Objective To compare the clinical effect in treating coronary heart disease patients complicated with chronic heart failure in different doses of rosuvastain.Methods A total of 120 coronary heart disease patients complicated with chronic heart failure were selected in the Fifth People′s Hospital of Qinghai Province from August 2015 to June 2016,and they were divided into control group and observation group according to random number table,each of 60 cases.Based on conventional treatment,patients of control group received low-dose rosuvastain(10 mg per day),while patients of observation group received high-dose rosuvastain(20 mg per day);both groups continuously treated for 6 months.Clinical effect,index of cardiac function(including LVEF,LVESV and LVEDV),NT-proBNP,blood lipids index(including TC,TG,LDL-C and HDL-L),inflammatory cytokines(including hs-CRP,TNF-α and IL-6),ET-1,NO,baseline arterial diameter,pressed arterial diameter and FMD before and after treatment,and incidence of adverse reactions during the treatment was observed.Results Clinical effect of observation group was statistically significantly better than that of control group(P<0.05).No statistically significant differences of LVEF,LVESV,LVEDV or NT-proBNP was found between the two groups before treatment(P>0.05);after treatment,LVEF of observation group was statistically significantly higher than that of control group,while LVESV,LVEDV and NT-proBNP of observation group were statistically significantly lower than those of control group(P<0.05).No statistically significant differences of TC,TG,LDL-C or HDL-C was found between the two groups before treatment(P>0.05);after treatment,TC,TG and LDL-C of observation group were statistically significantly lower than those of control group,while HDL-C of observation group was statistically significantly higher than that of control group(P<0.05).No statistically significant differences of hs-CRP,TNF-α or IL-6 was found between the two groups before treatment(P>0.05),while hs-CRP,TNF-α and IL-6 of observation group were statistically significantly lower than those of control group after treatment(P<0.05).No statistically significant differences of ET-1,NO,baseline arterial diameter,pressed arterial diameter or FMD was found between the two groups before treatment(P>0.05);after treatment,ET-1 of observation group was statistically significantly lower than that of control group,NO and FMD of observation group were statistically significantly higher than those of control group,meanwhile baseline arterial diameter and pressed arterial diameter of observation group were statistically significantly larger than those of control group(P<0.05).No statistically significant differences of incidence of adverse reactions was found between the two groups during the treatment(P>0.05).Conclusion High-dos rosuvastain(20 mg/d)has better clinical effect in treating coronary heart disease patients complicated with chronic heart failure,can more effectively improve the cardiac function and endothelial cell function,adjust the blood lipid metabolism and relive the inflammatory reaction,without increasing the risk of adverse reactions.%目的 比较不同剂量瑞舒伐他汀钙片治疗稳定型心绞痛并慢性心力衰竭的临床疗效.方法 选取2015年8月-2016年6月青海省第五人民医院收治的稳定型心绞痛并慢性心力衰竭患者120例,采用随机数字表法分为对照组与观察组,每组60例.在常规治疗基础上,对照组患者口服小剂量瑞舒伐他汀钙片(10 mg/d),而观察组患者口服大剂量瑞舒伐他汀钙片(20 mg/d);两组患者均连续治疗6个月.比较两组患者临床疗效,治疗前后心功能指标〔左心室射血分数(LVEF)、左心室收缩末期容积(LVESV)、左心室舒张末期容积(LVEDV)〕、氨基末端B型利钠肽前体(NT-proBNP)、血脂指标〔总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)〕、炎性因子〔超敏C反应蛋白(hs-CRP)、肿瘤坏死因子α(TNF-α)、白介素6(IL-6)〕、内皮素1(ET-1)、一氧化氮(N0)、基线动脉内径、加压后动脉内径、内皮依赖性舒张功能(FMD),并观察两组患者治疗期间不良反应发生情况.结果 观察组患者临床疗效优于对照组(P<0.05).治疗前两组患者LVEF、LVESV、LVEDV、NT-proBNP比较,差异无统计学意义(P>0.05);治疗后观察组患者LVEF高于对照组,LVESV、LVEDV、NT-proBNP低于对照组(P<0.05).治疗前两组患者TC、TG、LDL-C、HDL-C比较,差异无统计学意义(P>0.05);治疗后观察组患者TC、TG、LDL-C低于对照组,HDL-C高于对照组(P<0.05).治疗前两组患者hs-CRP、TNF-α、IL-6比较,差异无统计学意义(P>0.05);治疗后观察组患者hs-CRP、TNF-α、IL-6低于对照组(P<0.05).治疗前两组患者ET-1、NO、基线动脉内径、加压后动脉内径、FMD比较,差异无统计学意义(P>0.05);治疗后观察组患者ET-1低于对照组,NO、FMD高于对照组,基线动脉内径、加压后动脉内径大于对照组(P<0.05).两组患者治疗期间不良反应发生率比较,差异无统计学意义(P>0.05).结论 大剂量瑞舒伐他汀钙片(20 mg/d)治疗稳定型心绞痛并慢性心力衰竭的临床疗效优于小剂量瑞舒伐他汀钙片(10 mg/d),可更有效地改善患者心功能和血脂代谢,提高患者内皮细胞功能并减轻炎性反应,且不会增加不良反应发生风险.
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