Effect of different doses of Atorvastatin combined with Metoprolol in the treatment of acute congestive heart failure complicated with renal insufficiency
LI Jing1 LYU Guofen2 LIU Junfa1▲
1.NO.2 Department of Cardiology, the Second Hospital of Handan City, Hebei Province, Handan 056001, China;
2.Department of Cardiology, Gucheng County Hospital, Hebei Province, Gucheng 053800, China
Abstract:Objective To study the effect of different doses of Atorvastatin combined with Metoprolol in the treatment of acute congestive heart failure (CHF) complicated with renal insufficiency. Methods A total of 120 patients with acute CHF combined with renal insufficiency from April 2017 to April 2018 admitted to the Second Hospital of Handan City were selected as the research subjects and they were divided into observation group and control group by method of random sampling, with 60 cases in each group. The observation group was given Metoprolol and high-dose Atorvastatin (40 mg/d), and the control group was given Metoprolol and low-dose Atorvastatin (20 mg/d). After four weeks, the treatment effect of the two groups was compared, the cardiac function, renal function and levels of inflammatory factors were recorded before and after treatment in the two groups, and the incidence of adverse reactions during the treatment was recorded. Results There was no significant difference in the total effective rate between the two groups (P > 0.05). The effect of the observation group was significantly better than that of the control group, the difference was statistically significant (P < 0.05). After treatment, the left ventricular ejection fraction (LVEF) and the distance of 6 min walking test (6MWT) in the observation group were significantly higher than those before treatment and than those of the control group after treatment. After treatment, the left ventricular end diastolic diameter (LVEDD) of the observation group was significantly lower than that before treatment and that of the control group, and the difference was statistically significant (P < 0.05). After treatment, the glomerular filtration rate (GFR) of the observation group was significantly higher than that before treatment and that of the control group. After treatment, the blood urea nitrogen (BUN) and the serum creatinine (Scr) of the observation group were significantly lower those before treatment and those of the control group, the differences were statistically significant (P < 0.05). After treatment, the levels of hs-CRP, IL-6 and TNF-α in the observation group were significantly lower than those before treatment and those of the control group, the differences were statistically significant (P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P > 0.05). Conclusion High dose Atorvastatin combined with Metoprolol is superior to small dose in the treatment of acute CHF patients complicated with renal insufficiency, and the safety is high.
李静1 吕国芬2 刘俊法1▲. 不同剂量阿托伐他汀联合美托洛尔治疗急性充血性心力衰竭合并肾功能不全的临床效果[J]. 中国医药导报, 2019, 16(5): 51-54,62.
LI Jing1 LYU Guofen2 LIU Junfa1▲. Effect of different doses of Atorvastatin combined with Metoprolol in the treatment of acute congestive heart failure complicated with renal insufficiency. 中国医药导报, 2019, 16(5): 51-54,62.
[1] 王曼,朱俊,杨艳敏,等.ST段抬高型急性心肌梗死患者入院7天仍存在充血性心力衰竭事件分析[J].中国循环杂志,2013,28(1):9-12.
[2] Andreeva E,Burbello AT,Alexandrov VS. Could polyunsaturarated fatty acids affect on pathogenesis of congestive heart failure due to ischemic heart disease [J]. Eur J Heart Fail,2015,2(S1):77-78.
[3] Damman K,Tang WH,Fellker GM,et al. Current evidence on treatment of patients with chronic systolic heart failure and renal insufficiency:practical considerations from published data [J]. J Am Coll Cardiol,2014,63(9):853-871.
[4] Hawkins NM,Jhund PS,Pozzi A,et al. Severity of renal impairment in patients with heart failure and atrial fibrillation:implications for non-vitamin K antagonist oral anticoagulant dose adjustment [J]. Eur J Heart Fail,2016,18(9):1162-1171.
[5] 岑永艺,陈锋,梁政.美托洛尔联合乌司他丁治疗慢性阻塞性肺疾病合并慢性心力衰竭的临床观察[J].广西医科大学学报,2017,34(3):394-397.
[6] 彭环庆,彭志允,范志勇,等.阿托伐他汀对不同血脂水平的慢性心力衰竭患者血管内皮功能的影响[J].中国老年学,2015,35(19):5486-5487.
[7] Jaikumkao K,Pongchaidecha A,Chattipakorn N,et al. Atorvastatin improves renal organic anion transporter 3 and renal function in gentamicin-induced nephrotoxicity in rats [J]. Exp Phys,2016,101(6):743.
[8] 中华医学会心血管病学分会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志,2014,42(2):3-10.
[9] 高烨,李晓青,吴梦茹,等.前列地尔联合左卡尼汀治疗急性左心功能衰竭合并肾功不全效果观察[J].山东医药,2015,55(36):41-43.
[10] 余思韵,李觉,张丽娟.MDRD与CKD-EPI肾小球滤过率评估公式在外周动脉疾病患者中的应用[J].中华肾脏病杂志,2015,31(10):755-759.
[11] Sliwa K,Mayosi BM. Recent advances in the epidemiology,pathogenesis and prognosis of acute heart failure and cardiomyopathy in Africa [J]. Heart,2013,99(18):1317-1322.
[12] Poole-Wilson PA,Cleland JGF,Di LA,et al. Rationale and design of the carvedilol or metoprolol European trial in patients with chronic heart failure:COMET [J]. Eur J Heart Fail,2014,4(3):321-329.
[13] 张健,邹长虹.2014年中国心力衰竭指南更新亮点解读[J].中国循环杂志,2014,29(5):321-323.
[14] 王德平,王云枫,李娟,等.阿托伐他汀联合甲泼尼龙对肾病综合征患者肝功能的影响[J].中国药房,2015,26(21):2939-2941.
[15] Calza L,Magistrelli E,Colangeli V,et al. Significant association between statin-associated myalgia and vitamin D deficiency among treated HIV-infected patients [J]. Aids,2017,31(5):681-688.
[16] 张丽,段红霞,崔丽红.补阳还五汤治疗急性脑梗死伴心肌损害患者疗效及对血清hs-CRP、D-D、H-FABP、cTnI的影响[J].现代中西医结合杂志,2016,25(31):3446-3449.
[17] 陆任华,严玉澄,车妙琳,等.肾科医生会诊时的生物学标志物水平对预测急性肾损伤患者预后的价值[J].中华肾脏病杂志,2013,29(3):163-168.
[18] Miettinen TA,Gylling H. Synthesis and absorption markers of cholesterol in serum and lipoproteins during a large dose of statin treatment [J]. Eur J Clin Invest,2015, 33(11):976-982.
[19] 李萌萌,王清,万征,等.大剂量阿托伐他汀对急性前壁心肌梗死PCI患者急性对比剂肾损害的预防作用[J].山东医药,2013,53(20):55-57.
[20] 张今尧,王浩,叶平.阿托伐他汀对老年大鼠心肌缺血再灌注损伤及多器官功能的保护作用[J].南方医科大学学报,2012,32(3):322-328.