阿托伐他汀对慢性肺源性心脏病患者肺动脉高压的影响

Effect of atorvastatin on pulmonary hypertension in chronic pulmonary heart disease

目的探讨阿托伐他汀对慢性肺源性心脏病（肺心病）患者肺动脉高压的影响及其机制。方法将68例肺心病慢性缓解期患者随机分为治疗组（35例）和观察组（33例），选取同期进行体检的健康人30名作为正常组。两组患者均接受常规治疗，观察组在常规治疗的基础上加用阿托伐他汀（20mg／d），观察两组治疗前、治疗后6个月肺功能、超声心动图、血浆中超敏C反应蛋白（hs-CRP）、白细胞介素8（IL．8）水平的变化。结果治疗组、观察组血浆中hs-CRP，IL-8浓度及肺动脉压（PAP）治疗前明显高于正常组（t值分别为2．87，2．79，3．01，3．28，3．31，3．15；P值分别为0．005，0．007，0．004，0．001，0．001，0．002）。观察组治疗6个月后PAP、hs-CRP、IL-8较治疗前和治疗组治疗6个月后明显下降（t值分别为2．17，2．59，2．63，1．91，1．86，1．74；P值分别为0．039，0．008，0．007，0．031，0．037，0．042），第1秒用力呼气容积（FEV1）、FEV，／用力肺活量（FVC）指标比治疗组治疗6个月后有明显改善（t值分别为1．84，2．13；P值分别为0．037，0．024）；治疗组治疗前与治疗后6个月上述指标比较差异均无统计学意义（P均〉0．05）。结论阿托伐他汀可以改善慢性肺心病患者生活质量及肺功能、降低PAP，这些作用可能与阿托伐他汀抑制肺血管炎性反应有关。

Objective To explore the effect and mechanism of atorvastatin on pulmonary hyper-tension in chronic pulmonary heart disease. Methods Sixty eight patients with chronic pulmonary heart disease were randomly divided into treatment group （ n = 35 ） and observation group （ n = 33 ）. Thirty healthy people were picked up from people taking physical examination at the same stage as control group. Patients in both treatment and observation groups were given routine treatment and the observation group were given atorvastatin （20 mg/ d） supplement. Changes in pulmonary function, ultrasound cardiogram, plasma high-sensitive C-reactive protein （hs-CRP） and interleukin （IL-8） were observed before and after 6 months of treatment. Results The levels of hs-CRP, IL-8 and pulmonary arterial pressure in treatment and observation groups are higher than that in normal group before treatment （ t = 2. 87,2.79,3.01,3.28,3.31,3.15, respectively, and P = O. 005,0. 007, O. 004, O. 001,0. 001,0. 002, respectively）. The pulmonary arterial pressure, hs-CRP, IL-8 in observation group after treated for 6 months were significantly lower than those before treatment and in treatment group（ t = 2. 17,2. 59, 2. 63,1.91,1.86, 1.74, respectively, and P -- O. 039, O. 008, O. 007,0. 031, O. 037, O. 042, respectively）. The pulmonary function indexes including FEV1 and FEV1/FVC in observation group were much better than those in treatment group after 6 months treatment （ t = 1.84,2. 13, respectively, and = 0. 037,0. 024, respectively）. There were no significant differences on these indicators in treatment group after 6 months treatment when compared with before treatment （P 〉 O. 05 ）. Conclusion Atorvastatin can effectively improve the life quality and pulmonary function, decrease pulmonary arterial pressure of patients with chronic pulmonary heart disease. These effects may be related to the inhibition of inflammation in pulmonary vessels.