氟伐他汀对原发性高血压患者心脏肥厚及舒张功能的影响

Effect of fluvastatin on ventricular hypertrophy and diastolic function in essential hypertension

目的:探讨他汀类药物能否改善原发性高血压患者的左心室肥厚(left ventricular hypertrophy,LVH)及心脏舒张功能。方法:对110例血脂正常或轻度升高的原发性高血压患者采用随机、单盲、对照研究。用非洛地平降压同时分别加用氟伐他汀或安慰剂治疗24周。于治疗前、后检测室间隔厚度(IVS)、左心室后壁厚度(LVPW)、左心室舒张末期内径(LVDd),计算出左心室质量(LVM)及心肌重量指数(LVMI);测量及记录舒张早期及舒张晚期最大速度。检测血浆I型前胶原羧基端肽(PIP)及脑钠肽(BNP)。结果:联合治疗组较安慰剂组血压达标率增加,脉压减小,24周后血浆PIP及BNP水平降低,LVMH、LVMI显著降低(P<0.05);同安慰剂组相比,联合治疗组24周后二尖瓣后叶瓣环与左室侧壁交界处舒张早期及舒张晚期最大速度之比增加(P<0.05)。结论:高血压患者加用氟伐他汀可使心肌纤维化的相关指标改善、血压降低,逆转左心室肥厚及改善心脏舒张功能。

Objective：To investigate whether statins have the improvement effects on the left ventricular hypertrophy（LVH） and diastolic function of both left and right ventricles in essential hypertension（EH） patients.Methods：The randomized,mono-blind,placebo controlled study was adopted.110 EH patients with normal or slightly elevated cholesterol randomly took placebo or fluvatain（40 mg once per night） for 24 weeks.Felodipine tablets were given to EH patients.The left ventricular posterior wall thickness（LVPW）,the left ventricular end diastolic dimension（LVDd） and interventricular septal thickness（IVS） were detected before and after treatment.The left ventricular mass（LVMH） and the left ventricular mass index（LVMI） of two groups were calculated after Doppler examination.Early diastolic velocity（Em） and late diastolic velocity（Am） were obtained from left atrioventricular ring with pulsed wave tissue Doppler imaging at baseline and 24 weeks after fluvastain therapy.Plasma was obtained at baseline and 24 weeks after fluvastain therapy.Cholesterol and carboxy-terminal peptide of procollagen type I（PIP） and brain natriuretic peptide（BNP） were measured.Results：The levels of plasma PIP and BNP were higher in EH patients.After 24 weeks,the levels of plasma LDL-C,TC,BNP and PIP,LVM and LVMI were significantly lower in Fluvatain group than those in placebo group.Systolic and diastolic pressures were decreased both in placebo group and fluvatain group,meanwhile pulse pressure（PP） was decreased and Em/Am ratio at left atrioventricular ring was higher in fluvatain group as compared with those in placebo group.Conclusion：In EH patients,fluvatain exerts a beneficial effect on diastolic function of left ventricule via controlling blood pressure,lowering blood lipid and inhibiting myocardial fibrosis.