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目的观察小剂量普伐他汀对非缺血性心力衰竭(心衰)患者心脏功能的影响及应用的安全性。方法连续入选2005年1月至2006年7月医院就诊的非缺血性病因的心衰患者61例,随机分为普伐他汀(20 mg/d)组(n=30)与对照组(n=31),治疗期6个月。观察治疗前后患者心脏功能、肱动脉血管内皮功能、炎症因子与生化指标的变化。结果标准心衰治疗的基础上加用普伐他汀20 mg/d,与对照组相比,3个月时患者加压反应性充血前后血管内径变化百分率增加;6个月时NYHA 分级改善,血浆脑利钠肽水平下降,左心室内径缩小,左室射血分数增加,血浆肿瘤坏死因子-α有所下降(均为 P<0.01);对照组患者 NYHA 分级改善(P<0.05),左室射血分数有改善的趋势(P=0.052)。普伐他汀组患者的总胆固醇降低(P<0.05),高密度脂蛋白胆固醇无明显变化,无肝、肾功能异常,肌酸激酶无明显增高,1例患者因为过敏反应(皮疹)终止治疗。结论非缺血性心衰患者在标准心衰治疗的基础上加用普伐他汀20 mg/d 治疗6个月安全、有效,可以显著改善左室重构与心功能状态,并改善内皮功能,降低炎症因子水平。
Objective To observe the effects of low-dose pravastatin on cardiac function in patients with non-ischemic heart failure (HF) and its safety. Methods Sixty-one patients with non-ischemic etiology who were admitted to our hospital from January 2005 to July 2006 were randomly divided into two groups: pravastatin (20 mg / d) group (n = 30) and control group = 31), the treatment period of 6 months. The changes of cardiac function, vascular endothelial function, inflammatory factors and biochemical indexes of brachial artery were observed before and after treatment. Results Compared with the control group, pravastatin 20 mg / d was added to standard heart failure treatment. The percentage changes of vascular diameter before and after reactivity hyperemia were increased at 3 months. NYHA classification improved at 6 months, Brain natriuretic peptide levels decreased, left ventricular diameter decreased, left ventricular ejection fraction increased, plasma TNF-α decreased (all P <0.01); control group patients NYHA grading improved (P <0.05), left ventricular There was an improvement in ejection fraction (P = 0.052). In the pravastatin group, total cholesterol decreased (P <0.05), HDL cholesterol had no significant change, no liver and renal dysfunction, and no increase in creatine kinase. One patient died of allergic reaction (rash). Conclusions Non-ischemic heart failure patients treated with pravastatin 20 mg / d for 6 months on the basis of standard heart failure treatment are safe and effective. They can significantly improve left ventricular remodeling and cardiac function, improve endothelial function, Reduce the level of inflammatory cytokines.