强化他汀对急性心力衰竭伴2型糖尿病病人内皮功能的影响

Effects of intensive atorstatin on vascular endothelial function in patients with acute heart failure and type 2 diabetes

目的探讨强化他汀治疗对急性心力衰竭(心衰)伴2型糖尿病(T2DM)病人内皮功能的影响。方法将100例急性心衰伴T2DM病人随机分为2组,每组50例。在急性心衰常规治疗的基础上,强化组给予阿托伐他汀40 mg/d治疗,对照组给予阿托伐他汀10~20 mg/d治疗。分别检测治疗前和治疗7 d后病人的低密度脂蛋白胆固醇(LDL-C),脑钠肽(BNP)和内皮微粒(EMPs)水平,强化组检测治疗前后丙氨酸氨基转移酶(ALT)和血清肌酸激酶(CK)水平,并观察强化组不良反应。随访2组病人离院后30 d内心血管事件的发生情况。结果与治疗前比较,治疗7 d后对照组仅BNP水平明显下降,强化组BNP、LDL-C、EMPs水平均显著下降(P<0.01);治疗后2组间比较,EMPs水平差异有统计学意义(P<0.01)。强化组30 d内心血管病事件发生率为14.0%,较对照组(34.0%)显著下降(P=0.019)。强化组ALT升高7例,CK升高3例,没有发生严重药物性肝损病例。结论强化他汀治疗可显著降低急性心衰合并T2DM病人的EMPs水平,降低心血管事件发生率。

Objective To investigate the effects of intensive atorvastatin on vascular endothelial function in patients with acute heart failure（AHF） complicated with type 2 diabetes mellitus（T2DM）.Methods From March 2013 to March 2014,100 patients diagnosed as AHF and T2 DM were randomly divided into intensive group（n=50） and control group（n=50）.Intensive group received atorvastatin 40 mg/d while control group received atorvastatin 10-20 mg/d on the basis of conventional treatment.The levels of low-density lipoprotein cholesterol（LDL-C）,brain natriuretic peptide（BNP）,and CD31＋/Annexin V＋endothelial microparticle（EMPs） were detected at baseline and 7 days after treatment.The levels of aminotransferase and creatinine kinase（CK） were detected at baseline and 7 days after treatment in intensive group.All patients were followed for 30 days.Results The levels of BNP in two groups were decreased significantly after 7 days＇ treatment（P〈0.01）;The levels of LDL-C and EMPs in intensive group were also decreased significantly after 7 days＇ treatment（P〈0.01）;After 7 days＇ treatment,there was significant difference between two groups in EMPs（P〈0.01）.The incidence rate of cardiovascular event of intensive group and control group was 14.0% and 34.0% respectively（P=0.019）.The levels of alanine transaminase（ALT） and CK in intensive group elevated in 3 and 7 patients respectively.There were no severe drug-induced liver damage events.Conclusions Intensive atrovastatin can improve endothelia function of AHF patients combined with T2DM,and can reduce cardiovascular events.