阿托伐他汀对冠心病心力衰竭患者血浆钠尿肽水平及心功能的影响

Effect of atorvastatin on level of B-type natriuretic peptide and cardiac function in patients with coronary heart disease and heart failure

目的:观察阿托伐他汀对冠心病心力衰竭(心衰)患者血浆钠尿肽(BNP)水平和心功能的影响。方法:将128例冠心病心衰(心功能Ⅱ～Ⅲ级)患者随机分为10mg阿托伐他汀组(A组)、20mg阿托伐他汀组(B组)和对照组(C组),3组均给予抗心衰基础治疗,A组加服阿托伐他汀10mg/d,B组加服阿托伐他汀20mg/d。治疗前及治疗后12周时测定血浆BNP、血清高敏C反应蛋白(hs-CRP)水平、6min步行试验,并采用超声心动图测量左心室射血分数(LVEF)。结果:3组患者治疗12周时心功能指标、血浆BNP水平及血清hs-CRP水平均较治疗前明显改善,2种剂量治疗组血浆BNP、血清hs-CRP水平均降低,LVEF均升高,与对照组比较差异有统计学意义(P<0.01)。A、B治疗组的6min步行距离明显增加,与对照组比较,差异有统计学意义(P<0.05);而A、B治疗组间血浆BNP水平、血清hs-CRP水平、LVEF及6min步行距离无差异。结论:冠心病心衰患者在基础治疗上加用小剂量阿托伐他汀即可以降低BNP水平及血清hs-CRP水平,进一步改善心功能,抑制心肌微炎症可能是该药机制之一。

Objective To observe the effect of atorvastatin on level of B-type natriuretic peptide（BNP）and cardiac function in patients with coronary heart disease（CHD） and heart failure（HF）.Methods One hundred and twenty-eight patients with CHD and HF（NYHAⅡ-Ⅲdegree） were randomly divided into atorvastatin A group,atorvastatin B group and control group.All patients were given HF basic treatment.Patients in atorvastatin A group were given additionally atorvastatin 10 mg/d.and in atorvastatin B group 20 mg/d.The plasma level of BNP,serum level of high-sensitivity Creactive protein（hs-CRP） and 6 minutes walking test（6MWT） were determined before treatment and 12 weeks after treatment.The left ventricular ejection fraction（LVEF） was measured by echocardiography.Results The cardiac function,plasma BNP and serum hs-CRP in all three groups improved obviously after 12 weeks treatment.LVEF increased significantly（P〈0.01）,and BNP and hs-CRP decreased significantly（P〈0.01） in the two atorvastatin treated groups when compared with that in control group.Six minutes walking distance of the two atorvastatin treatment groups was significantly greater than that of control group（P0.05）.No significant differences in these parameters were found between the two atorvastatin treatment groups.Conclusions On the basis of basic HF treatment,the addition of small dose of atorvastatn could decrease plasma BNP and serum hs-CRP levels and further improve cardiac function in patients with CHD and HF,and the inhibition of myocardial micro-inflammation might be one of the mechanisms.