阿托伐他汀对冠心病合并心力衰竭患者心功能与预后的影响

Effects of Atorvastatin on the Cardiac Function and the Prognosis in Patients with Coronary Heart Disease Complicated with Heart Failure

目的探讨阿托伐他汀对冠心病合并心力衰竭患者心功能及预后的影响。方法选择2012年1月至2013年12月广元市中医院确诊为冠心病合并心力衰竭的住院患者112例为研究对象,依据抽签法分为研究组和对照组,各56例。对照组仅给予常规抗心力衰竭治疗,研究组在给予常规抗心力衰竭药物治疗的同时,每日服用阿托伐他汀(阿托伐他汀钙胶囊,起始剂量为10 mg)联合治疗。两组的疗程均为1个月。分别观察两组患者治疗前后心功能指标和血清肌钙蛋白I的变化情况。两组患者均随访1年,观察随访期间两组患者心力衰竭再住院率和主要不良心血管事件的风险。结果治疗后,研究组左心室舒张末期内径小于对照组[(55.3±3.4)mm比(57.5±3.2)mm],左心室射血分数和6 min步行试验距离大于对照组[(51.5±4.2)%比(46.3±4.4)%、(492.7±56.3)m比(390.7±57.4)m](P<0.01)。研究组治疗后心功能评级Ⅰ级9例,Ⅱ级31例,Ⅲ级11例,Ⅳ级5例;对照组治疗后心功能评级Ⅰ级2例,Ⅱ级18例,Ⅲ级21例,Ⅳ级15例,差异有统计学意义(P<0.01)。治疗后,研究组血清肌钙蛋白I水平低于对照组[(0.12±0.03)μg/L比(0.14±0.03)μg/L](P<0.01);研究组患者心力衰竭再住院率显著低于对照组[22.0%(11/50)比43.4%(23/53)](P<0.01)。结论对于冠心病合并心力衰竭的患者,阿托伐他汀可显著降低其血清肌钙蛋白I水平,改善其心功能,并显著降低这类患者的心力衰竭再住院率,但其未能改善患者的预后。

Objective To study the effects of atorvastatin on the cardiac function and the prognosis in patients with coronary heart disease complicated with heart failure. Methods From Guangyuan Hospital of Traditional Chinese Medicine between Jan. 2012 and Dee. 2013,112 patients hospitalized for coronary heart disease complicated with heart disease were selected and randomly divided into a study group and a control group ,56 patients each. The control group was only treated with conventional medication of anti-heart failure ,while the study group was given additional atorvastatin 10 mg daily. Then the cardiac function indexes before and after treatment in the two groups, and the changes of cardiac troponin Ⅰ levels before and after one month of treatment were observed. Both groups were followed up for one year, and the rates of rehospitalization for heart failure and the risk of the major adverse cardiovascular events were observed. Results After treatment, the cardiac function index left ventricnlar end-diastolic dimension, left ventricular ejection fraction, 6-minute walk test in the study group were significantly better than those in the control group[ （55.3 ± 3.4） mm vs （57.5 ± 3.2） ram, （51.5 ± 4. 2 ） % vs （46. 3 ± 4.4 ） %, （492. 7 ± 56. 3 ） m vs （ 390. 7 ± 57.4） m ] （ P 〈 0. 01 ）. Evaluation of cardiac function in two groups after treatment ： in the study group, there were 9 cases of grade Ⅰ ,31 cases of grade Ⅱ , 11 cases of grade Ⅲ ,5 cases of grade Ⅳ ;in the control group,there were 2 cases of grade Ⅰ , 18 cases of grade Ⅱ ,21 cases of grade Ⅲ, 15 cases of grade Ⅳ, and there was significant difference between the two groups （P 〈 0. 01 ）. One month after treatment, the levels of cardiac troponin Ⅰ of the study group and control group were （0. 12 ±0. 03） μg/L, （0. 14 ±0. 03） μg/L respectively,with statistically significant difference（P 〈0. 01 ）. The heart failure readmission rate of the study group was significantly lower than that of the control group[22. 0% （11/50） vs 43.4% （23/53） ] （P 〈0. 01 ）. Conclusion For the patients of coronary heart disease complicated with heart failure, atorvastatin can significantly reduce the cardiac troponin Ⅰ levels, improve the cardiac function and obviously reduce the rate of rehospitalization for heart failure,but it has no beneficial effect on the prognosis.