不同剂量瑞舒伐他汀对冠心病心力衰竭病人氧化应激及血液流变学的影响

目的:探讨大剂量瑞舒伐他汀对冠心病心力衰竭病人氧化应激及血液流变学的影响。方法:选取冠心病心力衰竭病人117例为研究对象，采用随机数字表法分为A组、B组、C组，各39例。3组病人均在心血管内科抗心力衰竭常规治疗基础上给予瑞舒伐他汀治疗，A、B、C组分别给予瑞舒伐他汀10、20、40 mg/d，所有病人均连续治疗1个月，比较3组病人应用瑞舒伐他汀前后心脏彩超指标、血液氧化应激指标、血液流变学以及肝功能丙氨酸氨基转移酶（ALT）及天门冬氨酸氨基转移酶（AST）]及心肌酶谱乳酸脱氢酶（LDH）及肌酸激酶（CK）]的变化情况。结果:加用瑞舒伐他汀治疗1个月后，3组病人左心室射血分数均显著升高（P<0.01），左心室舒张末期内径和左心室收缩末期内径均降低（P<0.05~P<0.01），且C组左心室射血分数显著高于A组与B组，左心室舒张末期内径和左心室收缩末期内径显著低于A组与B组（P<0.05~P<0.01）；3组病人一氧化氮、内皮素-1和丙二醛水平明显降低，超氧化物歧化酶明显升高（P<0.01），且C组病人改善程度优于A组与B组（P<0.05~P<0.01）； 治疗结束后，3组病人血液流变学指标均下降（P<0.05~P<0.01），且C组病人血浆黏度、纤维蛋白原、全血黏度切变率和相对血液黏度切变率等血液流变学指标水平低于A组与B组（P<0.05~P<0.01）；治疗后，除A组外，各组病人AST及ALT均较治疗前增加（P<0.05~P<0.01），但3组间比较差异无统计学意义（P>0.05）；3组病人LDH、CK水平均较治疗前明显下降（P<0.01），C组LDH及CK水平明显低于A、B组（P<0.01）。结论:针对冠心病心力衰竭病人采用瑞舒伐他汀特别是大剂量瑞舒伐他汀进行治疗，可使心脏功能好转，能够明显改善病人氧化应激水平，调节血液流变学指标，降低心肌酶谱水平，但可引起肝酶轻度升高。

Effect of different doses of rosuvastatin on oxidative stress and hemorheology in patients with coronary heart disease complicated with heart failure

Objective:To explore the effects of large dose of rosuvastatin on oxidative stress and hemorheology in patients with coronary heart disease complicated with heart failure. Methods:One hundred and seventeen patients with coronary heart disease complicated with heart failure were randomly divided into the group A,B and C(39 cases each group). Three groups were treated with conventional treatment of heart failure,and the group A,B and C were additionally treated with 10,20 and 40 mg/d of rosuvastatin for 1 month,respectively. The heart color ultrasound index,blood oxidative stress index,hemorheology,liver function-related enzyme( AST and ALT) and myocardial enzyme ( LDH and CK ) level between three groups before and after rosuvastatin treatment were compared. Results:After 1 month of rosuvastatin treatment,the left ventricular ejection fraction( LVEEF) in three groups significantly increased( P<0. 01),and the left ventricule end-diastolic dimension(LVEDD) and left ventricular end-systolic dimension(LVESD) in three groups significantly decreased(P<0. 05 to P<0. 01). The LVEFF in group C was significantly higher than that in group A and B,and the LVEDD and LVESD in group C were significantly lower than those in group A and B(P<0. 05～P<0. 01). The levels of the nitric oxide,endothelin 1 and malondialdehyde in three groups significantly decreased,the level of superoxide disnmtase significantly increased (P<0.01),and the improvement in group C was better than that in group A and B(P <0. 05 to P <0. 01). After treatment,the hemorheology index in three groups decreased(P<0. 05 to P<0. 01),and the levels of blood viscosity,fibrinogen,total blood viscosity shear rate and relative blood viscosity shear rate in group C were lower than those in group A and B(P<0. 05 to P<0.01). After treatment,the levels of AST and ALT in group B and C increased compared before treatment(P<0. 05 to P<0. 01),and the difference of which between three groups was not statistically significant(P >0. 05). The levels of LDH and CK in three groups significantly cardiac function and level of oxidative stress,regulate the hemorheology index,reduce the levels of myocardial enzyme and cause a mild rise in liver enzymes.