阿托伐他汀对急性心肌梗死患者血浆脑钠肽水平及心功能的影响

目的 探讨急性心肌梗死(AMI)患者血浆脑钠肽(BNP)水平、左心室收缩功能的变化及阿托伐他汀干预的影响.方法 选择2006年10月至2008年12月入住我院心内科的AMI患者80例,完全随机分为2组.①常规治疗组38例,患者在无用药禁忌的情况下应用血管紧张素转化酶抑制剂(ACEI)类药物和β受体阻滞剂、硝酸酯类、低分子肝素及阿司匹林等治疗.②阿托伐他汀组42例,在常规治疗的基础上给予阿托伐他汀片20 mg口服,每晚1次,服药时间为3个月.③选择同期经冠状动脉造影和超声心动图证实无器质性心脏病的成年人20名为健康对照.经超声心动图检测80例AMI患者以及20名健康对照者的左心室舒张末内径(LVEDd)、左心室射血分数(LVEF)及左心室短轴缩短率(LVFS);应用电化学发光法测定其血浆BNP的浓度.观察测定2组AMI患者治疗前(梗死后24 h内)、治疗后3周、治疗后3个月LVEDd、LVEF、LVFS和血浆BNP浓度.统计学分析采用SPSS12.0软件包.结果 ①常规治疗组、阿托伐他汀组AMI患者在治疗3周时LVEDd、LVEF及LVFS与治疗前比较差异均无统计学意义(t值分别为1.11、1.39、1.82,2.19、1.44、2.07,P均＞0.05);在治疗3个月时LVEDd、LVEF及LVFS与治疗前比较差异均有统计学意义(t值分别为5.55、6.40、7.58,18.01、22.37、20.78,P均＜0.01),阿托伐他汀组与常规治疗组治疗3个月时比较差异均有统计学意义(t值分别为7.61、8.89、5.43,P均＜0.05).②2组AMI患者在梗死后24 h内血浆BNP水平均高于健康对照组;AMI患者在治疗3周和3个月时与治疗前比较BNP水平明显下降,2组比较差异均有统计学意义(t值分别为5.58、7.06、6.29、7.24,P均＜0.01),阿托伐他汀组与常规治疗组治疗3周、3个月比较血浆BNP水平下降,差异均有统计学意义(t值分别为4.28、8.11,P均＜0.05).③2组AMI患者治疗后3个月血浆BNP水平与LVEF呈明显负相关(r1=-0.48,r2=-0.58,P均＜0.01).结论 ①AMI患者血浆BNP水平的改变早于心脏结构的变化.②长期应用阿托伐他汀可以改善AMI患者心功能,降低血浆BNP水平,逆转心室重构.③血浆BNP水平可作为评价AMI心功能及预后的观察指标.

Effect of atorvastatin on changes of heart function and plasma level of brain natriuretic peptide in acute myocardial infarction patients

Objective To observe changes in plasma level of brain natriuretic peptide ( BNP), left ventricular function in acute myocardial infarction (AMI) patients and discuss the effect of atorvastatin in these patients. Methods Eight patients with acute myocardial infarction hospitalized from October 2006 to December 2008 in our department were enrolled in the study. The AMI patients were further randomly assigned into the conventionsl treatment group ( n = 38 ) and atorvastatin treatment group ( n = 42 ). In the conventional group all patients took ACEI, beta-blocker, nitrate drugs, aspirin and low molecular beparin as their conventional therapy without medication taboo. In the atorvastatin group all patients took atorvastatin 20 mg per day for three months in addition to the conventional treatment. Twenty healthy individuals were testified by coronary arteriongraphy and ultrasonic cardiogram selected as controls ( n = 20). LVEDd, LVEF and left ventricular fractional shortening (LVFS) of 80 patients with AMI and 20 healthy controls were examined by ultrasonic cardiography and their plasma concentrations of BNP were measured. As to the conventional and atorvastatin group, the parameters were tested on the day of hospitalization (within 24 hours of AMI) ,also at the 3rd week and 3rd month after treatment. All data were analyzed statistically by SPSS12. 0. Results There were no significant changes in LVEDd, LVEF, LVFS after 3-week treatment compared to pre-treatment ( P ＞ 0.05 ), but significant changes after 3-month treatment ( P ＜0. 01 ) in 2 AMI groups. Moreover, LVEDd, LVEF, LVFS in the atorvastatin group were significantly greater than the conventional group (P ＜ 0.05). The plasma levels of BNP measured within 24 hours of AMI onset in two treatment groups were significantly higher than the control group. The plasma BNP level decreased significantly after 3 - week and 3-month treatment( all P value ＜0. 01 )in both treatment groups and atorvastatin group showed even lower BNP level with comparison to the conventional group( P ＜0.05 ). The plasma BNP in myocardial infarction patients after three months of treatment were negatively correlated with LVEF( r1 = -0.48 ,r2 = -0.58 ,P ＜ 0. 01 ) which implied a close relationship between BNP and heart function. Conclusions The changes of plasma BNP is earlier than that of heart structure. The long-treatment usage of atorvastatin may improve cardiac function, decrease the plasma BNP and convert ventricular remodeling,which benefit patients besides lipid managing. The plasma BNP could be used as a sensitive indicator of the treatment response and a useful index for evaluating the heart function and pronosis in AMI patients.