辛伐他汀改善慢性肺源性心脏病患者右心室功能的作用研究

Effect of simvastatin on right ventricular function in patients with chronic obstructive pulmonary diseases

目的评价辛伐他汀改善慢性肺源性心脏病(肺心病)患者右心室功能的作用及相关机制。方法选择2009年2月至2010年4月55例老年慢性阻塞性肺病(COPD)合并慢性肺心病患者,按随机数字表法分为辛伐他汀组(27例)和常规治疗组(28例)。两组均接受常规治疗,辛伐他汀组在常规治疗的基础上加用口服辛伐他汀(20 mg/d)。比较辛伐他汀组及常规治疗组治疗前、治疗后6个月血浆中一氧化氮(nitric oxide,NO)、内皮素I(endothelin-1,ET-1)、脑钠肽(brain natriuretic peptide,BNP)、右心室功能和肺动脉压。结果辛伐他汀组治疗6个月后ET-1、BNP、Tei指数、肺动脉压较治疗前和常规治疗组治疗6个月时明显下降,差异有统计学意义(P<0.05);常规治疗组治疗前、治疗后6个月上述指标比较,差异无统计学意义(P>0.05)。结论辛伐他汀可调节NO、BNP及ET-1的分泌,从而有效降低肺动脉压及改善右心功能。

Objectives To evaluate the effects of simvastatin on right ventricular function in patients with chronic obstructive pulmonary disease （COPD） and to explore the protective mechanism. Methods Fifty five patients with COPD were randomly divided into simvastatin group （n=27） and routine group （n=28） from Feb. 2009 to Apr 2010. Both two groups were given routine treatment and the simvastatin group were given simvastatin （20 mg/d） supplement in addition. Nitric oxide （NO）, endothelin-1 （ET-1）, brain natriuretic peptide （BNP）, Tei index and pulmonary arterial pressure were measured before treatment and after six months treatment. Results In simvastatin group, endothelin-1, BNP, Tel index and pulmonary arterial pressure decreased significantly while NO increased significantly after 6 months when compared with routine group and before treatment （both P〈0.05 ）. However, there were no significant changes of above parameters in routine group before and after treatment（P〉0.05 ）. Conclusions Simvastatin could adjust synthesis and secretion of NO, ET-1 and BNP which can efficiently decrease pulmonary arterial pressure and improve right veutricular function.