方敏

【摘要】 目的：探究三種劑量辛伐他汀分別聯(lián)合曲美他嗪對慢性心力衰竭患者血清hs-CRP及心功能的效果對比。方法：選取2017年1月-2018年1月間到本院就診的68例慢性心力衰竭患者，按照隨機(jī)數(shù)字表法分為小劑量組（23例）、常規(guī)劑量組（23例）和大劑量組（22例）。三組患者均給予曲美他嗪治療，小劑量組患者給予辛伐他汀10 mg/次，常規(guī)劑量組患者給予辛伐他汀20 mg/次，大劑量組患者給予辛伐他汀30 mg/次。連續(xù)治療6個月后觀察兩組患者心功能指標(biāo)、血清hs-CRP、TNF-α和IL-6、血脂指標(biāo)以及臨床療效。結(jié)果：治療后，各組患者LVEF均顯著增高，LVDD和LVSD均顯著減小，常規(guī)劑量組和大劑量組患者LVEF顯著高于小劑量組，LVDD和LVSD顯著低于小劑量組（P<0.05），但常規(guī)劑量組和大劑量組比較差異均無統(tǒng)計(jì)學(xué)意義（P>0.05）;各組患者血清hs-CRP、TNF-α和IL-6均降低，常規(guī)劑量組和大劑量組患者血清hs-CRP、TNF-α和IL-6均顯著低于小劑量組（P<0.05），但常規(guī)劑量組和大劑量組比較差異均無統(tǒng)計(jì)學(xué)意義（P>0.05）;各組患者TC、TG和LDL-C均顯著降低，HDL-C均顯著增高，且常規(guī)劑量組和大劑量組患者TC、TG和LDL-C均顯著低于小劑量組，HDL-C均顯著高于小劑量組（P<0.05），但常規(guī)劑量組和大劑量組比較差異均無統(tǒng)計(jì)學(xué)意義（P>0.05）;常規(guī)劑量組的治療總有效率91.30%和大劑量組95.45%顯著高于小劑量組65.22%（P<0.05），但常規(guī)劑量組和大劑量組治療總有效率比較差異無統(tǒng)計(jì)學(xué)意義（P>0.05）。結(jié)論：與小劑量辛伐他汀相比，常規(guī)劑量與大劑量辛伐他汀聯(lián)合曲美他嗪能有效改善慢性心力衰竭患者心功能和血清hs-CRP，降低血脂，提高臨床療效，但大劑量辛伐他汀并不能提高臨床療效。

【關(guān)鍵詞】 辛伐他汀; 曲美他嗪; 慢性心力衰竭; hs-CRP

【Abstract】 Objective：To compare the effects of three doses of Simvastatin combined with Trimetazidine on serum hs-CRP and cardiac function in patients with chronic heart failure.Method：68 patients with chronic heart failure in our hospital from January 2017 to January 2018 were selected and divided into small dose group（23 cases），routine dose group（23 cases）and large dose group（22 cases）.Three groups of patients were treated with Trimetazidine，small dose group was given Simvastatin 10 mg/times，while routine dose group with 20 mg/times，large dose group with 30 mg/times.After 6 months of continuous treatment，the cardiac function indexes，serum hs-CRP，TNF-α and IL-6，blood lipids and clinical efficacy were observed in the three groups.Result：After the treatment，the LVEF of all the groups increased significantly，and the LVDD and LVSD decreased significantly，the LVEF of the routine dose group and the large dose group were significantly higher than those of the small dose group，and the LVDD and LVSD were significantly lower than those in the small dose group（P<0.05），but there were no statistical differences between the routine dose group and the large dose group（P>0.05）.Serum hs-CRP，TNF-α and IL-6 decreased in all groups.The serum hs-CRP，TNF-α and IL-6 in the routine dose group and the large dose group were significantly lower than those in the small dose group（P<0.05），but there were no statistical differences between the routine dose group and the large dose group（P>0.05）.The levels of TC，TG and LDL-C were significantly decreased，and the HDL-C were significantly increased in all groups，the levels of TC，TG and LDL-C in the routine dose group and the large dose group were significantly lower than those in the small dose group，and the HDL-C was significantly higher than that of the small dose group（P<0.05），but there was no statistical difference between the conventional dose group and the large dose group（P>0.05）.The treatment effectiveness rate of the routine dose group and the large dose group was significantly higher than that of the small dose group（91.30%，95.45% vs 65.22%，P<0.05），but there were no significant differences between routine dose group and high-dose group（P>0.05）.Conclusion：Compared with low dose Simvastatin，conventional dose and large dose Simvastatin combined with Trimetazidine can effectively improve cardiac function and serum hs-CRP，reduce blood lipid and improve clinical efficacy in patients with chronic heart failure，but large dose of simvastatin can not improve the clinical efficacy.