辛伐他汀对急性心肌梗死患者左室收缩功能及血浆脑钠肽水平影响的研究

Effect of simvastatin on changes of left ventricular function and plasma level of brain natriuretic peptide in acute myocardial infarction patients

目的观察辛伐他汀对急性心肌梗死(AMI)患者左室收缩功能及血浆脑钠肽(BNP)的影响。方法经超声心动图检测80例AMI患者以及20例健康对照者的左室舒张末内径(LVEDd)、左室射血分数(LVEF)及左室短轴缩短率(LVFS),应用酶联免疫吸附法(ELISA)测定两组脑钠肽(BNP)的水平。将AMI患者随机分为常规治疗组(38例)和加用辛伐他汀组(42例),3周和3个月时再测定上述指标。结果AMI患者在治疗3周时LVEDd、LVEF及LVFS与治疗前比较差异均无统计学意义(P＞0．05);AMI患者在治疗3个月时的上述指标与治疗前比较差异有统计学意义(P＜0．01),两治疗组比较差异亦有统计学意义(P＜0．05),辛伐他汀组LVEF较常规治疗组两组比较升高明显。两组AMI患者在梗死后24h血浆BNP水平均高于正常对照组;AMI患者在治疗3周和3个月时与治疗前比较血浆BNP水平均明显下降,两组比较差异均有统计学意义(均P＜0．05),辛伐他汀组BNP水平下降明显。两组AMI患者血浆BNP水平与LVEF呈负相关(P＜0．01)。结论长期应用辛伐他汀可以改善AMI患者心功能,降低血浆BNP水平;AMI患者血浆BNP水平的改变早于心脏结构的变化,血浆BNP水平可作为治疗AMI的一个灵敏观察指标。

Objective To ohserve effect of simvastatin on the change of left ventricular function and plasma level of brain natriuretic peptide （ BNP） in acute myocardial infarction patients. Methods LVEDd, LVEF, left ventricular fractional shortening（LVFS） of 80 patients with acute myocardial infarction and 20 healthy controls were examined hy echocardiography and their plasma concentrations of BNP were measured by enzyme - linked immunosorbent assay （ ELISA）. The myocardial infarction group were further subdivided into conventional group or simvastatin group. The parameters were re - tested on 3rd week and 3rd month. Results LVEDd,LVEF,LVES improved significantly after 3 - month treatment alone, the plasma BNP level decreased significantly after 3 - week or 3 - month treatment （ P 〈 0.01 ）. The decreased level of these parameters were greater in simvastatin - treatment group than those in conventional group（ P 〈 0.05 ）. The plasma BNP in myocardial infarction patients were apparently higher than those in healthy subjects and negatively correlated with LVEF （ P 〈 0.01 ）. Conclusions The long - term treatment of simvastatin may improve cardiac function and decrease the plasma BNP. The changes of BNP is earlier than that of the parameters and plasma BNP can be used as a sensitive index for the treatment of acute myocardial infarction.