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目的 :观察阿托伐他汀对扩张型心肌病 (DCM )患者心功能及心率变异性的影响。方法 :选择 4 5例DCM患者 ,随机分为常规治疗组 (2 2例 )及阿托伐他汀治疗组 (2 3例 ) ,后者在常规治疗基础上合用阿托伐他汀10mg/d ,疗程 12周。采用心脏彩色多普勒超声测定左室射血分数 (LVEF)、左室收缩末期容量指数 ,动态心电图测定心率变异性 ,同时测定血浆丙二醛、一氧化氮 (NO)、肿瘤坏死因子 (TNF α)、白细胞介素 6 (IL 6 )及基质金属蛋白酶 9(MMP 9)。结果 :阿托伐他汀使血浆丙二醛、TNF α、IL 6及MMP 9明显降低 ,NO增加 (P <0 .0 1) ,LVEF增加、左室收缩末期容量指数降低 (P <0 .0 5 ) ,正常R R间期标准差 (SDNN)、低频成分增加 (P <0 .0 1)。LVEF增加与NO增加不相关 (r =0 .2 7,P >0 .0 5 ) ,与丙二醛、TNF α、IL 6及MMP 9降低呈负相关 (r =- 0 .4 0 ,- 0 .4 6 ,- 0 .4 8,- 0 .4 3,P <0 .0 5 )。SDNN增加与LVEF增加呈正相关 (r =0 .5 7,P <0 .0 1) ,与左室收缩末期容量指数降低呈负相关 (r =- 0 .5 8,P <0 .0 1)。结论 :阿托伐他汀改善DCM患者心功能的同时改善心率变异性 ,心功能改善可能与抗氧化及抗炎有关。
Objective: To observe the effect of atorvastatin on cardiac function and heart rate variability in patients with dilated cardiomyopathy (DCM). Methods: Forty-five DCM patients were randomly divided into routine treatment group (n = 22) and atorvastatin treatment group (n = 23). The latter group received atorvastatin 10 mg / d on the basis of routine treatment. 12 weeks. Left ventricular ejection fraction (LVEF), left ventricular end-systolic volume index, and dynamic electrocardiogram (HRP) were used to measure heart rate variability (HRV). Plasma malondialdehyde, nitric oxide and tumor necrosis factor α), interleukin 6 (IL 6) and matrix metalloproteinase 9 (MMP 9). Results: Atorvastatin decreased plasma MDA, TNFα, IL-6 and MMP-9, NO increased (P <0.01), LVEF increased, and left ventricular end-systolic volume index decreased 5), normal RR interval standard deviation (SDNN), low-frequency components increased (P <0.01). The increase of LVEF was not correlated with the increase of NO (r = 0.27, P> 0.05), but negatively correlated with the decrease of malondialdehyde, TNFα, IL 6 and MMP 9 (r = - 0.40, 0 .4 6, -0.48, -0.43, P <0. 05). The increase of SDNN was positively correlated with the increase of LVEF (r = 0.57, P <0.01), and was negatively correlated with the decrease of left ventricular end-systolic volume index (r = -0.58, P <0.01) . Conclusion: Atorvastatin can improve heart rate and improve heart rate variability in patients with DCM. Improvement of cardiac function may be related to anti-oxidation and anti-inflammation.