Résumé
Objective To investigate the impacts of carvedilol combined with pravastatin,on aminoterminal pro-brain natriuretic peptide(NT-proNBP),cardiac troponin Ⅰ(cTnI)and cardiac function in coronary heart disease patients with chronic heart failure.Methods One hundred and tewnty five cases of coronary heart disease patients with chronic heart failure were randomly divided into the carvedilol group(63 cases)and carvedilol combined with pravastatin group(62 cases).In addition to using certain dosage of the above-mentioned drugs respectively,both groups underwent routine anti heart failure treatment with the course of 12 weeks.The class of heart function and changes of heart rate(HR) were observed before and after treatment.Left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD) and left ventricular ejection fraction(LVEF) were determined by using ultrasound heartbeat graph.Six min walk test(6MWT)was also observed before and after treatment and the level of NT-proBNP and cTnI level were determined by using an enzyme immunoassay method.And patients readmission rates and the incidence of cardiovascular events were also observed.Results The condition of carvedilol and pravastatin group were improved after treatment compared with before treatment[HR:(78±12) CICCS/min vs(100±112) CICCS/min,t =13.682,P ＜ 0.05 ;LVEDD:(43±5)mmvs(53±8)mm,t=5.284,P＜0.01;LVESD:(42±6)mmvs(56±7)mm,t=6.454,P＜0.01;LVEF:(50±5)％ and(35±8)％,t=-6.091,P<0.01);NT-proBNp:(986±713)ng/Lvs (3328±1109) ng/L,t =17.626,P ＜ 0.05) ; CInI:(0.85±0.16) μg/L vs(2.03±0.63) μg,/L,t =5.879,P ＜ 0.01 ;6MWT:(355.6±92.5)m vs(238.8±101.4) m,t =-8.255,P ＜ 0.01].After 3 months follow-up,the condition of carvedilol combined with pravastatin group were better than carvedilol group;LVEDD:(43±5)mm vs(57±6)mm,t =5.892,P ＜0.05 ;LVESD:(42±6)mm vs(49±7) mm.t =3.243,P ＜0.01 ;LVEF:(50±5) ％ vs(42±8) ％,t =-12.036,P ＜ 0.01 ; NT-proBNP:(986±713) ng/L vs(1626±968) ng/L,t =3.603,P ＜0.01 ;cTnI:(0.85±0.16) μg/L vs(1.15±0.36) μg/L,t =3.200,P ＜ 0.01 ;6MWT:(355.6±92.5) mvs(296.2±99.5) m,t =-10.119,P ＜ 0.01].The rehospitalization rate(3.3 ％ vs 12.7％,x2 =6.224,P ＜ 0.05) and the incidence of cardiovascularevents(3.3％ vs 15.9％,x2 =5.974,P ＜ 0.05) were both decreased Significantly after treated with carvedilol combined with pravastatin.Conclusion Carvedilol combined with pravastatin can reduce the level of NT-proBNP and cTnI,improve heart function in coronary heart disease patients with chronic heart failure.