不同剂量阿托伐他汀治疗冠心病心力衰竭有效性及安全性的对比研究

摘要

Objective To compare the effectiveness and safety in treating coronary heart disease patients complicated with heart failure in different doses of atorvastatin.Methods A total of 165 coronary heart disease patients complicated with heart failure were selected in the People's Hospital of Zunhua from September 2014 to December 2016,and they were divided into A group,B group and C group according to random number table,each of 55 cases.Based on conventional treatment,patients of A group received low-dose atorvastatin (10 mg per time,1 time per day),patients of B group received medium-dose atorvastatin (20 mg per time,1 time per day),while patients of C group received high-dose atorvastatin (40 mg per time,1 time per day);all of the three groups continuously treated for 12 weeks.Index of ventricular remodeling,blood lipids index,plasma levels of NT-proBNP and hs-CRP before and after treatment were compared among the three groups,and incidence of adverse reactions was observed during the treatment.Results No statistically significant differences of LVEDD,LVESD or LVEF was found among the three groups before treatment (P ＞ 0.05);after treatment,LVEDD and LVESD of B group and C group were statistically significantly smaller than those of A group,while LVEF of B group and C group was statistically significantly higher than that of A group,respectively (P ＜ 0.05);after treatment,LVEDD and LVESD of C group was statistically significantly smaller than that of B group,respectively,while LVEF of C group was statistically significantly higher than that of B group (P ＜ 0.05).No statistically significant differences of TG,TC or LDL-C was found among the three groups before treatment (P ＞ 0.05);after treatment,TG,TC and LDL-C of B group and C group were statistically significantly lower than those of A group,meanwhile TG,TC and LDL-C of C group were statistically significantly lower than those of B group (P ＜0.05).No statistically significant differences of plasma level of NT-proBNP or hs-CRP was found among the three groups before treatment (P ＞ 0.05);after treatment,plasma levels of NT-proBNP and hs-CRP of B group and C group were statistically significantly lower than those of A group,meanwhile plasma levels of NT-proBNP and hs-CRP of C group were statistically significantly lower than those of B group (P ＜ 0.05).No statistically significant differences of incidence of adverse reactions was found among the three groups during the treatment (P ＞ 0.05).Conclusion Compared with low-dose atorvastatin (10 mg per day) and medium-dose atorvastatin (20 mg per day),high-dose atorvastatin (40 mg per day) can more effectively inhibit the ventricular remodeling,adjust the blood lipid metabolism and improve the cardiac function,without increasing the risk of adverse reactions.%目的 比较不同剂量阿托伐他汀治疗冠心病心力衰竭的有效性及安全性.方法 选取2014年9月-2016年12月遵化市人民医院收治的冠心病心力衰竭患者165例,采用随机数字表法分为A、B、C3组,每组55例.在常规治疗基础上,A、B、C组患者分别给予小剂量阿托伐他汀(10 mg/次,1次/d)、中剂量阿托伐他汀(20 mg/次,1次/d)、大剂量阿托伐他汀(40 mg/次,1次/d);3组患者均连续治疗12周.比较3组患者治疗前后心室重构指标、血脂指标及血浆氨基末端脑钠肽前体(NT-proBNP)、超敏C反应蛋白(hs-CRP)水平,并观察3组患者治疗期间不良反应发生情况.结果 治疗前3组患者左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)及左心室射血分数(LVEF)比较,差异均无统计学意义(P＞0.05);治疗后B、C组患者LVEDD和LVESD小于A组,LVEF高于A组(P＜0.05);治疗后C组患者LVEDD和LVESD小于B组,LVEF高于B组.(P＜0.05).治疗前3组患者三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)比较,差异均无统计学意义(P＞0.05);治疗后B、C组患者TG、TC、LDL-C水平低于A组,C组患者TG、TC、LDL-C水平低于B组(P＜0.05).治疗前3组患者血浆NT-proBNP和hs-CRP水平比较,差异均无统计学意义(P＞0.05);治疗后B、C组患者血浆NT-proBNP和hs-CRP水平低于A组,C组患者血浆NT-proBNP和hs-CRP水平低于B组(P＜0.05).3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 与小剂量(10 mg/d)、中剂量(20 mg/d)阿托伐他汀相比,大剂量(40 mg/d)阿托伐他汀能更有效地改善冠心病心力衰竭患者心室重构、血脂代谢及心功能,且未增加药物相关不良反应发生风险.