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目的研究瑞舒伐他汀治疗老年冠状动脉粥样硬化性心脏病(冠心病)对左心室功能、血管内皮舒张功能和血脂的影响及其临床意义。方法将2015年1月至12月收治的老年冠心病患者64例随机分为常规组和瑞舒伐他汀组,每组32例,选择同期健康体检者24例作为对照。常规组采用常规治疗(包括改善循环、调节饮食、控制血压、抗血小板凝集等基础治疗),瑞舒伐他汀组采用常规治疗加口服瑞舒伐他汀20 mg/d,连续8周。采用彩色多普勒超声评价研究对象治疗前后左心室射血分数(LVEF)、左心室高峰充盈率(LVPFR)、内皮依赖性舒张功能(EDD)、非内皮依赖性舒张功能(NEDD)变化,同时用酶法测定总胆固醇(TC),甘油三酯(TG)和高密度脂蛋白胆固醇(HDL-C)。比较研究对象治疗前后各指标的变化。结果与正常对照组比较,治疗前常规组和瑞舒伐他汀组LVEF、LVPFR、EDD、NEDD和HDL-C均显著降低(P均<0.05),而TC、TG水平则显著升高(P均<0.01),但常规组和瑞舒伐他汀组之间各值差异无统计学意义(P>0.05)。治疗2、4和8周后,常规组、瑞舒伐他汀组LVEF、LVPFR、EDD和NEDD均比治疗前升高(P<0.05),且瑞舒伐他汀组明显高于常规组(P均<0.05)。治疗4周和8周后,两组TC、TG均有下降,且瑞舒伐他汀组明显低于常规组(P<0.01)。而治疗后两组HDL-C水平明显上升,且瑞舒伐他汀组明显高于常规组(P<0.01)。老年冠心病患者EDD、NEDD与LVEF均呈正相关(r=0.624,0.712,P均<0.05),而EDD升高与血脂TC、TG和HDL-C呈负相关(r=-0.386,-0.428,-0.388,P均<0.05)。结论老年冠心病患者口服瑞舒伐他汀(20 mg/d)可以改善心功能和降低血脂,无明显不良反应。
Objective To investigate the effect of rosuvastatin on left ventricular function, vasodilatory function and serum lipids in elderly patients with coronary atherosclerotic heart disease (CHD) and its clinical significance. Methods 64 elderly patients with coronary heart disease who were admitted from January 2015 to December 2015 were randomly divided into routine group and rosuvastatin group, with 32 cases in each group. 24 healthy subjects were selected as control group. Routine treatment (including improving the circulation, adjusting diet, controlling blood pressure, anti-platelet aggregation and other basic treatment), rosuvastatin group with conventional treatment plus oral rosuvastatin 20 mg / d for 8 weeks. The changes of left ventricular ejection fraction (LVEF), left ventricular peak filling rate (LVPFR), endothelium-dependent relaxation function (EDD) and non-endothelium-dependent diastolic function (NEDD) before and after treatment were evaluated by color Doppler sonography. Enzymatic determination of total cholesterol (TC), triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C). Compare the change of each index before and after treatment. Results Compared with the normal control group, the levels of LVEF, LVPFR, EDD, NEDD and HDL-C in the normal group and the rosuvastatin group were significantly decreased before treatment (P <0.05), while the levels of TC and TG were significantly increased <0.01), but there was no significant difference between the conventional group and the rosuvastatin group (P> 0.05). After 2, 4 and 8 weeks of treatment, LVEF, LVPFR, EDD and NEDD were significantly increased in both the conventional and rosuvastatin groups (P <0.05), and were significantly higher in the rosuvastatin group than those in the conventional group <0.05). After 4 and 8 weeks of treatment, both TC and TG decreased, and the rosuvastatin group was significantly lower than the conventional group (P <0.01). After treatment, the level of HDL-C in the two groups increased significantly, and the rosuvastatin group was significantly higher than the conventional group (P <0.01). There was a positive correlation between EDD, NEDD and LVEF in elderly patients with coronary heart disease (r = 0.624,0.712, P <0.05), while EDD was negatively correlated with TC, TG and HDL-C (r = -0.386, -0.388, P <0.05). Conclusion Rosuvastatin (20 mg / d) in elderly patients with coronary heart disease can improve cardiac function and reduce blood lipid levels without obvious adverse reactions.