瑞舒伐他汀钙联合美托洛尔对冠心病合并心力衰竭患者血浆氨基末端脑肽钠前体水平的影响

Effect of rosuvastatin combined metoprolol on plasma NT-proBNP of patients with coronary heart disease complicated with heart failure

目的探讨瑞舒伐他汀钙联合美托洛尔对冠心病合并心力衰竭患者血浆氨基末端脑肽钠前体(NT-proBNP)的影响及其作用机制。方法按随机数字法将156例住院冠心病合并心力衰竭患者分为两组,每组78例。对照组给予常规治疗,观察组在对照组基础上加用瑞舒伐他汀钙与美托洛尔,两组均治疗12周。治疗后,比较两组血浆NT-proBNP、心功能[收缩末期左心室内径(LVESD)、舒张末期左心室内径(LVEDD)、左室射血分数(LVEF)]、炎性因子[超敏C反应蛋白(hs-CRP)、肿瘤坏死因子α(TNF-α)、白细胞介素-18(IL-18)]、神经内分泌及相关因子[血管紧张素Ⅱ(AngⅡ)、精氨酸加压素(AVP)、醛固酮(ALD)]水平的变化。结果治疗后,两组血浆NT-proBNP水平显著降低(P<0.05),且观察组明显低于对照组(P<0.05)。治疗后,两组LVESD、LVEDD水平明显降低(P<0.05),且观察组显著低于对照组(P<0.05);两组LVEF水平明显升高(P<0.05),且观察组显著高于对照组(P<0.05)。治疗后,两组hs-CRP、TNF-α、IL-18水平明显降低(P<0.05),且观察组显著低于对照组(P<0.05)。治疗后,两组AngⅡ、AVP、ALD水平显著降低(P<0.05),且观察组明显低于对照组(P<0.05)。结论瑞舒伐他汀钙联合美托洛尔可明显改善冠心病合并心力衰竭患者心功能,降低血浆NT-proBNP水平,其作用机制可能与联合用药可下调炎性因子及神经内分泌水平,抑制心肌重塑有关。

Objective To investigate the effect of rosuvastatin combined metoprolol on plasma NT-proBNP in patients with coronary heart disease complicated with heart failure and its mechanism.Methods Randomized digital method was used to divide 156 patients with coronary heart disease and heart failure into two groups,with 78 patients in each group.The control group received conventional treatment,and the observation group was given rosuvastatin and metoprolol based on treatment of the control group.Both groups were treated for 12 weeks.After treatment,the changes of levels ofplasma NT-proBNP,cardiac function(LVESD,LVEDD,LVEF),inflammatory factors(hs-CRP,TNF-α,IL-18),neuroendocrine and related factors(AngⅡ,AVP,ALD)in two groups were compared.Results After treatment,the levels of plasma NT-proBNP were significantly decreased in two groups(P<0.05),and the levels of plasma NT-proBNP in the observation group was significantly lower than those in the control group(P<0.05);the levels of LVESD and LVEDD were significantly decreased in two groups(P<0.05),and the levels of LVESD and LVEDD in the observation group were significantly lower than those in the control group(P<0.05);the LVEF levels were significantly increased in two groups(P<0.05),and the LVEF levels in the observation group was significantly higher than those in the control group(P<0.05);the levels of hs-CRP,TNF-αand IL-18 were significantly decreased in two groups(P<0.05),and the levels of hs-CRP,TNF-αand IL-18 in the observation group were significantly lower than those in the control group(P<0.05);the levels of AngⅡ,AVP and ALD were significantly decreased in two groups(P<0.05),and the levels of AngⅡ,AVP and ALD in the observation group were significantly lower than those in the control group(P<0.05).Conclusion Rosuvastatin combined with metoprolol can significantly improve cardiac function and decrease plasma NT-proBNP levels in patients with coronary heart disease and heart failure.The mechanism may be related to its effects in down-regulating inflammatory factors and neuroendocrine levels,and inhibiting myocardial remodeling.