阿托伐他汀对心脏舒张功能不全合并运动高血压患者运动耐量的影响  

Effect of atorvastatin on exercise tolerance in patients with diastolic dysfunction and exercise-induced hypertension

作　　者：叶萍仙 叶萍贞 朱建华[2] 陈巍 高丹忱[2] 

机构地区：[1]浙江金华广福医院心内科,浙江金华321000 [2]浙江大学医学院附属第一医院心内科,浙江杭州310006

出　　处：《浙江大学学报（医学版）》2014年第3期298-304,共7页Journal of Zhejiang University(Medical Sciences)

基　　金：金华市自然科学基金（2010-3-028）.

摘　　要：目的：观察阿托伐他汀治疗后心脏舒张功能不全合并运动高血压患者运动耐量的改变情况.方法：采用随机、双盲、安慰剂对照的方法,前瞻性选择左心室舒张功能不全（彩色多普勒二尖瓣血流频谱的舒张早期血流峰速度/舒张晚期血流峰速度比值＜1）合并运动高血压（运动最大收缩压＞ 200 mm Hg）患者60例,随机分成阿托伐他汀（立普妥20 mg,每天1次）治疗组及安慰剂对照组各30例.所有入选者入组后原治疗方案继续,疗程1年.两组治疗前后均行运动心肺功能检查、运动血压测定、静息及运动后血浆脑利钠肽（BNP）浓度测定,并测定血浆炎症指标超敏C反应蛋白（hs-CRP）及内皮功能指标内皮肽（ET）水平.结果：阿托伐他汀治疗组治疗后,静息收缩压和脉压差降低,运动最大收缩压降低,运动后血浆BNP浓度下降,运动耐量改善,表现为运动时间延长,运动当量、运动最大摄氧量、无氧阈值增大,各指标相比治疗前差异均有统计学意义（均P ＜0.05）;相比对照组治疗后静息脉压差、运动最大收缩压、运动后血浆BNP浓度、运动时间差异也有统计学意义（均P＜0.05）.治疗组治疗后血浆hs-CRP和ET浓度明显下降,与治疗前及对照组比较差异均有统计学意义（均P＜0.05）.对照组各指标治疗前后差异均无统计学意义（P＞0.05）.结论：阿托伐他汀治疗能有效降低心脏舒张功能不全合并运动高血压患者血浆hs-CRP和ET浓度,并降低运动最大收缩压,降低运动后血浆BNP浓度,改善运动耐量.Objective：To investigate the effect of atorvastatin on exercise tolerance in patients with diastolic dysfunction and exercise-induced hypertension.Methods：A randomized,double-blind,placebo-controlled prospective study was performed.Sixty patients with diastolic dysfunction （mitral flow velocity E/A 〈 1） and exercise-induced hypertension （SBP 〉 200 mm Hg） treated with atorvastatin （20 mg q.d） or placebo for 1 year.Cardiopulmonary exercise test and exercise blood pressure measurement were performed.Plasma B-natriuretic peptide （BNP） concentration at rest and at peak exercise,plasma high sensitive-C reaction protein （hs-CRP） and endothelin （ET） concentration were determined at baseline and after treatment.Results：After treatment by atorvastatin,the resting SBP,pulse pressure,the peak exercise SBP and BNP were significantly decreased; and the exercise time,metabolic equivalent,maximal oxygen uptake and anaerobic threshold were increased.All of these parameters had significant differences with baseline levels （P 〈 0.05）,and the rest pulse pressure,the peak exercise SBP and BNP,and the exercise time had significant differences compared with placebo treatment （P 〈 0.05）.Plasma concentrations of hs-CRP and ET were markedly reduced by atorvastatin treatment compared with baseline and placebo （P 〈 0.05）.No difference in above parameters was found before and after placebo treatment （P 〉 0.05）.Conclusion：In patients with diastolic dysfunction at rest and exercise-induced hypertension,atorvastatin can effectively reduce plasma hs-CRP and ET level,lower blood pressure and peak exercise SBP,decrease peak exercise plasma BNP concentration,and ultimately improve exercise tolerance.

关 键 词：庚酸类 治疗应用 高血压 血压 药物作用 运动试验 运动耐量 药物作用 心室功能障碍 左 心舒期 随机对照试验 

分 类 号：R544.1[医药卫生—心血管疾病]