不同剂量辛伐他汀对冠状动脉粥样硬化症患者血管内皮细胞功能的影响

摘要

Objective To observe the influences of simvastatin in different doses on vascular endothelial function in patients with coronary atherosclerosis. Methods The patients (n=133) were divided, according to the level of low-density lipoprotein-cholesterol (LDL-C), into 4 groups: 40 mg group (LDL-C≥4.16 mmol/L, n=30, treated with simvastatin, 40 mg/d), 20 mg group (3.64 mmol/L≤LDL-C<4.16 mmol/L, n=35, treated with simvastatin, 20 mg/d), 10 mg group (2.6 mmol/L≤LDL-C<3.64 mmol/L, n=37, treated with simvastatin, 10 mg/d) and control group (LDL-C<2.6 mmol/L, n=31, not treated with simvastatin). The changes of flow-mediated dilatation (FMD) and nitroglycerin-mediated dilatation (NMD) were detected by using color Doppler ultrasonic diagnostic apparatus. The content of serum nitric oxide (NO) was detected by using nitrate reductase method, and the levels of serum total cholesterol (TC), triglyceride (TG), LDL-C and high-density lipoprotein-cholesterol (HDL-C) were detected conventionally. Results Before treatment, the level of serum NO had no statistical difference in all simvastatin groups compared with control group (P>0.05). After treatment for 8 w, the level of serum NO increased significantly in all simvastatin groups (P<0.05), and had statistical difference compared with control group (P<0.05). The level of NO had no obvious changes in control group before and after treatment (P>0.05). Before treatment, the basis value of brachia diameter, FMD and NMD had no statistical difference between all simvastatin groups and control group (P>0.05). After treatment for 8 w, the basis value of brachia diameter and NMD had no statistical difference in all simvastatin groups (P>0.05) and FMD increased significantly, and the difference was statistically significant compared with control group (P<0.05). The difference in NMD had no statistically significance between all simvastatin groups and control group (P>0.05). Conclusion Simvastatin can increase the level of serum NO, improve vascular endothelial function in patients with coronary atherosclerosis, and there is no dose-effect relationship in its mechanism of ameliorating level of blood fat.%目的：观察不同剂量辛伐他汀对冠状动脉粥样硬化症患者血管内皮细胞功能的影响。方法纳入133例冠状动脉粥样硬化症患者，依据低密度脂蛋白胆固醇（LDL-C）水平将入组患者分为4组：LDL-C≥4.16 mmol/L患者30例，给予辛伐他汀40 mg/d干预治疗（40 mg组）；3.64 mmol/L≤LDL-C＜4.16 mmol/L患者35例，给予辛伐他汀20 mg/d干预治疗（20 mg组）；2.6 mmol/L≤LDL-C＜3.64 mmol/L患者37例，给予辛伐他汀10 mg/d干预治疗（10 mg组），LDL-C＜2.6 mmol/L患者31例，不给予辛伐他汀治疗（对照组）。应用彩色多普勒超声诊断仪测量受试者肱动脉血流介导的舒张功能（FMD）及硝酸甘油介导的舒张功能（NMD），应用硝酸酶还原法检测受试者血清一氧化氮的含量。常规检测血清总胆固醇、甘油三酯、低密度脂蛋白及高密度脂蛋白的水平。结果治疗前，辛伐他汀干预组（10 mg组、20 mg组、40 mg组）患者血清NO水平与对照组比较无统计学差异（P＞0.05）。治疗8周后，辛伐他汀干预组（10 mg组、20 mg组、40 mg组）患者NO水平显著升高，与治疗前比较，有明显统计学差异（P＜0.05）；与对照组比较有统计学差异（P＞0.05）。对照组患者治疗前后NO水平无明显变化（P＞0.05）。治疗前，辛伐他汀干预组（10 mg组、20 mg组、40 mg组）患者肱动脉内径基础值、FMD及NMD水平与对照组比较均无统计学差异（P＞0.05）。治疗8周后，辛伐他汀干预组（10 mg组、20 mg组、40 mg组）患者肱动脉内径基础值、NMD水平与治疗前比较，无统计学差异（P＞0.05）；FMD水平较治疗前显著增加，与对照组比较也呈明显增加趋势，差异有统计学意义（P＜0.05）；NMD水平与与照组比较，差异无统计学意义（P＞0.05）。结论辛伐他汀可增加冠状动脉粥样硬化症患者血清一氧化氮水平，改善血管内皮细胞功能，其作用机制与改善血脂水平无明显的量效关系。