阿托伐他汀对心肌梗死患者心率变异性的影响

目的:观察阿托伐他汀对急性心肌梗死(AMI)患者和陈旧性心肌梗死(OMI)患者心率变异性(HRV)的影响。方法:AMI和OMI患者各48例均随机分为试验组和对照组,每组各24例,试验组在常规治疗基础上加用阿托伐他汀10～20 mg·d-1,qd,疗程4周。对照组仅采用常规治疗(酒石酸美托洛尔12．5～50 mg,bid,硝酸异山梨酯5～10 mg,tid)。治疗前后用数字化24 h Holter记录测定心率变异性时域参数(SDNN)和频域参数(LF和HF)。结果:AMI患者试验组治疗4周后,HRV各项指标均明显好转,SDNN,LF和HF均明显增加,LF／HF明显降低,与治疗前比较和组间比较差异均有显著性(P<0．05)。OMI患者试验组SDNN与治疗前比较及组间比较无明显变化(P>0．05),LF和HF均明显增加,LF／HF明显降低,与治疗前比较和组间比较差异有显著性(P<0．05)。结论:阿托伐他汀具有降低心肌梗死患者交感神经活性,提高迷走神经张力的作用,使LF／HF趋于正常,提示该药具有稳定AMI患者自主神经功能的作用。

Effects of atorvastatin on heart rate variability in patients with myocardial infarction

Objective:To assess the effects of atorvastatin on heart rate variability in patients with old myocardial infarction (OMI) and acute myocardial infarction (AMI). Methods: 48 patients with AMI and 48 patients with OMI were randomly 1: 1 assigned to one of two treatment groups, respectively: conventional therapy with metoprolol tartrate (12. 5 - 50 mg, bid) and isosorbide dinitrate(5 - 10 mg, tid) plus atorvastatin (10 - 20 mg, qd) for 4 weeks, or the conventional therapy alone for 4 weeks. The heart rate variability (HRV) was monitored by electrocardiograph and digital 24 hour Holter before and after the therapy. Results: The atorvastatin-added patients with AMI experienced the significant improvements of HRV, i.e. , the increase of cardiac vagal tone (SDNN, LF and HF) and the decrease in the ratio of LF/HL level (P <0. 05) . The atorvastatin-added patients with OMI showed no significant improvements of SDNN, but significant escalation of LF and HF levels and the reduction of LF/HF ratio (P < 0.05). Conclusion: Atorvastatin functioned in the improvement of the autonomic nerve tone in patients with OMI and AMI by increasing vagal tone and decreasing sympathetic tone.