不同剂量氟伐他汀治疗老年冠心病伴心力衰竭的临床疗效及其对心功能、血清炎性因子水平、血浆 N -末端脑钠肽前体水平的影响研究

摘要

Objective to observe the clinical effect of different doses of fluvastatin in treating elderly coronary artery disease patients complicated with heart failure,to investigate the impact on cardiac function,serum levels of inflammatory cytokines and plasma Nt-proBNP level. Methods A total of 90 elderly coronary artery disease inpatients complicated with heart failure(over 65 years old)were selected in the third Hospital of Shijiazhuang in 2012,and they were randomly divided into A group,B group and C group,each of 30 cases. Patients of the three groups received basal treatment according to severity of illness,patients of B group received extra standard dose of fluvastatin(40 mg/ d),while patients of C group received large dose of fluvastatin(80 mg/ d);all of the three groups treated for 1 year. Clinical effect,cardiac function index(including LVEDD, LVESD,LVFS and LVEF),serum levels of inflammatory cytokines( including tNF-α and hs-CRP),plasma levels of Nt-proBNP and Hcy,blood lipids index(including LDL-C and tC),liver function indicators(including ALt and ASt)were compared among the three groups. Results the clinical effect of B group and C group was statistically significantly better than that of A group,respectively(P < 0. 05),while no statistically significant differences of clinical effect was found between B group and C group(P > 0. 05). No statistically significant differences of LVEDD,LVESD,LVFS 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 lower than those of A group,LVFS and LVEF of B group and C group were statistically significantly higher than those of A group,LVEDD and LVESD of C group were statistically significantly lower than those of B group(P < 0. 05),while no statistically significant difference of LVFS or LVEF was found between B group and C group( P > 0. 05). No statistically significant differences of serum level of hs-CRP or tNF-α,plasma level of Nt-proBNP or Hcy was found among the three groups before treatment(P > 0. 05);after treatment,serum levels of hs-CRP and tNF-α,plasma levels of Nt-proBNP and Hcy of B group were statistically significantly lower than those of A group,serum levels of hs-CRP and tNF-α,plasma levels of Nt-proBNP and Hcy of C group were statistically significantly lower than those of B group and A group( P < 0. 05). No statistically significant differences of LDL-C,tC,ALt or ASt was found among the three groups before treatment(P > 0. 05);after treatment,LDL-C and tC of B group and C group were statistically significantly lower than those of A group,tC of C group was statistically significantly lower than that of B group,ALt and ASt of C group were statistically significantly higher than those of A group and B group(P < 0. 05),while no statistically significant differences of LDL-C was found between B group and C group,nor was ALt or ASt between A group and B group(P > 0. 05). Conclusion Fluvastatin has certain clinical effect in treating elderly coronary artery disease patients complicated with heart failure,large dose of fluvastatin(80 mg/ d) has better improvement effect on cardiac function,serum levels of inflammatory cytokines,plasma Nt-proBNP level and blood lipid than standard dose(40 mg/ d),but has relatively higher risk of liver damage.%目的：探究不同剂量氟伐他汀治疗老年冠心病伴心力衰竭的临床疗效及其对心功能、血清炎性因子水平、血浆 N -末端脑钠肽前体（Nt-proBNP）水平的影响。方法选取2012年在石家庄市第三医院住院治疗的老年冠心病伴心力衰竭患者90例（年龄>65岁），随机分为对照组、治疗1组、治疗2组，每组30例。患者入院后均根据病情给予基础治疗，治疗1组患者在此基础上给予常规剂量氟伐他汀（40 mg/ d）治疗，治疗2组患者在此基础上给予大剂量氟伐他汀（80 mg/ d）治疗。3组患者均治疗1年。比较3组患者临床疗效，治疗前后心功能指标〔左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）、左心室短轴缩短率（LVFS）、左心室射血分数（LVEF）〕、血清炎性因子〔肿瘤坏死因子α（tNF-α）、超敏 C 反应蛋白（hs-CRP）〕、血浆Nt-proBNP及同型半胱氨酸（Hcy）水平、血脂指标〔低密度脂蛋白胆固醇（LDL-C）、总胆固醇（tC）〕、肝功能指标〔丙氨酸氨基转移酶（ALt）、天冬氨酸氨基转移酶（ASt）〕。结果治疗1组、治疗2组患者临床疗效优于对照组（P <0.05）；治疗1组与治疗2组患者临床疗效比较，差异无统计学意义（P >0.05）。3组患者治疗前 LVEDD、LVESD、LVFS、LVEF 比较，差异无统计学意义（P >0.05）；治疗1组及治疗2组患者治疗后 LVEDD、LVESD 低于对照组，LVFS、LVEF 高于对照组（P <0.05）；治疗2组患者治疗后 LVEDD、LVESD 低于治疗1组（P <0.05），而治疗1组与治疗2组患者治疗后 LVFS、LVEF 比较，差异无统计学意义（P >0.05）。3组患者治疗前血清hs-CRP、tNF-α水平及血浆Nt-proBNP、Hcy 水平比较，差异无统计学意义（P >0.05）；治疗1组患者治疗后血清hs-CRP、tNF-α水平及血浆Nt-proBNP、Hcy 水平均低于对照组（P <0.05）；治疗2组患者治疗后血清hs-CRP、tNF-α水平及血浆Nt-proBNP、Hcy 水平均低于治疗1组及对照组（ P <0.05）。3组患者治疗前 LDL-C、tC、ALt、ASt 比较，差异无统计学意义（P >0.05）；治疗1组及治疗2组患者治疗后 LDL-C、tC 均低于对照组（P <0.05）；治疗2组患者治疗后 tC 低于治疗1组，ALt、ASt 高于对照组和治疗1组（P <0.05）；治疗1组和治疗2组患者治疗后 LDL-C 比较，差异无统计学意义（P >0.05）；对照组与治疗1组患者治疗后 ALt、ASt 比较，差异无统计学意义（P >0.05）。结论氟伐他汀治疗老年冠心病伴心力衰竭患者的临床疗效确切，且大剂量氟伐他汀（80 mg/ d）对患者心功能、血清炎性因子水平、血浆Nt-proBNP水平及血脂的改善效果优于常规剂量（40 mg/ d），但易造成肝损伤。