他汀类药物对慢性心力衰竭合并中枢性睡眠呼吸暂停患者的影响研究

摘要

目的：探讨他汀类药物对慢性心力衰竭合并中枢性睡眠呼吸暂停患者的影响。方法选取2013年12月—2015年1月郑州大学第二附属医院心内科病房及门诊收治的经多导睡眠图（PSG）证实睡眠呼吸暂停低通气指数（AHI）≥5次/ h 的慢性心力衰竭患者120例为研究对象，采用随机数字表法分为亲脂性他汀组60例和亲水性他汀组60例。亲脂性他汀组给予阿托伐他汀20 mg，亲水性他汀组给予瑞舒伐他汀10 mg，均1次/ d，睡前口服，连续用药6个月。收集患者一般情况，检测患者血脂、肝功能、肾功能、超敏 C 反应蛋白（hs-CRP）、N 末端 B 型尿钠肽前体（NT-proBNP）水平等指标；超声心动图测定左心室射血分数（ LVEF）和左心室舒张末期内径（ LVEDD）；PSG 监测AHI 及觉醒次数。结果治疗前，亲脂性他汀组与亲水性他汀组患者三酰甘油（ TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、血肌酐（Scr）、hs-CRP、NT-proBNP水平、LVEF、LVEDD、AHI、觉醒次数比较，差异均无统计学意义（P >0.05）。治疗后，亲水性他汀组患者 TG、TC水平较亲脂性他汀组降低（ P <0.05），AHI、觉醒次数较亲脂性他汀组升高（ P <0.05）；两组患者 LDL-C、ALT、AST、Scr、hs-CRP、NT-proBNP 水平、LVEF、LVEDD 比较，差异均无统计学意义（ P >0.05）。两组患者治疗后 TG、TC、LDL-C、hs-CRP、NT-proBNP 水平、LVEDD、AHI、觉醒次数较治疗前降低，LVEF 较治疗前升高（P <0.05）；两组治疗前与治疗后 ALT、AST、Scr 水平比较，差异均无统计学意义（P >0.05）。结论他汀类药物可以改善慢性心力衰竭合并中枢性睡眠呼吸暂停患者的血脂水平、心功能指标及睡眠呼吸指标，亲水性他汀类药物在降低血脂水平方面优于亲脂性他汀类药物，而亲脂性他汀类药物在改善睡眠呼吸指标方面优于亲水性他汀类药物。%Objective To investigate the effects of statins on patients with chronic heart failure combined with central spleep apnea. Methods A total of 120 chronic cardiac failure inpatients and outpatients who were confirmed to have apnea hyponea index(AHI)≥5 times/ h by polysomnogram(PSG)in the Department of Cardiology of the Second Affiliated Hospital of Zhengzhou University from December 2013 to January 2015 were enrolled in the study. The patients were divided into lipophicity statin group(n = 60)and hydrophily statin group(n = 60)by random number table method. Patients of lipophilic statin group were given atorvastatin 20 mg,while hydrophilic statin group were given rosuvastatin 10 mg. The drugs were given orally once per day before sleep for 6 months consecutively. Patients′ general condition was collected; blood lipid, liver function, renal function,hs-CRP and NT-proBNP were detected;left ventricular ejection fraction(LVEF)and left ventricular end - diastolic diameter(LVEDD)were measured by ultrasonic cardiogram;AHI and the times of awakening were monitored by PSG. Results Before treatment,the two groups were not significantly different in TG,TC,LDL-C,ALT,AST,Scr,hs-CRP,NT-proBNP level,LVEF,LVEDD,AHI and the times of awakening(P > 0. 05);after treatment,hydrophilic statin group was lower than lipophilic statin group in TG and TC level(P < 0. 05),and higher than lipophilic statin group in AHI and the times of awakening (P < 0. 05);the two groups were not significantly different in the levels of LDL-C,ALT,AST,Scr,hs-CRP and NT-proBNP, LVEF and LVEDD( P > 0. 05 ) . After treatment,the two groups had lower levels of TG, TC, LDL-C, hs-CRP and NT-proBNP,LVEDD,AHI and the times of awakening,and higher LVEF than before treatment( P < 0. 05);the levels of ALT,AST and Scr of the two groups were not significantly different between before treatment and after treatment(P > 0. 05). Conclusion Statins can improve blood lipid level,cardiac function index and sleep breathing indicators of patients with chronic heart failure combined with central spleep apnea. Hydrophilic statins are superior to lipophilic statins in lowering blood lipid level, while lipophilic statins are superior to hydrophilic statins in improving sleep breathing indicators.