不同剂量辛伐他汀对老年冠心病患者血管内皮功能的影响

Effects of different doses of simvastatin on endothelial function in elderly patients with coronary artery disease

目的分析辛伐他汀10 mg、20 mg 2种剂量对老年冠心病患者血管内皮功能的影响。方法选取2009年1月~2010年12月在萧山区第一人民医院住院的92例老年冠心病患者,随机分为3组,每组32例。对照组患者给予扩冠脉、活血、抗凝等基础治疗,观察1组和观察2组在扩冠脉、活血、抗凝等基础治疗上,分别每日加服辛伐他汀10 mg、20 mg。比较治疗前后3组患者内皮依赖性血管舒张(FMD,flow-mediated vasodilatation)功能和非内皮依赖性血管舒张(NMD,nitroglycerin-mediated dilation)功能以及一氧化氮(NO)、内皮素(endothelin,ET)含量变化。结果治疗前3组患者FMD、NMD、NO、ET无显著差异;治疗后3组患者FMD均升高,但两观察组组间差异无统计学意义;3组患者的NO值均有上升,但2观察组的升幅更为显著,与对照组相比,差异均有统计学意义(P<0.05);治疗后3组NMD无显著变化;观察1组和观察2组患者治疗后ET均显著降低(P<0.05)。结论辛伐他汀能有效的纠正老年冠心病患者血管内皮细胞的代谢失衡,促进FMD的改善,但在10 mg^20 mg剂量之间无显著差异。

Objective To analyze the effect of 10 mg,20 mg simvastatin on vascular endothelial function in elderly patients with coronary heart disease. Methods 96 cases withcoronary heart disease admitted in the First people''s Hospital of Xiaoshan District from Janary 2009 to December 2010 were selected and divided into three groups,each had 32 cases. Control group were given expanding coronary artery,blood,anticoagulation therapy.Observation group 1 and observation group 2 were separately taking 10 mg,20 mg simvastatin on the basis of control group. Endothelium-dependent vasodilation (FMD)functional,non-endothelium-dependent vasodilation (NMD)functions,nitric oxide (NO),and endothelin (ET)in three groups before and after treatment were detected and compared. Results Before treatment,the differences of FMD,NMD,NO,ET in three groups were not significant. After treatment,FMD were increased in all three groups,but the difference between two observation group was not statistically significant.NO was also increased in all three groups,but value in two observation group was higher than control group. NMD were unchanged in all three groups.Compared with before treatment,ET in two observation groups after treatment were decreased significantly (P<0.05 ). Conclusion simvastatin can effectively rectify the metabolic imbalances of vascular endothelial cells in patients with coronary heart disease and promote the improvement of FMD,but there is no significant difference between 10 mg^20 mg dose.