辛伐他汀和卡维地洛对慢性心力衰竭心室重构的影响

Effect of simvastatin and carvedilol on ventricular remodeling in patients with chronic heart failure

目的探讨辛伐他汀、卡维地洛及联用对慢性心力衰竭病人血清高敏C-反应蛋白(highsensitivity-Creactiveprotein,hs-CRP)、基质金属蛋白酶(matrixmetalloproteinases,MMPs)、心室重构及心功能的影响。方法慢性心力衰竭病人180例,分为辛伐他汀组,口服辛伐他汀20mg/d;卡维地洛组,口服6.25～50mg/d);联合用药组,联用辛伐他汀和卡维地洛,每组60例。疗程8个月,用酶联免疫吸附法测定外周血MMPs-2、MMPs-9和hs-CRP水平,并检查核素心血池及超声心动图,对比组内治疗前后MMPs-2、MMPs-9、hs-CRP、左心室重量指数及心功能指标变化和组间差异。结果①辛伐他汀及联合用药组病人治疗8个月后,hs-CRP及MMPs明显降低,尤以联合用药组较甚;而卡维地洛组病人治疗8个月后,hs-CRP及MMPs无明显的变化。治疗后,联合用药组与卡维地洛组比较,hs-CRP及MMPs水平显著降低;②与治疗前相比,联合用药组及辛伐他汀组的左心室后壁厚度(leftventricularposteriorwallthickness,PWTD)与室间隔厚度(interventricularseptumthicknessatdiastole,IVSD)治疗8个月后均显著下降,左心室质量(leftventricularmass,LVM)及左心室质量指数(leftventricularmassindex,LVMI)下降更显著;卡维地洛组治疗后的LVM及LVMI下降显著;治疗8个月后,联合用药组与卡维地洛组比较,PWTD、IVSD、LVM、及LVMI下降显著;③辛伐他汀治疗8个月后核素心血池检查的左心室高峰充盈率(leftventriclepeakengorgerate,LVPER)明显增加;联合用药组治疗8个月后核素心血池检查左心室射血分数(leftejectionfraction,LVEF)及LVPER均明显增加;治疗8个月后,联合用药组与卡维地洛组比较,LVEF及LVPER增加显著。结论辛伐他汀能缓解慢性心力衰竭病人的心室重构、改善心功能,辛伐他汀合用β受体阻断药对改善收缩功能较单用更显著。

Objectives To explore the effect of simvastatln, carvedilol and their combination on matrix metaUoproteinase, hypersensitive C-reactive protein and ventrlcular remodeling in patients with chronic heart failure（CHF）. Methods A total of 180 patients with the regular treatment （ACEI＋digoxin＋diuretic）, one was simvastatin treatment group treated with simvastatin, another were carvedilol and their combination treatment group treated with carvedilol and their combination （simvastatin＋carvedilol） in addition to the above regular treatment. All the patients were followed up for 8 months and observed the changes of matrix metaUoproteinase,hypersensitive C-reactive protein, ventricular remodeling and cardiac function. Results Data were analyzed and showed that： 1. At the end of 8 months, patients treated with simvastatin or their combination produced significant improvement in matrix metalloproteinase and high sensitivity-C reactive protein compared to carvedilol group. Carvedilol and their combination group showed significant change in matrix metaUoproteinase and hypersensitive C-reactive protein. 2. After 8 months of treatment with simvastatin, carvedilol or their combination, left ventrlcular mass index decreased from 165 g/m^2 to 128g/m^2 （P〈0.01）, from 163 to 139 g/m^2 （P〈0.05） or 176 to 129 g/m^2 （P〈0.01） respectively.There were significant differences between the carvedilol and their combination group in PWTD, IVSD, LVM and LVMI. 3. After 8 months of treatment with simvastatin, LVPFR increased from 1.87 to 2.59 （P〈0.05）. After 8 months of treatment with their combination, LVEF increased from 60.25 to 64.39（P〈0.05） and LVPFR increased from 1.78 to 2.89（P〈0.01）. There were significant differences between the carvedilol and combination group in LVEF and LVPFR. Conclusions Simvastatin showed favorable effects on left ventricular remodeling and demonstrated improved cardiac function in patients with CHF. The combined treatment group yielded better results in the context of improving left ventricular systolic function.