阿托伐他汀钙对扩张型心肌病伴慢性充血性心力衰竭患者心功能及预后的影响

Effect of atorvastatin calcium on heart function and prognosis in patients with non-ischemic cardiomyopathy

目的:观察阿托伐他汀钙对扩张型心肌病(DCM)伴慢性充血性心力衰竭(CHF)患者血浆低密度脂蛋白胆固醇(LDL-C)、C反应蛋白(CRP)、心房利钠肽(ANP)和脑利钠肽(BNP)水平的影响,探讨阿托伐他汀钙对心脏内分泌的病理生理影响及可能机制。方法:86例患者入选,其中阿托伐他汀钙组44例,另42例为对照组。分别于治疗前和治疗12个月后测定LDL-C、CRP、ANP和BNP,以X线胸片及超声心动图评价心脏结构与心功能变化。结果:阿托伐他汀钙治疗12个月后,患者症状明显改善,总有效率95.5%,心输出量、心脏指数及左室射血分数均有明显提高,但左室舒张末内径及X线心胸比例未见明显缩小,治疗后血浆LDL-C、CRP、ANP、BNP水平显著降低。1年预后明显改善,患者对阿托伐他汀钙耐受良好。结论:阿托伐他汀钙治疗DCM伴CHF患者,可明显减轻患者症状,LDL-C与CRP显著降低,心脏内分泌功能显著改善。这种心脏内分泌变化有益于心力衰竭短期预后。

Objective To investigate the effect of atorvastatin calcium on plasma levels of low density lipoprotein cholesterol （LDL-C）, C-reactive protein （CRP）, atrial natriuretic peptide （ANP）, and brain natriuretic peptide （BNP） in patients with dilated cardiomyopathy （DCM） complicated with chronic heart failure （CHF）. Methods 86 patients with DCM complicated with CHF were divided into atorvastatin calcium group （n = 44） and control group （n = 42）. Plasma levels of LDL-C, CRP, ANP and BNP were measured before and 12 months after treatment. The changes of cardiac structure and function were examined by ultrasound and X-ray. Results 12 months after atorvastatin calcium treatment, symptoms in patients were improved （total effective rate was 95.5%）. Cardiac output, cardiac index, and ejection fraction were increased. Plasma levels of LDL-C, CRP, ANP, and BNP were significantly decreased （P 〈 0.01 ）. One-year prognosis was improved. All patients were tolerant to atorvastatin calcium treatment. Conclusion Atorvastatin calcium can improve the symptoms in patients, reduce plasma levels of LDL-C and CRP, and improve cardio-endocrine function in patients with DCM complicated with CHF.