普伐他汀治疗AMI急诊PCI术后CHF患者血浆NT-proBNP和MMP-2的变化及与左室重构的关系

Changes of plasma NT-ProBNP and MMP-2 levels and relationship with left ventricular remodeling in patients treated by pravastatin with CHF after PCI therapy for AMI

目的观察他汀类药物普伐他汀对急性心肌梗死(AMI)急诊经皮冠状动脉介入术(PCI)后较为稳定的慢性心力衰竭(CHF)患者氨基末端脑钠肽前体(NT-proBNP)、基质金属蛋白酶-2(MMP-2)和左室重构的影响及相关性。方法96例AMI急诊PCI术后CHF患者(NYHA分级Ⅱ/Ⅲ)随机分为普伐他汀20 mg组(普伐他汀20 mg/d治疗,n=52)和普伐他汀40 mg组(普伐他汀40 mg/d治疗,n=44),比较两组治疗前一般资料、两组治疗前和治疗18个月后血浆NT-proBNP和MMP-2水平以及左室重构相关指标的变化,并分析其相关性。结果两组治疗后血浆NT-proBNP和MMP-2水平均较治疗前显著降低(P<0.05),治疗后普伐他汀40 mg组血浆NT-proBNP和MMP-2水平显著低于普伐他汀20 mg组(P<0.05)。普伐他汀治疗后,两组左室质量指数(LVMI)、左室舒张末期内径(LVEDD)、舒张末左室后壁厚度(LVPWT)较治疗前均显著降低(P<0.01),普伐他汀40 mg组LVMI、LVEDD、LVPWT显著小于普伐他汀20 mg组(P<0.01);两组舒张末室间隔厚度(IVST)、左室短轴缩短率(FS)、左室平均周径缩短率(MVCF)、二尖瓣口多普勒舒张早期最大流速与舒张末期最大流速比率(E/A)较治疗前均显著增加(P<0.01),普伐他汀40 mg组IVST、FS、MVCF、E/A显著大于普伐他汀20 mg组(P<0.01)。两组治疗前后血浆NT-proBNP和MMP-2的下降水平均与LVMI、LVEDD、LVPWT减少呈正相关,均与IVST、FS、MVCF、E/A增加呈负相关;NT-proBNP、MMP-2下降水平两者呈正相关(均P<0.05)。结论他汀类药物普伐他汀对AMI急诊PCI术后较为稳定的CHF患者心功能改善有益,这可能与其抑制MMP-2、减轻左室重构作用相关。

Objective To observe the effects of pravastatin on plasma N-terminal pro-brain natriuretic peptide （NT- ProBNP）, matrix metalloproteinase-2 （MMP-2） and left ventricular remodeling in patients with stable chronic heart failure （CHF） after percutaneous coronary intervention （PCI） therapy for acute myocardial infarction （AMI）, and explore their relationship. Methods Ninety-six patients with CHF （ II/III of NYHA Classification） after PCI therapy for AMI were randomly divided into pravastatin 20 mg group （treated by 20 mg pravastatin, n = 52） and pravastatin 40 mg group （treated by 40 mg pravastatin, n =44）. The general conditions before treatment by pravastatin, the changes of plasma NT-ProBNP and MMP-2 levels and parameters of left ventricular remodeling before treatment and 18 months after treatment by pravastatin were compared between two groups, and their relationship was explored. Results The plasma levels of NT-proBNP and MMP-2 after treatment were significantly lower than those before treatment in both groups （ P 〈0.05）, and the plasma levels of NT-proBNP and MMP-2 after treatment in pravastatin 40 mg group were significantly lower than those in pravastatin 20 mg group （P 〈 0. 05）. After treatment by pravastatin, left ventricular mass index （LVMI）, left ventricular end-diastolic dimension （LVEDD） and end-diastolic left ventricular posterior wall thickness （LVPWT） in both groups were significantly lower than those before treatment （P 〈 0.01）, and these parameters in pravastatin 40 mg group were significantly lower than those in pravastatin 20 mg group （P 〈 0.01）. After treatment by pravastatin, end-diastolic interventricular septal thickness （ IVST）, left ventricular shortening fraction （ FS）, mean velocity of circumferential fiber shortening of left ventricle （MVCF） and E/A in both groups were significantly higher than those before treatment （ P 〈 0. 01）, and these parameters in pravastatin 40 mg group were significantly higher than those in pravastatin 20 mg group （P 〈 0.01）. The decrease of plasma NT-proBNP and MMP-2 after treatment in both groups was positively related to the decrease of LVMI, LVEDD and LVPWT, and was negatively related to the increase of IVST, FS, MVCF and E/A （P 〈 0.05）. The decrease of plasma NT-proBNP was positively related to the decrease of MMP-2 （P 〈 0.05）. Conclusion Provastatin has beneficial effects on cardiac function of stable CHF after PCI therapy for AMI, which may be related to the inhibition of MMP-2 and left ventricular remodeling.