阿托伐他汀对慢性阻塞性肺疾病并肺动脉高压患者的临床研究  

Effects of atorvastatin on pulmonary hypertension in chronic obstructive pulmonary disease

作　　者：于凤霞[1] 杨海燕[1] 范民忠 康丽君[3] 曲昌华 王淑娟[5] 金玉光 孔令亭[1] 李菲[6] 

机构地区：[1]烟台市烟台山医院急诊科,山东省264001 [2]烟台市烟台山医院超声室,山东省264001 [3]烟台市烟台山医院呼吸科,山东省264001 [4]烟台市烟台山医院检验科,山东省264001 [5]烟台市烟台山医院心电图室,山东省264001 [6]烟台市烟台山医院保健科,山东省264001

出　　处：《中华临床医师杂志（电子版）》2012年第5期I0001-I0006,共6页Chinese Journal of Clinicians(Electronic Edition)

基　　金：2010年烟台市科技发展计划项目(2010314)

摘　　要：目的研究他汀类药物在慢性阻塞性肺疾病(COPD)合并肺动脉高压(PH)患者中疗效和机制以及对预后的影响。方法选择2007年1月至2011年1月诊治的COPD合并PH患者156例,随机分为治疗组和对照组各78例。对照组给予常规治疗;治疗组在常规治疗基础上加用阿托伐他汀,首剂10～20 mg/d,qd,若无不良反应,则维持剂量,10 mg/d。疗程1个月、6个月、12个月,观察高敏感性C-反应蛋白(hs-CRP)、D-二聚体、一氧化氮(NO)、内皮素-1(ET-1)、Tei指数、肺动脉收缩压(PAPs)、1 s用力呼气容积占预计值百分比(FEV1%)及6 min步行距离(6MWD)。治疗后1年随访患者的再入院人数及死亡人数。结果治疗1个月后,两组CRP、D-二聚体、ET-1显著下降(P均<0.01),NO明显升高(P均<0.01);但治疗组较对照组更明显,差异有统计学意义,继续服药6个月、12个月时,治疗组CRP、D-二聚体、ET-1持续下降,NO持续升高,6个月与1个月(P<0.01,P<0.05)、12个月与6个月(P<0.01,P<0.05)比较差异有统计学意义。而对照组CRP、D-二聚体、ET-1、NO无明显变化(P>0.05)。Spearman相关分析显示,血hs-CRP、ET-1、D二聚体水平与PAPs呈正相关(r=0.478,-0.564,0.562,0.716,P<0.05),NO数值与PAPs呈负相关(r=-0.564)。应用阿托伐他汀治疗1个月后,两组PAPa、Tei指数显著下降(P均<0.01),FEV1%、6MWD明显升高(P均<0.01);治疗组FEV1%、6MWD、PAPa较对照组明显好转(P<0.01),Tei指数变化无明显差异(P>0.05)。继续用药治疗,FEV1%、6MWD、PAPa进一步改善,6个月与1个月,12个月与6个月变化均有统计学意义;而Tei指数的改善较缓慢,6个月时治疗组与对照组出现统计学差异;同组比较,治疗组6个月与1个月,12个月与6个月无统计学意义,12个月与1个月比较差异有统计学意义(P<0.01);而对照组FEV1%、6MWD、PAPa、Tei指数均无明显变化(P>0.05)。随访1年的再入院人数及死亡人数,治疗组较对照组明显减少,差异有统计学意义(P均<0.05)。结论阿�Objective To observe the effects of atorvastatin treatment in patients with chronic obstructive pulmonary disease（COPD） combining with pulmonary hypertension（PH）,explore the effect mechanism,and to provide a safe and effective therapy for COPD.Methods 156 patients with COPD combining with PH from January 2007 to January 2011 were assigned randomly to two groups：treatment group（n=78）and control group（n=78）.Patients in the control group were given with oxygen therapy,vasodilator,anticoagulant,anti-infection and so on.Patients in the treatment group were given with atorvastatin besides the treatment on control group for one year,the first dose was 10-20 mg/d,qd and sustained dose was 10 mg/d,qd.Before and after 1 month,6 months and 12 months of treatment,the changes of PAPs,6MWD,Tei index,FEV1%,hs-CRP,D-dinner,NO,ET-1 were measured.The date of readmission and death were followed up after 12 monthes of treatment.Results After 1 month treatment,CRP,D-dinner,ET-1 in the two groups decreased significantly（all P〈0.01） while NO increased significantly（all P〈0.01）,but the change of the indexes in treatment group was more obvious than that in control group.After 6 months,CRP,D-dinner and ET-1 were lower than that in the first month while NO was higher.After 12 months,CRP,D-dinner and ET-1 were lower than that in the 6 months while NO was higher in treatment group.There were no significant changes of above parameters in routine group（P〈0.05）.Spearman correlation analysis showed：CRP,D-dinner and ET-1 levels were correlated positively with PAPs,NO was correlated negatively with PAPs.After 1 month treatment,PAPs,Tei index in the two groups decreased significantly（all P〈0.01） while FEV1%,6MWD increased significantly（all P〈0.01）,but the change of FEV1%,6MWD,PAPs in treatment group was more obvious than that in control group while Tei index had no significant changes in two groups（P〈0.05）.After 6 months,PAPs were further decreased while FEV1%,6MWD further increased than that

关 键 词：肺疾病 慢性阻塞性 高血压 肺性 阿托伐他汀 内皮素-1 TEI指数 

分 类 号：R563.9[医药卫生—呼吸系统] R543.2[医药卫生—内科学]