不同剂量辛伐他汀与阿托伐他汀分别联合曲美他嗪对CHF患者血脂及心功能的影响

Effects of different doses of simvastatin and atorvastatin combined with trimetazidine on blood lipids and cardiac function in patients with chronic heart failure

目的探索不同剂量辛伐他汀与阿托伐他汀分别联合曲美他嗪对慢性心力衰竭(CHF)患者血脂及心功能的影响。方法选取济南市第二人民医院2019年9月至2021年8月收治的CHF患者100例为观察对象,根据治疗方法不同分为A(33例)、B(33例)、C(34例)三组,A组采用常规剂量辛伐他汀联合曲美他嗪治疗,B组采用大剂量辛伐他汀联合曲美他嗪治疗,C组采用阿托伐他汀联合曲美他嗪治疗,均治疗6个月,比较三组治疗后心功能、血脂、炎性因子以及优良率,统计用药期间不良反应。结果B组和C组血脂、心功能、血清炎性因子以及各时间段优良率比较,差异均无统计学意义(均P>0.05)。治疗后6个月,B组和C组高密度脂蛋白胆固醇(HDL-C)[(1.99±0.25)mmol/L、(2.01±0.16)mmol/L]、左室射血分数(LVEF)[(51.29±4.15)%、(51.37±4.44)%]均显著高于A组[(1.52±0.16)mmol/L、(42.28±4.86)%](t=9.10、6.24;8.10、11.38,均P<0.05),半胱氨酸蛋白酶1(Caspase-1)[(42.33±3.19)ng/L、(41.87±3.55)ng/L]、白细胞介素18(IL-18)[(54.55±4.39)ng/L、(53.98±4.45)ng/L]、左心室收缩末期内径(LVESD)[(35.13±2.13)mm、(35.68±2.46)mm]、左心室舒张末期内径(LVEDD)[(44.39±3.65)mm、(44.42±3.32)mm]、低密度脂蛋白胆固醇(LDL-C)[(2.69±0.39)mmol/L、(2.57±0.13)mmol/L]、总胆固醇(TC)[(3.79±0.13)mmol/L、(3.56±0.69)mmol/L]、三酰甘油(TG)[(1.12±0.05)mmol/L、(1.10±0.07)mmol/L]水平均显著低于A组[(68.41±10.23)ng/L、(88.37±6.65)ng/L、(42.63±3.13)mm、(51.68±5.42)mm、(3.13±0.11)mmol/L、(4.21±0.11)mmol/L、(1.51±0.11)mmol/L](t=-13.98、-24.38、-14.27、-24.95、-6.41、-5.64、-8.00、-10.12、-14.17、-18.54、-12.53、-19.01、-5.35、-18.26,均P<0.05),6 min步行距离[(352.19±25.4)m、(351.74±24.29)m]长于A组[(319.71±21.11)m](t=6.63、5.75,均P<0.05),治疗后3个月及6个月的优良率均显著高于A组(χ^(2)=4.00、4.16,均P<0.05),但B组不良反应发生率[18.18%(6/33)]均高于A组[3.03%(1/33)]和C组[2.94%(1/34)](均P<0.05),A组和C组不良反应比较,差异无统计学意义(P>0.05)。结论阿托伐他汀与大剂量辛伐他汀分别联合曲美他嗪治疗CHF均可获取良好的治疗效果,利于改善心功能,减轻心肌损伤,但阿托伐他汀安全性更高。

Objective To investigate the effects of different doses of simvastatin and atorvastatin combined with trimetazidine on blood lipids and cardiac function in patients with chronic heart failure.Methods A total of 100 patients with chronic heart failure who received treatment in Jinan Second People's Hospital from September 2019 to August 2021 were included in this study.These patients were divided into three groups according to different treatment methods:group A(n=33),group B(n=33),and group C(n=34).Group A was treated with a conventional dose of simvastatin combined with trimetazidine.Group B was treated with a high dose of simvastatin combined with trimetazidine.Group C was treated with atorvastatin combined with trimetazidine.All patients were treated for 6 months.Cardiac function,blood lipids,inflammatory factors,and excellent and good rates of therapeutic effects post-treatment were compared between the three groups.The adverse events during the treatment were recorded.Results There were no significant differences in blood lipids,cardiac function,inflammatory factors,and excellent and good rates of therapeutic effects between the two groups(all P>0.05).After 6 months of treatment,high-density lipoprotein cholesterol[(1.99±0.25)mmol/L,(2.01±0.16)mmol/L]and left ventricular ejection fraction[(51.29±4.15)%,(51.37±4.44)%]in groups B and C were significantly higher than those in group A[(1.52±0.16)mmol/L,(42.28±4.86)%,t=9.10,6.24;8.10,11.38,all P<0.05].Caspase-1[(42.33±3.19)ng/L,(41.87±3.55)ng/L],interleukin-18[(54.55±4.39)ng/L,(53.98±4.45)ng/L],left ventricular end-systolic diameter[(35.13±2.13)mm,(35.68±2.46)mm],left ventricular end-diastolic diameter[(44.39±3.65)mm,(44.42±3.32)mm],low-density lipoprotein cholesterol[(2.69±0.39)mmol/L,(2.57±0.13)mmol/L],total cholesterol[(3.79±0.13)mmol/L,(3.56±0.69)mmol/L],triacylglycerol[(1.12±0.05)mmol/L,(1.10±0.07)mmol/L]levels in groups B and C were significantly lower than those in group A[(68.41±10.23)ng/L,(88.37±6.65)ng/L,(42.63±3.13)mm,(51.68±5.42)mm,(3.13±0.11)mmol/L,(4.21±0.11)mmol/L,(1.51±0.11)mmol/L,t=-13.98,-24.38,-14.27,-24.95,-6.41,-5.64,-8.00,-10.12,-14.17,-18.54,-12.53,-19.01,-5.35,-18.26,all P<0.05].6-minute walking distances[(352.19±25.4)m,(351.74±24.29)m]in groups B and C were significantly longer than that in group A[(319.71±21.11)m,t=6.63,5.75,both P<0.05].The excellent and good rates at 3 and 6 months after surgery in group B was significantly higher than that in group A(χ^(2)=4.00,4.16,both P<0.05),but the incidence of adverse reactions in group B[18.18%(6/33)]was significantly higher than 3.03%(1/33)in group A and 2.94%(1/34)in group C(both P<0.05).There was no significant difference in the incidence of adverse reactions between group A and group C(P>0.05).Conclusion Atorvastatin and high-dose simvastatin alone combined with trimetazidine can achieve good therapeutic effects on chronic heart failure.Both combined therapies are beneficial to improve heart function and reduce myocardial damage.However,atorvastatin combined with trimetazidine is safer than high-dose simvastatin combined with trimetazidine.