小剂量辛伐他汀对急性心肌梗死患者 血管内皮功能的影响

目的　观察心肌梗死急性期降脂治疗对内皮依赖性血管舒张功能的作用。方法　采用超声法检测 39例急性心肌梗死 (AMI)患者和 31例无心肌梗死者肱动脉内皮依赖性舒张功能。应用随机、交叉实验设计 ,将 39例AMI受试者随机分为单纯常规治疗组和加服辛伐他汀 5mg/d或 10mg/d治疗组 ,治疗 2个月后复测其肱动脉内皮依赖性舒张功能。然后交叉 ,即单纯常规治疗组加服辛伐他汀 5mg/d或 10mg/d ;原服辛伐他汀治疗组停用 ,仅接受常规治疗 ;第 4个月再次检测肱动脉内皮依赖性舒张功能。结果　AMI患者肱动脉内皮依赖性舒张功能 n =39,(2 .44± 3.31) % ]较对照组 n=31,(8.13± 4.77) % ]明显降低 (P <0 .0 0 1)。AMI患者服用 5mg/d辛伐他汀 (n =19)治疗 2个月后 ,肱动脉内皮依赖性舒张功能 (4 .2 9± 2 .91) %与治疗前基础水平 (2 .5 4± 2 .5 2 ) %、常规治疗后 (2 .89±3.71) %相比差别无显著性 ;而服用 10mg/d ,辛伐他汀 (n =2 0 )治疗 2个月后 ,肱动脉内皮依赖性舒张功能 (6 .2 4± 4.14) % ]与治疗前基础水平 (2 .35± 3.92 ) %P <0 .0 1]、常规治疗后 (2 .5 7± 3.5 7) %P <0 .0 5 ]相比 ,有显著性改善。同时还观察到 ,与常规治疗相比较 ,辛伐他汀 (5mg/d或 10mg/d)治疗后血总胆固醇水平有明显降低。结论

Preliminary observation on the effect of the different dosage simvastatin on the endothelial function in patients with acute myocardial infarction

Objective To study the effect of different dosage simvastatin onthe endothelial function in patients with acute myocardial infarction (AMI). Methods The flow mediated vasodilatation (endothelial dependent vasodilatation) was measured by ultrasound technique, in 39 patients with AMI and in 31 control subjects. A randomized and crossover therapy was designed. The patients with AMI received either conventional medication or conventional medication plus simvastatin (5 or 10 mg ) for the first 2 months, and then the therapies changed over for the other 2 months between these two groups. The studies of endothelial dependent vasodilatation for each patient were performed before, 2 and 4 months after the treatment. Results In patients with AMI(n=39), flow mediated vasodilatation (2.44±3.31)% was much reduced compared with that in the control subjects (n=31) (8.13±4.77)%, P<0.001. Flow mediated vasodilatation had no significant differences among the values at the baseline, after conventional therapy and after 5 mg simvastatin plus conventional therapy (n=19). However, flow mediated vasodilatation was improved after 10 mg simvastatin plus conventional therapy (n=20)(6.24±4.14)% as compared with those at the baseline(2.35±3.92)%,P<0.01, and after conventional therapy (2.57±3.57)%, P<0.05. Conclusion This study indicated that endothelial dependent vasodilatation was impaired in patients with AMI, which could be improved by 10 mg simvastatin therapy in short period.