早期他汀药物治疗与非缺血性扩张性心肌病患者病死率关系的研究  

Effect of statin therapy on mortality in patients with non-ischemic dilated cardiomyopathy

作　　者：黎旭[1] 刘兴鹏[1] 刘小慧[1] 杜昕[1] 康俊萍[1] 吕强[1] 王海云[1] 徐霞[1] 梁翠[1] 闫倩[1] 雷涛[1] 耿丽丽[1] 刘百球[1] 马长生[1] 

机构地区：[1]首都医科大学附属北京安贞医院心内科,100029

出　　处：《中华医学杂志》2010年第28期1974-1977,共4页National Medical Journal of China

摘　　要：目的探讨早期脂溶性他汀药物（阿托伐他汀和辛伐他汀）治疗与非缺血性扩张性心肌病患者病死率的关系。方法本研究为单中心回顾性研究，入选了2002年1月至2008年12月在北京安贞医院住院治疗的非缺血性扩张性心肌病患者315例，比较患者初次入院期间应用他汀药物组（辛伐他汀20mg／d或阿托伐他汀10—20mg／d）和未应用他汀药物治疗组随访全因病死率，中位随访时间为45．1个月。结果他汀组58例，未用他汀组257例，单因素分析，应用他汀组随访病死率为17．2％，显著低于未应用他汀治疗组37．4％（P=0．003）；心功能NYHACⅢ-Ⅳ患者中，他汀组的病死率为17．2％，非他汀组病死率高达47．4％，两组差异有统计学意义（P=0．003）；心功能NYHAⅠ-Ⅱ级患者中，两组随访病死率差异无统计学意义。多因素分析，在校正了年龄、性别、高血压史、糖尿病史、当前吸烟、血脂、左室射血分数、NYHA心功能分级及是否使用血管紧张素转换酶抑制剂（ACEI）、β受体阻滞剂、醛固酮、其他利尿剂、地高辛和钙离子拮抗剂，总研究人群中他汀组的死亡相对危险度（RR）为0．352（95％CI 0．135～0．920，P=0．033），心功能NYHA Ⅲ～Ⅳ患者中他汀组的死亡RR为0．250（95％CI 0．081～0．778，P=0．017）。结论早期阿托伐他汀或辛伐他汀药物治疗与非缺血性扩张性心肌病患者的病死率降低密切相关，特别是中重度心功能不全患者的病死率降低，而这种相关是独立于他汀药物的降脂作用及ACEI、β受体阻滞剂等目前心衰治疗基石作用的。Objective To explore the effect of early statin therapy（ atorvastatin and simvastatin） on mortality in patients with non-ischemic dilated cardiomyopathy. Methods A retrospective study was conducted at a single center. A total of 315 patients with non-ischemic dilated cardiomyopathy, admitted into our hospital from January 2002 to December 2008, were enrolled. The association of statin therapy at the initial hospitalization with all-cause mortality was evaluated. The median follow-up period was 45.1 months. Results By the single-factor analysis, we found that the follow-up mortality was 17. 2% in statin group and it was significantly lower than 37.4% of non-statin users （ P = 0. 003 ） ; in patients with worsening cardiac function NYHA Ⅲ - Ⅳ, the mortality of statin group was 17. 2% while a much higher mortality of 47. 4% was found in non-statin users（P =0. 003） ; in patients with NYHA Ⅰ -Ⅱ, no significant difference was found in mortality between two groups. By the multi-factor analysis adjusting for age, gender, history of hypertension, diabetes mellitus, current cigarette smoking, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, left ventricular ejection fraction, NYHA functional class, use of anglotensin-converting enzyme inhibitor, β blocker, aldosterone, other diuretics, digoxin and calcium channel blocker, we found the relative risk（RR） of death in statin use was 0. 352（95% CI 0. 135 -0. 920, P =0.033）. In patients with NYHA Ⅲ - Ⅳ, the relative death risk of statin therapy was 0. 250 （ 95% CI O. 081 - 0. 778, P = 0. 017 ）. Conclusions Early treatment of atorvastatin or simvastatin is closely correlated with the reduction of mortality in non-ischemic dilated cardiomyopathy patients, especially in those with severe heart failure. And the correlation is independent of the lipid-lowering effects of statins, ACEI and β-blocker therapy.

关 键 词：心肌病 充血性 心力衰竭 充血性 死亡率 

分 类 号：R542.2[医药卫生—心血管疾病]