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目的 探讨心力衰竭患者交感神经 β肾上腺素能系统的变化特征及美托洛尔对其影响。方法 对 96例心功能分级 (NYHA)Ⅱ～Ⅳ级患者和 4 0名健康人采用放射性配基 (3 H DHA)结合分析法测定外周血淋巴细胞 β受体密度 (βmax) ;放免法测定血淋巴细胞内环核苷酸 (cAMP)含量 ;高效液相 电化学检测法测定血浆去甲肾上腺素 (NE)浓度。对 6 8例心功能Ⅱ、Ⅲ级的患者在美托洛尔 (12 .5～ 5 0mg)治疗 12周后 ,再次测定上述指标并进行比较。结果 心功能Ⅱ、Ⅲ、Ⅳ级组患者与正常对照比较 ,外周血淋巴细胞β受体 密度、cAMP含量依次降低 ,血浆NE浓度依次增加。美托洛尔治疗 12周后外周血淋巴细胞 β受体密度、cAMP含量上调 ,血浆NE浓度降低。结论 交感神经 β肾上腺素能系统参与了心力衰竭的病理生理过程 ,美托洛尔能改善心肌细胞的信息传导 ,有助于心肌细胞生物学功能恢复。
Objective To investigate the changes of sympathetic β-adrenergic system in patients with heart failure and the effects of metoprolol. Methods Ninety-two patients with NYHA class Ⅱ ~ Ⅳ and 40 healthy people were enrolled in this study. The β-cell density (βmax) of peripheral blood lymphocytes was measured by 3 H DHA binding assay. The contents of intracytoplasmic nucleotides (cAMP) in the lymphocytes were measured. Plasma norepinephrine (NE) concentration was determined by high performance liquid chromatography. Sixty-eight patients with heart function Ⅱ and Ⅲ were treated with metoprolol (12.5 ~ 50 mg) for 12 weeks. The above indexes were measured again and compared. Results Compared with the normal control group, the β receptor density, cAMP content of peripheral blood lymphocytes decreased in turn, and plasma NE concentration increased in turn. After 12 weeks of metoprolol treatment, peripheral blood lymphocyte beta receptor density, cAMP content was increased and plasma NE concentration was decreased. Conclusion Sympathetic β-adrenergic system participates in the pathophysiological process of heart failure. Metoprolol can improve the information transduction of cardiomyocytes and the recovery of cardiomyocyte biological function.