不同剂量阿托伐他汀对老年冠心病合并心房颤动患者炎症因子及预后的影响

Effects of varied dosage atorvastatin on inflammatorv factors and prognosis in aged patients with coronary heart disease and atrial fibrillation

目的:观察不同剂量阿托伐他汀对老年冠心病合并心房颤动(房颤)患者炎症因子及预后的影响,探讨阿托伐他汀抗房颤的可能机制。方法:将100例老年冠心病合并房颤患者随机分为2组,10mg阿托伐他汀组和20mg阿托伐他汀组,观察2组患者治疗前后血清炎症因子[高敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]、左心房内径(LAD)及心房利尿钠肽(ANP)的变化,同时记录治疗6个月后2组患者窦性心律维持率及栓塞事件发生率。结果:治疗后,2组hs-CRP、IL-6、TNF-α、ANP水平及LAD内径均较治疗前降低(P<0.05),且20mg阿托伐他汀组降低更明显(P<0.05),同时20mg阿托伐他汀组较10mg阿托伐他汀组窦性心律维持率高,栓塞事件发生率低(P<0.05)。结论:阿托伐他汀能降低老年冠心病合并房颤患者血清炎症因子水平,同时能降低ANP水平及LAD内径,提高窦性心律维持率、降低栓塞事件发生率,且呈剂量依赖性,这可能是阿托伐他汀发挥抗房颤作用的机制之一。

Objective：To observe the effects of different dosages of atorvastatin on serum inflammatory factors and prognosis in patients with coronary heart disease （CHD） and atrial fibrillation （Af）,and to investigate its possible mechanism of anti-atrial fibrillation.Method：One hundred aged patients with CHD and atrial fibrillation were randomly divided into two groups：10 mg atorvastatin group （n=50） and 20 mg atorvastatin group （n=50）.Changes of levels of serum inflammatory factors （high sensitive C-reactive protein,tumor necrosis factor-alpha,interleukin-6）,left atrium diameter （LAD） and atrial natriuretic peptide （ANP） in two groups were observed before and after treatment.Maintenance rate of sinus rhythm and incidence rate of embolism were also recorded at the 6th month after treatment.Result：The serum levels of hs-CRP,IL-6,TNF-α were significantly decreased in 6 months after treatment in both groups compared to those before treatment （P〈0.05）,especially in the 20 mg atorvastatin group （P〈0.05）.LAD and ANP in 20 mg atorvastatin group were significantly smaller than those in 10 mg atorvastatin group （P〈0.05）;Maintenance rate of sinus rhythm was significantly higher and incidence rate of embolism was obviously lower in 20 mg atorvastatin group than that in 10mg atorvastatin group at the 6th month （P〈0.05）.Conclusion：Atorvastatin could reduce levels of serum inflammatory factors,LAD,ANP and incidence rate of embolism and increase the maintenance rate of sinus rhythm in aged patients with CHD and Af.Those effects were dose dependent.The inhibitory effect of atorvastatin on serum inflammatory factors may be one of its anti-Af mechanisms.