普伐他汀对心力衰竭血浆脑钠素及心功能的研究

The Effects of Pravastatin on Cardiac Function and Plasma Level of Brain Natriuretic Peptide in Patients with Heart Failure

目的探讨在慢性心力衰竭患者普伐他汀治疗对血浆脑钠素水平和心功能的影响及其关系。方法56例慢性心力衰竭患者随机分为常规治疗组(26例)和普伐他汀治疗组(30例),剂量为10mg,每晚1次,疗程8周,测定左室舒张末内径、左室射血分数、血浆BNP浓度和总胆固醇在治疗前后的变化。结果普伐他汀治疗8周后,血浆BNP浓度由(218.6±64.2)pg/mL降至(149.4±50.1)pg/mL(P<0.01);LVEF由(34.4±3.4)%升至(45.4±4.9)%(P<0.05),LVDd由(65.5±5.1)mm降至(45.4±4.9)mm,改善程度明显好于对照组;普伐他汀治疗前后,患者血浆BNP降低值与LVEF增加存在良好的负相关(r=-0.71,P<0.01),而与LVDd减小呈正相关(r=0.79,P<0.01)。结论普伐他汀能明显改善慢性心力衰竭患者的血流动力学,抑制神经内分泌的过度激活,改善心功能;血浆BNP可作为评价他汀类药物治疗CHF疗效的监测指标之一。

Objective To investigate the changes of cardiac function and plasma brain natriuretic peptide（BNP）levels in patients with chronic heart failure（CHF） after pravastatin treatment. Methods 56 patients with CHF who had already received conventional therapy were randomly divided into two groups, the pravastatin group （30 patients） and the conventional group （26 patients）. Patients in the pravastatin group were given pravastatin 10mg/d for 8 weeks. Plasma BNP,TC levels and echocardiographic indices were evaluated before and after 8 weeks＇ therapy. Results Pravastatin significantly decreased LV diastolic dimensions [LVDd： （ 65.5 ＋_ 5.1 ） mm vs （45.4 ± 4.9）mm] （P 〈 0.05 ）, increased LV ejection fraction[LVEF ： （34.4 ± 3.4）% vs （45.4 ± 4.9）%]（P〈 0.05） ,and attenuated BNP[（218.6 ± 64.2）pg/mL vs （ 149.4 ± 50.1 ） pg/mL]（P〈 0.01 ） compared with the patients in the conventional group. Meanwhile,changes in BNP level were positively correlated with those in LVDd （r -- 0.79, P 〈 0.01 ）, and negatively correlated with those in LVEF （r = -0.71, P 〈 0.01 ）. Conclusion Pravastatin may stabilize hemodynamics,suppress neurohormonal activation,and improve cardiac function in CHF patients and plasma BNP level may serve as a therapeutic indicaion for statin treatment in CHF patients.