慢性充血性心力衰竭患者自主神经功能与阿托伐他汀的干预

Autonomic nervous function in patients with chronic congestive heart failure and intervention of atorvastatin

目的:探讨具有降低血清胆固醇水平的阿托伐他汀对心力衰竭患者心率变异性的影响,以评价其对心力衰竭患者自主神经功能的干预作用。方法:①选择2004-01/06黑龙江省医院心内科住院慢性充血性心力衰竭患者68例,男37例,女31例。患者均知情同意。68例患者被随机分为2组:常规治疗组及阿托伐他汀组各34例。②常规治疗组给与强心、利尿、硝酸酯类扩血管治疗;阿托伐他汀组在常规治疗基础上,加服阿托伐他汀10mg,每晚8时服,治疗30d。③所有受试者均接受24h动态心电图监测。用配套电脑软件分析磁带数据,进行下列心率变异性参数分析:R-R间期的标准差、5minR-R间期标准差的均值、5minR-R间期均值的标准差、相邻R-R间期之差的均方根值、相邻心搏R-R间期差值大于50ms的百分比。④计数资料差异性比较采用χ2检验;计量资料组内差异性比较采用配对t检验,组间比较采用成组设计的t检验。结果:慢性充血性心力衰竭患者68例均进入结果分析。①组内比较:经30d治疗后常规治疗组和阿托伐他汀组R-R间期的标准差、5minR-R间期标准差的均值、5minR-R间期均值的标准差、相邻R-R间期之差的均方根值、相邻心搏R-R间期差值大于50ms的百分比均明显高于治疗前犤常规治疗组治疗前后:(96.80±27.50),(40.00±14.08),(102.00±22.45),(22.54±7.65)ms,(9.05±6.50)%;(110.60±23.40),(50.10±13.06),(110.80±19.08),(30.50±9.58)ms,(10.08±5.60)%;阿托伐他汀组治疗前后:(97.80±29.50),(39.08±16.10),(104.50±25.01),(25.60±9.00)ms,(7.08±5.50)%;(128.34±29.60),(61.25±24.50),(120.90±21.50),(38.65±10.11)ms,(16.90±8.78)%,t=2.25～4.05,P<0.05犦。②组间比较:两组治疗前心率变异性差异不明显(P>0.05)。经30d治疗后阿托伐他汀组心率变异性指标明显高于常规治疗组(t=2.02～3.82,P<0.05犦。结论:阿托伐他汀通过改善心力衰竭患者的自主神经功能,从而改善心力衰竭患者心功能。

AIM： To investigate the effects of atorvastatin, which can decrease the serum level of cholesterol, on the heart rate variability of patients with heart failure, and estimate the interventional effect of atorvastatin on the cardiac autonomic nervous function in patients with heart failure. METHODS： ① Between January and June 2004, 68 inpatients with chronic congestive heart failure （37 males and 31 females） in the Department of Cardiology, Heilongjiang Provincial Hospital took part in the study voluntarily, and they were randomly divided into two groups： routine therapy group （n=34） and atorvastatin group （n=34）. ② Patients in the routine therapy group received treatments for strengthening heart and benefiting urine, and vasodilatation of nitrates, besides, those in the atorvastatin group took atorvastatin 10 mg at 20：00 every day for 30 days. ③ All the patients received 24-hour ambulatory electrocardiogram monitoring. Tape data were analyzed by complete set of computer software, and the parameters of heart rate variability were analyzed, including the standard deviation of R-R interval, the average value of 5-minute R-R interval standard deviation, the standard deviation of average 5-minute R-R interval, the root mean square of the difference between adjacent R-R intervals and the percentage of the difference 〉 50 ms between adjacent R-R intervals. ④ The differences among the data were compared with the chi-square test, and the intragroup differences were analyzed with the paired t test, and the intergroup differences were compared with the grouped t test. RESULTS： All the 68 patients with chronic congestive heart failure were involved in the analysis of results. ① Intragroup comparison： After 30-day treatment, the standard deviation of R-R interval, the average value of 5-minute R-R interval standard deviation, the standard deviation of average 5-minute R-R interval, the root mean square of the difference between ad jacent R-R intervals and the percentage of the difference 〉 50 ms between adjacent R-R intervals were obviously higher than those before treatment in both the routine therapy group and atorvastatin group [routine therapy group before and after treatment： （96.80±27.50）, （40.00±14.08）, （102.00±22.45）,（22.54±7.65） ms, （9.05±6.50）%; （110.60±93.40）, （50.10±13.06）, （110.80±19.08）,（30.50±9.58） ms, （10.08±5.60）%; atorvastatin group before and after treatment： （97.80±29.50）, （39.08±16.10）, （104.50±25.01）, （25.60±9.00） ms,（7.08±5.50）%; （128.34±99.60）, （61.25±94.50）, （120.90±21.50）, （38.65±10.11） ms,（16.90±8.78）%, t=2.25 to 4.05, P 〈 0.05]. ② Intergroup comparison： There were no obvious differences in the heart rate variability between the two groups before treatment （P 〉 0.05）. After 30-day treatment, the parameters of heart rate variability in the atorvastatin group were markedly higher than those in the routine therapy group （t=2.02 to 3.82, P 〈 0.05）. CONCLUSION： Atorvastatin can improve the autonomic nervous function of patients with heart failure, and then ameliorate their cardiac function.