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目的:观察阿托伐他汀对心力衰竭患者血浆中细胞凋亡抑制因子(sFas)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)及超敏C反应蛋白(hs-CRP)水平的影响,探讨阿托伐他汀对心力衰竭的治疗作用。方法:将60例心力衰竭患者随机分为对照组和干预组,采用酶联免疫吸附法测定其治疗前后血浆中sFas、TNF-α、IL-6、hs-CRP水平。结果:左室射血分数(LVEF)≤30%者较>30%者sFas水平明显升高(P<0.05),sFas与LVEF及左室短轴缩短率(FS)呈显著负相关(r=-0.425,P<0.01),(r=-0.309,P<0.05)。hs-CRP水平在心功能Ⅳ级明显高于心功能Ⅲ级。TNF-α水平2组治疗后均较治疗前有显著下降(P<0.01或0.05),干预组较对照组下降更明显(P<0.05)。对照组血浆sFas水平较治疗前明显降低(P<0.05)而干预组治疗前后没有明显变化。干预组血浆IL-6水平较治疗前明显降低(P<0.05)。结论:在常规治疗的基础上加用阿托伐他汀可进一步降低心力衰竭患者血浆中TNF-α、IL-6等细胞因子水平,提示阿托伐他汀具有抗炎保护心肌作用;但阿托伐他汀可能影响Fas/FasL系统活性而促进心肌细胞凋亡,对患者产生不利影响。
Objective: To observe the effects of atorvastatin on plasma levels of sFas, TNF-α, IL-6 and high sensitivity C-reactive protein in patients with heart failure hs-CRP) levels of atorvastatin on the treatment of heart failure. Methods: Sixty patients with heart failure were randomly divided into control group and intervention group. The plasma levels of sFas, TNF-α, IL-6 and hs-CRP were measured by enzyme-linked immunosorbent assay before and after treatment. Results: The levels of sFas in patients with LVEF ≤30% were significantly higher than those with> 30% (P <0.05), while there was a significant negative correlation between sFas and LVEF and shortening of left ventricular fraction (r = -0.425, P <0.01), (r = -0.309, P <0.05). hs-CRP levels in cardiac function Ⅳ was significantly higher than the heart function Ⅲ. TNF-α levels in both groups were significantly lower than those before treatment (P <0.01 or 0.05), while those in the intervention group decreased more significantly than those in the control group (P <0.05). The level of plasma sFas in the control group was significantly lower than that before treatment (P <0.05), while there was no significant change in the intervention group before and after treatment. Interventional plasma IL-6 levels were significantly lower than before treatment (P <0.05). Conclusion: Adding atorvastatin to conventional therapy can further decrease the levels of TNF-α, IL-6 and other cytokines in patients with heart failure, suggesting that atorvastatin has an anti-inflammatory effect on myocardial protection. However, atorvastatin Statins may affect Fas / FasL system activity and promote myocardial apoptosis, adversely affecting patients.