不同剂量氟伐他汀对急性心肌梗死患者远期血脂MMP-9因子及左心室重构的影响

doi:10.3969/j.issn.1006-6233.2021.01.031

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摘要 目的: 研究不同剂量氟伐他汀对急性心肌梗死患者远期血脂、MMP-9因子及左心室重构的影响。方法: 将2017年1月至2019年3月本院收治的192例AMI患者随机分为大剂量组和小剂量组,分别有93例、94例患者完成治疗。小剂量组在常规治疗基础上给予40mg/d的氟伐他汀治疗,大剂量组则给予80mg/d氟伐他汀治疗,均治疗6个月。检测两组治疗前后左室射血分数(LVEF)、左心室舒张末直径(LVEDd)、左心室收缩末内径(LVESd)、血清中总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、基质金属蛋白酶-9(MMP-9)、N末端脑钠肽前体(NT-proBNP)、心肌钙蛋白(cTnT)水平,统计两组治疗期间不良反应发生情况。结果: 治疗后,两组患者TC、TG、LDL-C、MMP-9、NT-proBNP、cTnT水平明显下降,HDL-C水平明显上升,差异有统计学意义(P<0.05),且大剂量组患者治疗后的TC、LDL-C、MMP-9、NT-proBNP、cTnT指标的下降程度明显低于小剂量组,差异有统计学意义(P<0.05)。治疗后,两组患者LVEF指数明显升高,LVEDd、LVESd指数明显下降,差异有统计学意义(P<0.05),且大剂量组患者治疗后的LVEF、LVEDd、LVESd指数的变化幅度明显大于小剂量组,差异有统计学意义(P<0.05)。两组患者不良反应主要以恶心、头晕、腹痛、低血压为主,大剂量组与小剂量组的不良反应发生率分别为21.51%、17.02%,组间差异无统计学意义(P>0.05)。结论: 氟伐他汀能够有效干预AMI患者血脂水平,降低MMP-9因子水平,抑制左心室重构,且大剂量(80mg/d)的治疗效果更优。

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关键词 ：氟伐他汀, 急性心肌梗死, 血脂, 基质金属蛋白酶-9, 左心室重构

Abstract：Objective: To study the effects of different doses of fluvastatin on long-term blood lipid, MMP-9 factor and left ventricular remodeling in patients with acute myocardial infarction (AMI). Methods: A total of 192 AMI patients who were admitted to the hospital between January 2017 and March 2019 were randomly divided into high-dose group and low-dose group. And there were 93 cases and 94 cases in the above two groups completing the treatment, respectively. On basis of routine treatment, low-dose group had 40 mg/d fluvastatin, while high-dose group had 80 mg/d fluvastatin. All were treated for 6 months. The left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDd), left ventricular end systolic diameter (LVESd), levels of serum total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), matrix metalloprotein-9 (MMP-9), N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac troponin T (cTnT) in both groups before and after treatment were detected. The occurrence of adverse reactions during treatment in both groups was statistically analyzed. Results: After treatment, levels of TC, TG, LDL-C, MMP-9, NT-proBNP and cTnT were significantly decreased, while level of HDL-C was significantly increased in both groups (P<0.05). After treatment, decrease amplitude of TC, LDL-C, MMP-9, NT-proBNP and cTnT in high-dose group was significantly less than that in low-dose group (P<0.05). After treatment, LVEF was significantly increased, while LVEDd and LVESd were significantly decreased in both groups (P<0.05). After treatment, change amplitude of LVEF, LVEDd and LVESd in high-dose group was significantly greater than that in low-dose group (P<0.05). The adverse reactions in both groups were mainly on nausea, dizziness, abdominal pain and hypotension. There was no significant difference in the incidence of adverse reactions between high-dose group and low-dose group (21.51% vs 17.02%) (P>0.05). Conclusion: Fluvastatin can effectively interfere with blood lipid level in AMIpatients, reduce levels of MMP-9 factors, and inhibit left ventricular remodeling. The curative effect of high-dose (80 mg/d) fluvastatin is better.

Key words： Fluvastatin Acute myocardial infarction Blood lipid Matrix metalloprotein-9 Left ventricular remodeling

基金资助:海南省卫生计生行业基金项目,(编号:13A200032)

通讯作者: 刘煜

引用本文:

陈冬琳, 邓晓兰, 刘煜. 不同剂量氟伐他汀对急性心肌梗死患者远期血脂MMP-9因子及左心室重构的影响[J]. 河北医学, 2021, 27(1): 131-135.
CHEN Donglin, DENG Xiaolan, et al. Effects of Different Doses of Fluvastatin on Long-Term Blood Lipid MMP-9 Factor and Left Ventricular Remodeling in Patients with Acute Myocardial Infarction. HeBei Med, 2021, 27(1): 131-135.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2021.01.031 或 http://www.hbyxzzs.cn/CN/Y2021/V27/I1/131

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