强化阿托伐他汀改善缺血性心力衰竭患者近期疗效及对铁死亡通路蛋白的影响

The effect of intensive atorvastatin on the short-term efficacy of patients with ischemic heart failure and ferroptosis pathway proteins

目的探讨强化阿托伐他汀对缺血性心力衰竭患者的近期疗效及对铁死亡信号通路相关蛋白表达的影响。方法选取2021年1月至2022年10月海南医学院第一附属医院诊断的缺血性心力衰竭患者124例,按照随机数字表法分为对照组和观察组,各62例。对照组采用常规药物和介入治疗,观察组在对照组的基础上强化应用阿托伐他汀治疗。比较2组患者主要不良心血管事件(MACE)发生率、心力衰竭指标、氧化应激指标、血脂指标和铁死亡通路蛋白水平。结果观察组MACE总发生率低于对照组[6.5%(4/62)比19.4%(12/62)],差异有统计学意义(χ^(2)=4.593,P=0.032)。治疗1个月后,对照组左心室射血分数高于治疗前,B型脑钠肽低于治疗前;观察组左心室射血分数和超氧化物歧化酶均高于治疗前,B型脑钠肽和丙二醛均低于治疗前;观察组超氧化物歧化酶高于对照组,丙二醛低于对照组,差异均有统计学意义(均P<0.05)。治疗1个月后,观察组总胆固醇、低密度脂蛋白胆固醇和脂蛋白a水平均低于治疗前,且观察组均低于对照组(均P<0.05)。治疗1个月后,观察组烟酰胺腺嘌呤二核苷酸磷酸(NADPH)和谷胱甘肽水平以及谷胱甘肽过氧化物酶4、醌氧化还原酶1和溶质载体家族7成员11蛋白表达量均高于治疗前,且观察组均高于对照组;非血红素铁水平和NADPH氧化酶2蛋白表达量均低于治疗前,且观察组均低于对照组(均P<0.05)。结论强化应用阿托伐他汀治疗缺血性心力衰竭能够改善近期疗效,这可能与降血脂、抗氧化应激以及抑制铁死亡信号通路的活性表达有关。

Objective To investigate the short-term efficacy of atorvastatin on patients with ischemic heart failure and its effect on the expression of ferroptosis signaling pathway related proteins.Methods A total of 124 patients with ischemic heart failure diagnosed in the First Affiliated Hospital of Hainan Medical University from January 2021 to October 2022 were selected.The patients were randomly divided into control group and observation group,with 62 cases in each group.The control group was treated with conventional drugs and interventional therapy,and the observation group was treated with atorvastatin on the basis of the control group.The incidence of major adverse cardiac events(MACE),heart failure indicators,oxidative stress indicators,blood lipid indicators and ferroptosis pathway proteins were compared between the two groups.Results The total incidence of MACE in the observation group was lower than that in the control group[6.5%(4/62)vs 19.4%(12/62)](χ^(2)=4.593,P=0.032).After 1 month of treatment,the left ventricular ejection fraction of the control group was higher than that before treatment,and the brain natriuretic peptide was lower than that before treatment;the left ventricular ejection fraction and superoxide dismutase in the observation group were higher than those before treatment,and the brain natriuretic peptide and malondialdehyde were lower than those before treatment;the superoxide dismutase in the observation group was higher than that in the control group,and the malondialdehyde was lower than that in the control group(all P<0.05).After 1 month of treatment,the levels of total cholesterol,low-density lipoprotein cholesterol and lipoprotein a in the observation group were lower than those before treatment,and those in the observation group were lower than those in the control group(all P<0.05).After 1 month of treatment,the levels of nicotinamide adenine dinucleotide phosphate(NADPH)and glutathione,and the protein expression of glutathione peroxidase 4,quinone oxido-reductase 1 and solute carrier family 7 member 11 in the observation group were higher than those before treatment,and those in the observation group were higher than those in the control group;the levels of non-heme iron and the protein expression of NADPH oxidase 2 were lower than those before treatment,and those in the observation group were lower than those in the control group(all P<0.05).Conclusion Routine use of atorvastatin in the treatment of ischemic heart failure can improve the short-term efficacy,which may be related to lowering blood lipids,anti-oxidative stress and inhibiting the active expression of ferroptosis signaling pathway.