调脂治疗对慢性心力衰竭患者超氧化应激损伤的干预作用

Interventional effect of lipid treatment on oxidative stress in patients with chronic heart failure

目的:观察在标准抗心衰药物治疗的基础上加用他汀类调脂药物,通过对心衰患者超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GPX-3)、左室射血分数等指标影响的观察,探讨调脂治疗抑制超氧化应激损伤、改善心衰患者心脏功能的可能机制。方法:将入选慢性心力衰竭患者,随机分为标准治疗+调脂治疗组(观察组)和标准治疗组(对照组),均于治疗前后进行血液分析、血脂分析、肝功能、肾功能、电解质分析、心电图等常规检查。6个月后,观察2组治疗前后SOD、GPX-3、心脏功能及安全性指标,进行比较分析。结果:与治前比较,2组心衰患者左室射血分数(LVEF)均有一定改善,但差异无显著性,组间比较,差异亦无显著性;与治前比较,2组患者心功能分级改善,组间比较,观察组略优于对照组,但差异无显著性;与治前比较,2组SOD、GPX-3浓度均降低(P<0.01),组间比较,SOD观察组下降幅度优于对照组(P<0.01),GPX-3观察组下降幅度优于对照组(P<0.05)。与治前比较,观察组总胆固醇(TC)、低密度脂蛋白(LDL)水平降低(P<0.01),与对照组治后比较(P<0.01);观察组三酰甘油(TG)水平降低(P<0.05),与对照组治后比较(P<0.05);对照组治疗后TC、TG、LDL水平有下降,但与治前比较差异无显著性;2组治疗前后高密度脂蛋白(HDL)水平无差异。治疗前后查三大常规、肝肾功能、电解质及心肌酶学检查均无明显变化(P>0.05)。结论:在标准抗心衰治疗的基础上加用他汀类调脂药物,能进一步抑制慢性心力衰竭患者体内氧化应激反应,从而减轻超氧化应激损伤。

OBJECTIVE To oberserve the effects of antiheart failure drug therapy added with statins treatment via the detection of superuxide dismutase, glutathione peroxidase, left ventricular ejection fraction and other factors of heart failure patients , and to explore the possible mechanism of lipid lowering therapy in inhibition of superoxide dismutase injury and improving cardiac function in patients with heart failure. METHODS Patients with chronic heart failure were randomly divided into two groups ： standard treatment plus lipid treatment group （observation group） and the standard therapy group （control group）. Both groups were examined by the tests of blood analysis, blood lipid analysis, liver function, renal function, electro- lyte analysis, etc. , before and after treatment. After 6 months, the two groups were comparatively analyzed by the observetion of the superoxide dismutase （SOD）, glutathione peroxidase （GPX-3）,cardiac index function and safety before and after treat- ment. RESULTS Compared with before treatment, left ventricular ejection fraction （LVEF） of the two group were improved, but no significant difference between before and after treatment, and there was no significant difference between the two groups. Compared with before treatment, the cardiac functional grading of the two group were improved, but no significant difference between before and after treatment, and there was no significant difference between the two groups. Compared with before treatment, the density of SOD, GPX3 decreased in both groups （P〈0. 01）, and in the observation group the decrease of SOD was more significant than that in control group （P〈0. 01）, so of GPX 3（P〈0. 05）. Compared with before treatment, the observation group＇s level of TG reduced（P〈0. 01）, and there was significant difference as compared with control group（P〈 0. 01）. Compared with before treatment, the observation group＇s level of TC and LDL reduced（P〈0. 05）, and also there was significant difference as compared with control group（P〈0. 05） . the control group＇s level of TC, TG, LDL reduced after the treatment, but there was no significant difference compared with before treatment. There was no significant difference in HDL between the two groups before and after the treatment. Three conventional tests, liver and kidney function, electrolytes and myocardial enzyme examination showed no significant changes before and after the treatment（P〉0.05）. CONCLUSION The standard anti- heart failure treatment added with statins can further inhibit oxidative stress reaction in patients with chronic heart failure, thus reducing the oxidative stress.