辛伐他汀对冠心病患者血管内皮功能作用的时效关系

Time-effect relationship between simvastatin amd vascular endothelial function in patients with coronary heart disease

目的探讨辛伐他汀改善冠心病患者血管内皮功能的时效关系。方法共入选30例确诊冠心病患者，每天服用辛伐他汀20mg，进行1年随访。采用超声法检测血流介导的肱动脉内皮依赖性舒张功能（flow mediated dilation，FMD），同时观察血脂水平、肝肾功能、血糖以及心肌酶学的变化。结果完成50周随访的25例冠心病患者，辛伐他汀（20mg／d）服后2周、4周、8周、12周及50周可分别使患者血清总胆固醇（TC）降低18．9％、24．3％、29．0％、30．1％、29．4％，低密度脂蛋白胆固醇（LDL-C）降低20．1％、26．8％、34．7％、36．0％、35．2％。辛伐他汀治疗可显著改善冠心病患者的血管内皮功能，FMD较治疗前明显增加，2周：64％，4周：95％，8周：123％，12周：179％，52周：142％（2周、4周P〈0．05；8周、12周、52周P〈0．01）。FMD的改善与血清TIE和LDL-C降低水平无显著相关，而与基础FMD有关。所有患者耐受性好，无明显不良反应。结论辛伐他汀治疗冠心病患者2周时，血管内皮功能即有改善，8～12周达高峰，长期治疗能产生持续的血管内皮功能改善。

Objective To explore the time-effect relationship of simvastatin to vascular endothelial function in patients with coronary heart disease（CHD）. Methods Thirty patients with CHD diagnosed by coronary artery angiography or history of myocardial infarction were included. All patients took 20mg simastatin per day and were followed up for one year. The endothelial dependent flow-mediated dilation（ FMD） of brachial artery was measured by ultrasound technique before and after treatment. At the same time, changes of serum levels of lipids, glucose, myocardial enzymes functions of liver kidney were also assessed. Results In the 2th, 4th, 8th, 12th, 50th weeks after the treatment with simvastatin 20mg/d, TC levels in 25 patients who completed the follow-up were decreased by 18.9%, 24.3%, 29.0%, 30.1%, 29.4%, respectively. LDL-C levels were decreased by 20.1%, 26.8%, 34.7 %, 36.0%, 35.2%, respectively. The values of FMD were increased by 64%, 95%, 123%, 179%, 142%, respectively （P〈0.05 in 2th and 4th weeks; P〈0.01 in 8th, 12th, 50th weeks）. The changes of FMD did ：not relate to the changes of TC and LDL-C in the serum and it related to the value of baseline FMD. There was no significant change of liver and kidney function tests, blood glucose level and myocardial enzymes in all patients. Conclusion The vascular endothelial functions were improved significantly after 2 weeks＇ therapy of simvaststin in patients with CHD and the effect peaked during 8 to 12 weeks. Long-term treatment with simvastatin produced a sustained improvement of endothelial function in patients with CHD.