阿托伐他汀对扩张型心肌病患者肌钙蛋白I水平及预后的影响

Effects of atorvastatin on levels of serum cardiac troponin I and prognosis in patients with dilated cardiomyopathy

目的:研究阿托伐他汀对扩张型心肌病(DCM)患者血清肌钙蛋白I(cTnI)水平及预后的影响。方法:对72例DCM住院患者随机分成2组:他汀组及非他汀组(各36例),治疗前两组在性别、年龄、病程、NYHA心功能分级、左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、心律失常等方面无显著差异,两组均常规抗心力衰竭等治疗,而他汀组加用阿托伐他汀(立普妥)10 mg/d,分别随访1年,观察治疗前、治疗3个月后两组的cTnI水平变化情况,评估随访1年内主要不良心血管事件(心血管死亡、心脏骤停复苏及卒中)风险及心力衰竭再住院率。结果:他汀组治疗3个月后cTnI水平较非他汀组有所下降,但差异无统计学意义;随访期间非他汀组主要心血管不良事件发生16例次(48%),他汀组14例次(42%);非他汀组因心衰再住院16例次(48%),他汀组11例次(33%),P>0.05。结论:低剂量阿托伐他汀治疗对DCM患者的cTnI水平及预后无明显影响,对心衰住院率亦无明显降低作用。

AIM：To study the effects of atorvastain on serum cardiac troponin I （cTnI） levels and the prognosis in patients with dilated cardiomyopathy （DCM）. METHODS： Seventy two consecutive patients hospitalized for DCM were divided randomly into two groups： statin group and no-statin group. There were no significant differences between groups according to gender, age, history of DCM, NYHA cardiac functional grading, left ventricular ejection fraction （LVEF）, left ventricular end-diastolic dimension （LVEDD） and cardiac arrhythmia. Patients of both groups were treated with conventional medication for anti-heart failure strategies, whereas patients in statin group were additionally given atorvastatin （10 mg daily）. Both groups were followed up for ~1 year. Changes of cTnI levels were determined before and after 3 months treatment. Risk of major adverse cardiovascular events （MACE） was evaluated including cardiovascular mortality, resuscitated cardiac arrest and stroke, and rates of rehospitalization for worsening heart failure （HF） during 1-year follow-up. RESULTS： Lower levels of the cTnI were observed in the statin group compared with those in the no-statin group after 3 months treatment but no significant difference was seen. There were 30 episodes of MACE during follow-up, 16 in no-statin group and 14 in statin group （P〉0.05） and a nonsignificant trend toward lower readmission rate for worsening HF in statin group （33% vs. 48%, P〉0.05）. CONCLUSION： Low-dose atorvastatin therapy has no significant beneficial effect on the prognosis in DCM patients and did not significantly reduce the rate of rehospitalization for worsening HF.