|本期目录/Table of Contents|

[1]黄琼,陈俭,丁奇,等.阿托伐他汀、二甲双胍、依折麦布联合治疗缺血性心肌病疗效观察[J].慢性病学杂志,2015,(05):528-531.
　HUANG Qiong,CHEN Jian,DING Qi,et al.Effects of atorvastatin, metformin and ezetimibe combination therapy on patients with ischemic cardiomyopathy[J].,2015,(05):528-531.
点击复制

阿托伐他汀、二甲双胍、依折麦布联合治疗缺血性心肌病疗效观察(PDF)

《慢性病学杂志》[ISSN:1674-8166/CN:11-5900/R]

卷:
期数:
2015年05期
页码:
528-531
栏目:
论著
出版日期:
2015-10-15

文章信息/Info

Title:
Effects of atorvastatin, metformin and ezetimibe combination therapy on patients with ischemic cardiomyopathy
作者:
黄琼; 陈俭; 丁奇; 毛幼林
郑州市第七人民医院（郑州市心血管病医院），郑州 450016
Author(s):
HUANG Qiong; CHEN Jian; DING Qi; MAO You-lin
Zhengzhou7 th People’s Hospital, Zhengzhou Cardiovascular Hospital, Zhengzhou, Henan450016, China Corresponding author: MAO You-lin,E-mail:mohdmao2004@hotmail.com
关键词:
缺血性心肌病; 阿托伐他汀; 血管内皮功能; 炎性反应; 心室重塑
Keywords:
Ischemic cardiomyopathy;  Atorvastatin;  Endothelial function;  Inflammatory reaction;  Ventricu-lar remodeling
分类号:
R542.2
DOI:
-
摘要:
目的 评价早期不同剂量阿托伐他汀与阿托伐他汀联合其他药物对改善缺血性心肌病患者血脂、血管 内皮功能、炎性反应及心室重塑的效果。方法 选取郑州市第七人民医院276例缺血性心肌病患者，依据给药 方案不同分为：大剂量组92例，口服阿托伐他汀2次/d、每次20 mg口服；联合治疗组92例，口服阿托 伐他汀1次/d、20 mg/次，加用依折麦布10 mg、1次/d，二甲双胍0.85 g、1次/d口服；小剂量组92 例，阿托伐他汀10 mg，睡前口服。3个月后，检测并比较两组血脂、一氧化氮（NO）、血栓素A2(TXA2) 及C反应蛋白(CRP)水平的差异；比较两组左心室射血分数(LVEF)、左心室收缩末期容积(LVESV)和左心 室舒张末期容积( LVEDV)的差异，并观察肝功能及不良反应的发生。结果 与小剂量组比较，大剂量组 及联合治疗组的HDL-C及NO均显著增高，而TC、TG、LDL-C、TXA2及CRP水平显著降低(P＜ 0.05)；大剂量组及联合治疗组的LVEF水平显著增高，而LVESV、LVEDV水平显著降低(P＜0.05) 。上 述指标大剂量组与联合治疗组差异无统计学意义（P>0.05）。大剂量组谷草转氨酶（P=0.042）和谷丙转氨 酶（P=0.022）较治疗前升高。结论 大剂量阿托伐他汀及阿托伐他汀联合其他药物治疗能更显著改善缺 血性心肌病患者的血管内皮功能及心室重塑效果，但大剂量阿托伐他汀有明显升高转氨酶等不良反应。
Abstract:
Objective To evaluate the effects of atorvastatin, metformin and ezetimibe combination thera-py on vascular endothelial function, inflammatory reaction and ventricular remodeling in patients with ischemic cardiomyopathy. MethodsA total of276 patients with ischemic cardiomyopathy were enrolled from clinics and assigned evenly into high dose group (in which patients were given atorvastatin 20 mg twice per day), low dose group (in which patients were given atorvastatin 10 mg once per day), and combined therapy group (in which patients were given atorvastatin 20 mg once per day, ezetimibe10 mg once per day, and metformin0.85 g once per day). Physical examinations were conducted for all patients both before treatments and 3 months after treatments. Levels of serum lipids, creatine kinase, liver function, nitric oxide (NO), thromboxane A2 (TXA2), C-reactive protein (CRP), left ventricular end systolic volume (LVESV), left ventricular end diastolic volume (LVEDV), and left ventricular ejec-tion fraction (LVEF) of patients were collected. Results Compared with the low dose group, the aver-age levels of NO and LVEF in other groups were significantly higher, and the average levels of total cholesterol (TC), triglyceride (TG), low- density lipoprotein cholesterol (LDL- C), TXA2, CRP,LVESV, and LVEDV were significantly lower (P<0.05). The differences between the outcomes of high dose group and combined therapy group were not significant. The levels of transaminase increased signif-icantly in high dose group. Conclusions The high dose of atorvastatin and atorvastatin combined ther-apy demonstrate beneficial effects on the lipid modification, endothelial function, and ventricular remodel-ing in patients with ischemic cardiomyopathy. However, high dose atorvastatin therapy has more side ef-fects.

参考文献/References:

[1] Huang BS, Ahmad M, Tan J,et al. Sympathetic hyperactivi? ty and cardiac dysfunction post MI: different impact of specific CNS versus generalAT1receptor blockade [J]. J MolCellCar? diol,2007,43(4):479-86.
[2] Schafers M, Matheja P, Hasfeld M,et al. The clinical impact of thallium-201reinjection for the detection of myocardial hi? bernation [J].EurJ NuclMed,1996,23(4):407-413.
[3] Vander Vusse CJ, Clatz JF, Stam HC, et al. Fatty acid ho? meostasis in the normoxic and ischemic heart [J]. Physiol Rev, 1992,72(4):881-940.
[4] Tang WH, Francis GS.Statin treatment for patients with heart failure[J].NatRev Cardiol,2010,7(5):249-255.
[5] Huang B, Cheng Y, Xie Q,et al. Effect of40mg versus10mg of atorvastatin on oxidized low-density lipoprotein, high-sen? sitivity C-reactive protein, circulating endothelial derived mic? roparticles, and endothelial progenitor cells in patients with ischemic cardiomyopathy [J]. Clin Cardiol, 2012,35(2):125-130.
[6] Gomez-Garre D, Mvmoz-Pacheco P, Gonzalez-Rubio ML, et al. Ezetimibe reduces plaque inflammation in a rabbit model of atherosclerosis and inhibits monocyte migration in addition to its lipid-lowering effect [J]. Br J Pharmacol, 2009,156(8): 1218-1227.
[7] Isoda K, Young JL, Zirlik A, et a1. Metformin inhibits proin? flammatory responses and nuclear factor-κB in human vascular wall cells [J]. Arterioscler Thromb Vasc Biol,2006,26(3): 611-617.
[8] Katz SD, Hryniewicz K, Hriljac I, et al. Vascular endothelial dysfunction and mortality risk in patients with chronic heart fail? ure [J].Circulation,2005,111(3):310-314.
[9] Caballero AE, Delgado A, Aguilar- Salinas CA, et a1.The differential effects of metformin on markers of endothelial acti? vation and inflammation in subjects with impaired glucose toler? ance: a placebo-controlled, randomized clinical trial [J]. Clin EndocrinolMetab,2004,89(8):3943-3948.
[10] Undmesser U, Engberding N, Bahlmann FH,et al. Statin in? duced improvement of endothelial progenitor cell mobilization, myoeardial neovascularization, left ventricular function, and survival after experimental myocardial infarction requires endo? thelial nitric oxide synthase [J]. Circulation, 2004,110(14): 1933-1939.
[11] Bai J, Zhang N, Hua Y, et al. Metformin inhibits angiotensin II-induced differentiation of cardiac fibroblasts into myofibro? blasts [J].PLoS One,2013,8(9):e72120.
[12] Cittadini A, Napoli R, Monti MQ, et al. Metformin Prevents the Development of chronic heart failure in the SHHF Rat Model[J].Diabetes,2012,61(4):944-953.
[13] Wang XF, Zhang JY, Li L,et al. Metformin improves cardiac function in rats via activation of AMP activated protein kinase [J].Clin Exp PharmacolPhysiol,2011,38(2):94-101.

备注/Memo

备注/Memo:
作者简介：黄琼，硕士，主治医师，研究方向：心血管病的诊治 通信作者：毛幼林，E-mail: mohdmao2004@hotmail.com
更新日期/Last Update: 2015-10-16