早期强化降脂对稳定型心绞痛患者运动耐量的影响

Study on effect of early intensive lipid- lowering therapy on exercise tolerance in patients with stable angina

目的探讨早期强化降脂对稳定型劳力型心绞痛患者运动耐量的影响。方法随机将180例入选稳定性劳力型心绞痛患者分为两组:对照组90例在常规抗心绞痛治疗基础上每晚睡前口服阿托伐他汀10 mg;治疗组90例在常规抗心绞痛治疗基础上每晚睡前口服阿托伐他汀40 mg,共12周。治疗前后均行运动平板试验和6分钟步行试验(6MWT)。观察服药前后每周心绞痛发作的次数、运动诱发心绞痛发作所需时间、记录运动持续时间、运动后ST段下降≥1 mm所需时间、6MWT距离。结果两组患者治疗后运动诱发心绞痛发作所需时间、诱发ST段下降≥1 mm所需时间均较治疗前明显延长,运动持续时间增加,6MWT距离明显增加,治疗前后比较差异有统计学意义(P<0.05或P<0.01)。而治疗组各临床指标均显著优于对照组(P<0.05)。结论早期强化降脂治疗能明显改善稳定性劳力型心绞痛患者的临床症状,减轻运动诱发的心肌缺血,还能提高心绞痛患者的运动耐量。

Objective To explore the effect of early intensive lipid- lowering therapy on stability of exercise tolerance in patients with laborious angina. Methods A total of 180 cases of laborious angina were randomly divided into two groups,90 cases in control group were treated on the basis of conventional anti- angina treatment every night with 10 mg atorvastatin before going to bed,and 90 cases in trial group were treated on the basis of conventional anti- angina treatment with oral atorvastatin 40 mg every night before going to bed,and the therapeutic course was 12 weeks. Athletic flat test and 6 minutes walk test（ 6 MWT） were performed before and after treatment. The attack times of angina pectoris in each week were observed before and after medication,the duration of movement needed for inducing angina after exercise had been recorded. The induced decline of ST segment greater than 1 mm was the time needed for. The distance of walk test for 6 minutes was also observed. Results The time needed for movement induce angina attack and induced ST segment decline in patients of 2 groups after treatment greater than 1 mm was significantly prolonged. The duration for exercise was increased,and 6 minutes walking distance test was also significantly increased. The difference in comparison before and after treatment was statistically significant（ P 0. 05,or P 0. 01）. The above indexes in trial group after treatment were obviously better than those of control group. Their difference was statistically significant（ P 0. 05）. Conclusion Early intensive lipid-lowering therapy can significantly improve the clinical symptoms in patients with stable angina,and it may improve the movement induced myocardial ischemia. It can also improve the exercise tolerance of patients with angina pectoris.