白偶联型β1-肾上腺素能受体与M2-胆碱能受体的自身抗体，并认为它们与扩张型心肌病(dilated cardiomyopathy，DCM)的发病相关。本研究通过使用新型β受体阻断药 物卡维地洛治疗DCM患者，观察治疗前后患者血清中β1和M2受体自身抗体的变化和对心功能的影响，探讨卡维地洛在DCM中改善预后的作用机制。 1 资料与方法 1.1 一般资料 2005年6月～2006年12月在我院住院及门诊初次确诊的扩张型心肌病50例，年龄25岁～73岁，平均(56.6±15.7)岁，其中男32例，女18例；心功能NYHA 2级～3级36例，NYHA 4级14例。研究病例通过相关检查排除了缺血性心肌