两种剂量瑞舒伐他汀辅助治疗高龄冠心病合并CHF临床对比研究

Clinical comparative study on rosuvastatin in different doses in elderly patients with coronary heart disease complicated with chronic heart failure

目的探讨常规剂量与加倍剂量他汀类药物对高龄冠状动脉粥样硬化性心脏病（冠心病）合并慢性心力衰竭（CHF)患者心脏功能、实验室指标及活动耐量的影响。方法选取西安市第一医院心内四科2012年1月?2015年6月收治的高龄（為75岁）冠心病合并CHF患者共150例，以随机抽签法分为对照组（75例）和观察组（75例），在对症干预基础上，对照组给予常规剂量瑞舒伐他汀10mg/d，观察组给予加倍剂量瑞舒伐他汀20mg/d口服治疗；根据心衰症状改善情况评价两组患者治疗总有效率，治疗前后6min步行试验（6MWT)、高敏C反应蛋白（hs-CRP)、N末端脑钠肽原（NT-proBNP)、同型半胱氨酸（Hcy)及肿瘤坏死因子a(TNF-a)及左室收缩末期内径（LVESD)、左室舒张末期内径（LVEDD)、左心室射血分数（LVEF)。结果观察组患者平均年龄（79.12±4.86)岁，男性比例60%，对照组平均年龄（79.40±4.92)岁，男性62.7%。两组患者年龄、男性比、合并基础疾病、NYHA心功能分级及服用药物类型等一般资料比较差异无统计学意义（P>0.05);观察组患者治疗总有效率显著高于对照组（P<0.05);两组治疗前6MWT、hs-CRP、NT-proBNP、Hcy、TNF-a、LVESD、LVEDD及LVEF水平比较差异无统计学意义（P>0.05)，治疗后观察组与对照组上述指标较治疗前均有改善，且以观察组治疗后改善更为明显（P<0.05)。结论相较于常规剂量他汀类药物，加倍剂量他汀类药物用于高龄冠心病合并CHF患者可有效改善心脏功能，降低炎症反应水平，并有助于提高生活质量。

Objective To investigate the influence of statins in routine and double doses on heart function,laboratory indexes and exercise tolerance in elderly patients with coronary heart disease(CHD)complicated withchronic heart failure(CHF).Methods The patients(aged^75,n=150)were chosen from the Fourth Departmentof Cardiology of the First Hospital of X i’an City from Jan.2012to Jun.2015,and randomly divided into controlgroup and observation group(each n=75).On the base of symptomatic intervention,control group was orally givenrosuvastatin(10mg/d)and observation group was orally given rosuvastatin(20mg/d).The total effective rate,6-m inute walk test(6MWT),high sensitivity C-reactive protein(hs-CRP),N-term inal pro-brain natriuretic peptide(NT-proBNP),homocysteine(Hcy),tumor necrosis factor-a(TN F-a),left ventricular end-systolic diam eter(LVESd),left ventricular end-diastolic inner diam eter(LVEDd)and left ventricular ejection fraction(LVEF)beforeand after treatment were reviewed according to relief of CHF symptoms.Results In observation group,the averageage of patients was(79.12±4.86)and ratio of male cases was60%,and in control group,the average age of patientswas(79.40±4.92)and ratio of male cases was62.7%.The difference in age,male ratio,complicating basic disease,NYHA grades and drug types had no statistical significance between2groups(P>0.05).The total effective rate wassignificantly higher in observation group than that in control group(P<0.05).The difference in6MWT,hs-C R P,NT-proBNP,Hcy,T N F-a,LVESD,LVEDD and LVEF had no statistical significance between2groups beforetreatment(P>0.05),and all these indexes were improved in both2groups after treatm ent and the improvement wasmore significant in observation group(P<0.05).Conclusion Statins in double dose can effectively enhance heartfunction,reduce inflammatory reaction level and improve life quality compared with statins in routine dose in elderlypatients with CHD complicated with CHF..