阿托伐他汀对老年冠状动脉严重病变患者左心室功能的影响

目的探讨不同剂量阿托伐他汀对老年冠脉严重病变且未进行血运重建患者左心室功能的影响。方法连续入选40例冠状动脉造影证实血管严重病变但不适于血运重建术或不愿行血运重建术的老年患者，完全随机分为小剂量组（10mg／d）20例、大剂量组（40mg／d）20例，随访1年，检测基础条件下、治疗6个月、治疗12个月时脑利钠肽前体（Pro—BNP）水平，超声心动图测定左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）、左心室射血分数（LVEF）等参数变化，并测定血脂水平、炎症因子（hs-CRP）、ALT、AST、CPK等指标。结果治疗6个月时，2组Pro—BNP水平下降[小剂量组（1204．44±1117．72）pg／ml，大剂量组（727．07±720．26）pg／m1]，LVEF水平升高[小剂量组（59．634-5．59）％，大剂量组（62．08±5．77）％]（均P〈0．05）；治疗1年时，2组心功能均显著改善，包括血浆Pro—BNP水平下降[小剂量组（778．55±1316．33）pg／ml，大剂量组（344．89±303．52）pg／ml]、LVEF升高[小剂量组（61．56±6．60）％，大剂量组（63．49±8．17）％]、左心室内径缩小（P〈0．01），但2组问比较差异无统计学意义。3个月后2组患者血浆hs—CRP水平明显下降[小剂量组（4．68±2．19）mg／L，大剂量组（4．63±1．91）mg／L]（P〈0．05），治疗6个月和1年时总胆固醇水平、低密度脂蛋白水平、hs—CRP水平显著下降6个月[小剂量组分别为（2．08±0．41）mmol／L、（3．40±2．10）mg／L；大剂量组分别为（3．50±0．53）mmol／L、（1．88±0．49）mmo]／L、（2．31±1．55）mg／L。1年时小剂量组分别为（3．50±0．40）mmol／L、（1．97±0．45）mmol／L、（2．34±1．61）mg／L，大剂量组分别为（3．42±0．54）mmol／L、（1．77±0．44）mmol／L、（1．58±1．17）mg／L]（P〈0．01）。治疗1年，所有患者无肝功能异常，肌酸激酶无明显增高。结论在冠脉严重病变患者中无论应用大剂量、小剂量阿托伐他汀均可以显著降低血浆hs—CRP、Pro—BNP水平，改善左心室功能，并且未见明显不良反应。

Effects of atorvastatin on left ventricular function in old patients with serious-ischemic coronary artery disease

Objective To investigate the effect of different doses of atorvastatin on left ventricular function in old patients with senous ischemic and non-revascularization coronary artery diseases. Methods Fourty patients with serious isehemic coronary artery diseases and improper or unwilling to have revascularization were enrollod.The8e patients randomly received atorvastatin(10 mg/d)or atorvastatin(40 mg/d)and were prospectively followed up for 1 year.Before therapy,we measured plasma concentrations of Pro-brain natriuretic peptides(Pro-BNP),left ventricular end-diastolic dimension(LVEDD),left ventricular end-systolic dimension(LVESD)and left ventricular ejection fraction(LVEF)by echoeardiography.Furthermore these measurements were repeated every 6 months.The serum level of blood lipid,plasma of high-sensitive C-reaction Protein,liver function and creatine kinase were observed and were also tested every 3 months.Results After a follow-up period of 6 months,the level of Pro-BNP decreased and LVEF increased significanfly in both groups(P<0.05).The levels of Pro-BNP and LVESD decreased and LVEF increased significantly in both groups(P<0.01)at the end of 1 year follow-up.The changes of Pro-BNP,LVEDD,LVESD,LVEF showed no significant differences between the two groups.After a follow-up period of 3 months,the level of hs-CRP decreased(P<0.05)in both groups.The level of hs-CRP,TC,LDL-C significantly decreased in both group.No liver danger was observod and the level of creatine kinase did not increase.Conclusions Atorvastatin is effective of treating serious isehemie coronary artery diseases patients and can improve left ventricular function and reduce the level of hs-CRP,BNP.Thereis no serious side effect observed in this study.