阿托伐他汀对冠状动脉血流缓慢患者冠状动脉血流储备的影响

目的 探讨冠状动脉血流缓慢患者冠状动脉血流储备(CFR)的改变以及阿托伐他汀对这类患者CFR的影响.方法 入选有胸痛症状但冠状动脉造影结构正常的冠状动脉血流缓慢患者91例,分为治疗组(51例)和无治疗组(40例).治疗组给予阿托伐他汀20 mg治疗8周.另选26例冠状动脉造影正常且运动试验阴性的无心脏疾患者为正常对照组.治疗前后测定治疗组和无治疗组的血脂以及利用腺苷负荷超声记录左前降支远端血流频谱,并评价CFR.结果 (1)冠状动脉血流缓慢者接受阿托伐他汀8周治疗后总胆固醇(TC)和低密度脂蛋白胆固醇(LDL-C)较无治疗组及正常对照组明显减低TC:(3.83±0.80)mmol/L比(5.30±1.18)mmol/L和(5.32±1.17)mmol/L,均P＜0.05:LDL=C:(2.26±0.64)mmol/L比(3.28±0.85)mmol/L和(3.30±0.82)mmol/L,均P＜0.05].(2)给予阿托伐他汀前,治疗组与无治疗组CFR(分别为2.32±0.30和2.25±0.33)均低于正常对照组(3.15±0.34,P＜0.05);8周后,治疗组冠状动脉血流速度(CFV)(26.06±3.22)cm/s]较无治疗组(29.02±3.36)cm/s]及治疗前静息状态(28.43±3.40)cm/s]低(均P＜0.05),最大冠状动脉扩张状态CFV高于无治疗组和对照组分别为(77.63±8.96)、(65.17±7.22)和(64.58±6.26)cm/s,P＜0.05],CFR低于治疗前和无治疗组(分别为3.07±0.29、2.28±0.35和2.32±0.30,P＜0.05),且与正常对照组差异均无统计学意义.结论 冠状动脉血流缓慢患者CFR明显减低,短期阿托伐他汀在调脂的同时可以有效改善其CFR.

Atrovastatin use and coronary flow reserve in patients with coronary slow flow

Objective To investigate the impact of statin use on coronary flow reserce(CFR)in patients with slow coronary flow.Methods A total of 91 patients with chest pain and coronary slow flow but normal coronary angiography were included in this study,patients were divided into statin group(atrovastatin 20 ms/d for 8 weeks,n=51)and non-statin group(n=40),26 healthy subjects with normal angiography and negative exercise ECG test served as normal controls.Blood cholesterol was measured.Doppler coronary flow velocity and Doppler reserve measurement of distal left anterior descending were recorded at rest and adenosine infusion(140 μg·kg~(-1)·min~(-1))induced hyperemia state,CFR was calculated by the ratio of maximal hyperemia and baseline peak diastolic coronary flow velocity(hCFV and bCFV)before and after atrovastatin treatment.Results (1)Eight weeks later,total cholesterol and LDL-C levels were significantly lower in statin group than in non-statin group and control groupTC(3.83±0.80)mmol/L vs.(5.30±1.18)mmol/L vs.(5.32±1.17)mmol/L,P＜0.05;LDL-C(2.26±0.64)mmol/L vs.(3.28±0.85)mmoL/L vs.(3.30±0.82)mmol/L,P＜0.05].(2)Baseline CFR levels were significantly lower in statin group and non-statin group than that in control group(2.32±0.30 vs.2.25±0.33 vs.3.15±0.34,P＜0.05).Compared with non-statin group and statin group before treatment,8 weeks statin treatment was associated with reduced bCFV(26.06±3.22)cm/s vs.(29.02±3.36)cm/s and(26.06±3.22)cm/svs.(28.43±3.40)cm/s,P＜0.05],increased hcFV(77.63±8.96)cm/s vs.(65.17±7.22)cm/sand(77.63±8.96)cm/s vs.(64.58±6.26)cm/s,P＜0.05]and increased CFR(3.07±0.29 vs.2.28±0.35 and 3.07±0.29 vs.2.32±0.30,P＜0.05).bCFV,hCFV and CFR of statin group post treatment were similar to those of controls(P＞0.05).Conclusion Patients with coronary slow flow were associated with lower CFR which could be significantly improved by statin therapy.