普伐他汀对心衰伴急性冠脉综合征患者临床疗效及预后的影响

Effects of pravastatin on clinical efficacy and prognosis of patients with heart failure combined with acute coronary syndrome

目的探讨普伐他汀对心衰伴急性冠脉综合征患者临床疗效及预后的影响。方法选择2014年1月-2017年3月在西安市第五医院诊治的心衰伴急性冠状动脉综合征(ACS)患者119例,根据治疗方法的不同分为观察组60例与对照组59例。对照组在基础治疗的基础上给予阿托伐他汀治疗,观察组在基础治疗的基础上给予普伐他汀治疗,都治疗观察1个月。比较两组治疗前后血脂、血管内皮相关指标的变化情况,比较两组临床疗效及心血管不良事件的发生情况。结果治疗后两组三酰甘油(TG)、总胆固醇(TC)与低密度脂蛋白胆固醇(LDL-C)值低于治疗前,而高密度脂蛋白胆固醇(HDL-C)值高于治疗前,对比差异都有统计学意义(P<0.05),组间对比差异无统计学意义。观察组与对照组治疗后的氧化低密度脂蛋白(OX-LDL)水平显著低于治疗前,同组治疗前后比较差异有统计学意义(P<0.05),观察组也显著低于对照组,差异有统计学意义(P<0.05)。治疗后两组的反应性充血内径变化率显著高于治疗前,同组治疗前后比较差异有统计学意义(P<0.05),观察组也高于对照组,差异有统计学意义(P<0.05),两组治疗前后肱动脉基础内径与反应性充血时内径对比差异无统计学意义。观察组治疗的总有效率(95.00%)显著高于对照组(89.83%),差异有统计学意义(P<0.05)。所有患者治疗后随访1年,观察组的心源性死亡、再发心肌梗死、靶病变血管重建等MACE发生率为5.0%,对照组为18.6%,观察组显著低于对照组,差异有统计学意义(P<0.05)。结论普伐他汀在心衰伴ACS患者中的应用可起到调节血脂与抑制OX-LDL的双重作用,从而改善血管内皮功能,提高临床疗效,改善患者的远期预后。

Objective To investigate the effects of pravastatin on clinical efficacy and prognosis of patients with heart failure combined with acute coronary syndrome(ACS).Methods From January 2014 to March 2017,119 cases of heart failure combined with ACS patients were selected and were divided into the 60 cases in the observation group and 59 cases in the control group accorded to the different treatment methods.The control group was treated with atorvastatin,the observation group was treated with pravastatin on the basis of the control group,and the two groups were treated for 1 months.The changes of blood lipids and vascular endothelium related parameters before and after treatment were compared between the two groups,and the clinical efficacy and occurrence of adverse cardiovascular events in the two groups was compared.Results After treatment,the values of TG,TC and LDL-C in the two groups were lower than those before the treatment,while the HDL-C values were significantly higher than those before the treatment (P<0.05),and there were no significant difference in the comparison between the groups.The content of OXLDL in the observation group and the control group after treatment were significantly lower than that before treatment (P<0.05),and the observation group were also significantly lower than that in the control group (P<0.05).After treatment,the change rate of reactive hyperemia in the two groups were significantly higher than that before treatment (P<0.05),and the observation group were also higher than that of the control group (P<0.05),there were no significant difference compared between the two groups of brachial artery base diameter and reactive hyperemia before and after treatment.The total effective rate (95.00%) in the observation group was significantly higher than that in the control group (89.83%)(P<0.05).All patients were followed up for 1 years,the incidence of MACE in the observation group were 5%,so that were 18.6% in the control group,and the observation group were lower than the control group (P<0.05).Conclusions The application of pravastatin in patients with heart failure combined ACS can play a dual role in regulating blood lipids and inhibiting OX-LDL,thus improve vascular endothelial function,clinical efficacy and the long-term prognosis of patients.