氟伐他汀对扩张型心肌病患者血炎症介质及心功能的影响

Effect of fluvastatin on cytokines and cardiac function in patients with idiopathic dilated cardiomyopathy

目的研究氟伐他汀对扩张型心肌病患者血清细胞因子水平及心功能的影响。方法心功能Ⅱ、Ⅲ级的扩张型心肌病患者随机分为2组。氟伐他汀组(n=32例)每日口服氟伐他汀40mg,对照组(30例)不用降脂药物。于研究开始及6个月结束时监测血清肿瘤坏死因子α(TNF-α)、白细胞介素-6(IL-6)、血清超敏C反应蛋白(hs-CRP)水平,监测肝酶及肌酶变化及左心室射血分数(LVEF)。结果氟伐他汀组及对照组治疗后的LVEF均较治疗前明显改善,差异有统计学意义(t分别=5.75、6.78,P均<0.05);两组的血TNF-a、IL-6及hs-CRP水平在治疗前后比较,差异均无统计学意义(t分别=1.37、0.46、1.73、0.37、0.63、0.46,P均>0.05);但对于心功能Ⅲ级患者氟伐他汀组能显著降低血TNF-a、IL-6水平(t分别=2.55、2.77,P均<0.05),与对照组治疗后比较,差异也有统计学意义(t分别=2.13、2.05,P均<0.05)。治疗后的氟伐他汀组LVEF较对照组明显提高(t=2.80,P<0.05)。结论对心功能Ⅲ级的扩张型心肌病患者使用氟伐他汀治疗有一定的治疗价值,但对扩张型心肌病患者中常规缺乏依据。

Objective To investigate the effect of fluvastatin on cytokines and cardiac function of patients with idiopathic dilated eardiomyopathy. Methods Idiopathic dilated eardiomyopathy patients with NYHA class Ⅱ or Ⅲ were randomly divided into ：2 groups.Fluvastatin group received fluvastatin 40 mg per clay and control group received no lipid-lowering drugs.At the beginning and after 6 months of the study the serum levels of tumor necrosis faetor-α （TNF-α）, interleukin-6 （IL--- 6）,high-sensitivity C-reactive protein （hs-CRP） and left ventrieular ejection fraction （LVEF） were measured. Results The LVEF was significantly improved after therapy in both fluvastatin and control group （t=5.75, 6.78, P〈0.05）;The serum levels of TNF-a, IL-6 or hs-CRP did not change significantly （t= 1.37,0.46,1.73,0.37,0.63,0.46, P〉0.05）;But after therapy in patients with NYHA III the serum levels of TNF-α,IL-6 were decreased significantly in fluvastatin group （t=2.55,2.77, P〈0.05）, and also decreased when compared with control group （t= 2.13,2.05, P 〈0.05）; Meanwhile the LVEF after fluvastatin treatment was significantly improved when compared with control group in patients with NYHA Ⅲ （t=2.80, P〈0.05）. Conclusion Fluvastatin should not be used routinely in patients with idiopathic dilated eardiomyopathy, but it may be beneficial to those with NYHA Ⅲ.