两种不同剂量辛伐他汀对冠心病患者血管内皮功能的影响

The Effects of Two Different Doses of Simvastatin on Vascular Endothelial Function of Patients with Coronary Heart Disease

目的探讨辛伐他汀10 mg与20 mg不同剂量对冠心病患者血管内皮功能作用的影响。方法共入选66例冠心病患者,随机分为对照组、辛伐他汀10 mg组和辛伐他汀20 mg组,治疗8周。采用超声法检测血流介导的肱动脉内皮依赖性舒张功能,同时观察血脂水平的变化。结果辛伐他汀治疗8周后,10 mg和20 mg辛伐他汀呈剂量依赖性显著降低血总胆固醇和低密度脂蛋白胆固醇水平(总胆固醇分别降低18.3%和29.3%;低密度脂蛋白胆固醇分别降低25.3%和35.4%;P<0.05)。对照组治疗8周后血脂水平无明显变(P>0.05)。10 mg和20 mg辛伐他汀均可显著改善肱动脉内皮依赖性舒张功能(10 mg辛伐他汀组为3.51%±4.03%比7.46%±5.90%;20mg辛伐他汀组为3.89%±3.97%比7.98%±6.16%;P均<0.01)。但两组之间肱动脉内皮依赖性舒张功能的变化值比较差异无显著性(P>0.05),且肱动脉内皮依赖性舒张功能的改善与血总胆固醇和低密度脂蛋白胆固醇水平的降低不相关。对照组肱动脉内皮依赖性舒张功能虽有轻度增加,但无统计学意义。辛伐他汀治疗后肱动脉内径和肱动脉对硝酸甘油的反应均无显著改变。结论10 mg和20 mg辛伐他汀治疗8周后,可显著改善冠心病患者血管内皮功能,但该作用在这2种剂量之间无显著不同,可能独立于调脂作用之外。

Aim Aim To explore the effects of two different doses of simvastatin （ 10 mg, 20 mg/day） on vascular endothelial function of patients with coronary heart disease（CHD）. Methods Totally 66 patients with CHD were included and randomly divided into： control group and simvatafin groups of different dose groups（ 10 mg/day, 20 mg/day）, 22 patients in each group, The endothelial dependent flux modulated dilation （FMD） of brachial artery was measured by ultrasound technique before and after 8 weeks treatment. At the same time, we also examined the changes of the serum levels of lipids. Results After 8 weeks treatment, 2 simvastatin groups （10 mg, 20 mg） apparently reduced the serum level of TC （18.3%, 29.3%, respectively） and the serum level of LDLC（25.3%,35.4%, respectively）, The values of P between different dese groups comparisen were all less than 0.05. The serum levels of lipids in control group did not significantly change after therapy, The values of FMD apparently increased in simvastatin groups（10 mg：3.51% ± 4.03% vs 7.46% ± 5.90% ; 20 mg： 3.89% ± 3.97% vs 7.98% ± 6.16% ; P 〈 0.01 ）. But there was no statistic difference between them. The increase of FMD did not relate to the changes of TC and LDLC level in the serum. Although the value of FMD slightly increased in control group, it had no statistic significance. There was no significant change of vasedilation responding to nitroglycerin and brachial diameter in all groups after simvastafin therapy. Conclusion Different doses of simvastatin （ 10 mg, 20 mg） can obviously improve the vascular endothelial function of patients with CHD in 8 weeks. But there is no significant changes between two different doses and it may not relate to lipid-lowering action.