阿地力江·托呼提　阿力木江·阿不来提　李杰　李国庆

[摘要] 目的 探究阿托伐他汀聯合重组人脑钠肽（rhBNP）在治疗急性心肌梗死（AMI）合并心力衰竭（HF）中的临床效果及对患者心肾功能、Ⅲ型前胶原氨基端肽（PⅢNP）和高敏C反应蛋白（hs-CRP）水平的影响。 方法 选择2015年10月～2016年10月于武警新疆总队医院就诊的AMI合并HF患者90例，按照随机数字表法将其分为对照组（45例）和治疗组（45例）。在常规治疗的基础上，对照组给予阿托伐他汀钙片，治疗组给予阿托伐他汀钙片和rhBNP。比较两组患者治疗前后的心肾功能指标、N末端脑钠肽前体（NT-proBNP）、PⅢNP和hs-CRP水平，以及主要心血管事件（MACE）和不良反应发生情况。 结果 治疗前，两组患者左心室射血分数（LVEF）、左心室收缩末期容积（LVESV）和左心室舒张末期容积（LVEDV）比较差异无统计学意义（P > 0.05）；治疗后，两组LVEF较治疗前显著升高（P < 0.05），LVESV和LVEDV均较治疗前显著降低（P < 0.05），且治疗组变化幅度较对照组更大（P < 0.05）。治疗前，两组患者血清中肌酐（Cr）、胱抑素C（Cys-C）、血尿素氮（BUN）和尿酸（UA）水平比较差异均无统计学意义（P > 0.05）。治疗后，治疗组Cr、Cys-C水平较治疗前明显下降（P < 0.05），两组治疗后BUN、UA水平与治疗前比较差异无统计学意义（P > 0.05），且两组治疗后组间Cr、Cys-C、BUN及UA水平比较差异无统计学意义（P > 0.05）。治疗前，两组NT-proBNP、PⅢNP和hs-CRP比较差异无统计学意义（P > 0.05）；治疗后，两组NT-proBNP、PⅢNP和hs-CRP均较治疗前显著降低（P < 0.05），治疗组的降低幅度较对照组更大（P < 0.05）。治疗组MACE发生风险和全因死亡风险明显低于对照组（P < 0.05），两组不良反应发生率比较差异无统计学意义（P > 0.05）。 结论 对AMI合并HF患者应用阿托伐他汀联合rhBNP治疗能够显著改善患者的心肾功能，有效调节PⅢNP和hs-CRP水平，明显降低患者MACE发生风险和死亡风险。

[关键词] 心肌梗死；心力衰竭；阿托伐他汀；心肾功能

[中图分类号] R541.6 [文献标识码] A [文章编号] 1673-7210（2018）09（b）-0038-05

[Abstract] Objective To explore the clinical effect of Atorvastatin combined with recombinant human brain natriuretic peptide （rhBNP） in the treatment of acute myocardial infarction （AMI） with heart failure （HF）， and its effects on cardiorenal function and levels of procollagen Ⅲ N-terminal peptide （PⅢNP） and high sensitive C reactive protein （hs-CRP）. Methods Ninety cases of patients with AMI and HF in Xinjiang General Hospital of Armed Police Forces from October 2015 to October 2016 were divided into control group （45 cases） and treatment group （45 cases） by random number table method. On the basis of routine treatment， control group was treated by Atorvastatin Calcium Tablets， treatment group was treated by Atorvastatin Calcium Tablets and rhBNP. The cardiorenal function， levels of N-terminal pro-brain natriuretic peptide （NT-proBNP）， PⅢNP and hs-CRP as well as major adverse cardiovascular events （MACE） and adverse reactions before and after treatment were compared. Results Before treatment， there were no statistically significant differences of left ventricular ejection fractions （LVEF）， left ventricular end systolic volume （LVESV） and left ventricular end diastolic volume （LVEDV） between the two groups （P > 0.05）. After treatment， the levels of LVEF in the two groups were significantly higher than those before treatment （P < 0.05）， while the levels of LVESV and LVEDV were significantly lower than those before treatment （P < 0.05）， and the variation range of the treatment group was greater than that of the control group （P < 0.05）. Before treatment， there were no significant differences in the levels of creatinine （Cr）， cystatin-C （Cys-C）， blood urea nitrogen （BUN） and uric acid （UA） between the two groups （P > 0.05）. After treatment， the levels of Cr and Cys-C in treatment group were significantly lower than those before treatment （P < 0.05） ， while there were no signfiicant differences of the levels of BUN and UA in the two groups compared with those before treatment （P > 0.05）. And the levels of Cr， Cys-C， BUN and UA also showed no significant differences between the two groups after treatment （P > 0.05）. Before treatment， there were no significant differences of NT-proBNP， PⅢNP and hs-CRP between the two groups （P > 0.05）. After treatment， the levels of NT-proBNP， PⅢNP and hs-CRP in the two groups were significantly lower than those before treatment （P < 0.05）， and the variation range of the treatment group was greater than that of the control group （P < 0.05）. The risk of MACE and all-cause death in the treatment group were significantly lower than those of the control group （P < 0.05）， and there was no significant difference in the incidence of adverse reactions between the two groups （P > 0.05）. Conclusion Atorvastatin combined with rhBNP in treatment of patients with AMI and HF can significantly improve the cardiorenal function of the patients， effectively regulate the levels of PⅢNP and hs-CRP， and significantly reduce the risk of MACE and death of the patients.