卡维地洛加普伐他汀对冠心病慢性心力衰竭患者心功能的影响

Effect of Combined Carvedilol-Pravastatin Treatment on Cardiac Function of Patients with Coronary Heart Disease and Chronic Heart Failure

目的探讨卡维地洛加普伐他汀对冠心病心力衰竭患者末端脑钠肽原(N-terminal pro-brain natriuretic peptide,NT-proBNP)及心肌肌钙蛋白I(cardiac troponin I,cTnI)水平及心功能的影响。方法将183例冠心病心衰患者随机分为卡维地洛组(63例)、普伐他汀组(58例)和卡维地洛普伐他汀联合用药组(62例)。3组均在常规抗心力衰竭治疗基础上分别加用一定剂量的上述药物,疗程12周。观察患者治疗前后纽约心脏病学会(New York heart association,NYHA)心功能分级和血压、心率变化;采用超声心动图测定患者前后左心室舒张末期内径(left ventricular end diastolic diameter,LVEDD)、左心室收缩末期内径(left ventricular end diastolic diameter,LVESD)和左心室射血分数(leftventricular ejection fraction,LVEF);治疗前后进行6 min步行试验(6-min walking test,6-MWT),采用酶联免疫吸附测定(enzyme-linked immunosorbent assay,ELISA)法检测患者治疗前后NT-proBNP、cTnI水平变化,观察3个月内患者再住院率和心血管事件发生率。结果治疗12周后,3组患者的LVEF与LVEDD、LVESD和血压、心率均得到明显的改善(P<0.05),血浆中NT-proBNP与cTnI分子水平均呈现明显下降(P<0.05),6-MWT提高明显(P<0.05)。卡维地洛加普伐他汀组治疗效果最明显,且再住院率和心血管事件发生率明显低于其他2组(P<0.05)。结论卡维地洛加普伐他汀联合用药组可以降低冠心病慢性心力衰竭患者的NT-proBNP、cTnI水平,改善心功能。

Objective To investigate the effect of combined carvedilol-pravastatin treatment on N-terminal pro-brain natriuretic peptide（NT-proBNP） and cardiac troponin I（cTnI） levels and cardiac function of patients with coronary heart disease and chronic heart failure.Methods A total of 183 patients with coronary heart disease and heart failure were randomly divided into the carvedilol group（63 cases）,the pravastatin group（58 cases） and joint carvedilol-pravastatin group（62 cases）.These groups were administrated with the corresponding drugs besides the conventional anti-failure therapy for 12 weeks.The heart function classification according to New York Heart Association（NYHA）,the blood pressure and heart rate were measured before and after treatment.The left ventricular end-diastolic diameter（LVEDD）,left ventricular systolic final inner diameter（LVESD） and left ventricular ejection fraction（LVEF） were measured by echocardiography.The 6-minute walk test（6-MWT） was performed before and after treatment.The NT-proBNP and cTnI levels were tested by enzyme-linked immunosorbent assay（ELISA）.The eadmission rates and incidence of cardiovascular events in three months were observed.Results After 12 weeks of treatment,LVEF,LVEDD,LVESD,blood pressure and heart rate in all the 3 groups were significantly improved（P〈0.05）,the plasma NT-proBNP and cTnI levels were significantly decreased（P〈0.05）,and 6-MWT were significantly increased（P〈0.05）.The treatment effect was the most obvious,the re-hospitalization rates and the incidence of cardiovascular events was the lowest in the joint carvedilol-pravastatin group（P〈0.05）.Conclusion Combined utilization of carvedilol and ravastatin can reduce the NT-proBNP and cTnI levels and improve the cardiac function of patients with coronary heart disease and chronic heart failure.